COVID-19 severity is related to poor executive function in people with post-COVID conditions.

Patients with post-coronavirus disease 2019 (COVID-19) conditions typically experience cognitive problems. Some studies have linked COVID-19 severity with long-term cognitive damage, while others did not observe such associations. This discrepancy can be attributed to methodological and sample variations. We aimed to clarify the relationship between COVID-19 severity and long-term cognitive outcomes and determine whether the initial symptomatology can predict long-term cognitive problems. Cognitive evaluations were performed on 109 healthy controls and 319 post-COVID individuals categorized into three groups according to the WHO clinical progression scale: severe-critical (n = 77), moderate-hospitalized (n = 73), and outpatients (n = 169). Principal component analysis was used to identify factors associated with symptoms in the acute-phase and cognitive domains. Analyses of variance and regression linear models were used to study intergroup differences and the relationship between initial symptomatology and long-term cognitive problems. The severe-critical group performed significantly worse than the control group in general cognition (Montreal Cognitive Assessment), executive function (Digit symbol, Trail Making Test B, phonetic fluency), and social cognition (Reading the Mind in the Eyes test). Five components of symptoms emerged from the principal component analysis: the "Neurologic/Pain/Dermatologic" "Digestive/Headache", "Respiratory/Fever/Fatigue/Psychiatric" and "Smell/ Taste" components were predictors of Montreal Cognitive Assessment scores; the "Neurologic/Pain/Dermatologic" component predicted attention and working memory; the "Neurologic/Pain/Dermatologic" and "Respiratory/Fever/Fatigue/Psychiatric" components predicted verbal memory, and the "Respiratory/Fever/Fatigue/Psychiatric," "Neurologic/Pain/Dermatologic," and "Digestive/Headache" components predicted executive function. Patients with severe COVID-19 exhibited persistent deficits in executive function. Several initial symptoms were predictors of long-term sequelae, indicating the role of systemic inflammation and neuroinflammation in the acute-phase symptoms of COVID-19." Study Registration: www.ClinicalTrials.gov , identifier NCT05307549 and NCT05307575.

The Bivalent Shape Task in a Dutch primary school population: A pilot study for a first psychometric assessment.

OBJECTIVE: The Bivalent Shape Task (BST) tests the ability to suppress interfering information. The purpose of this study was to assess some psychometric properties of the BST in 5-11-year-old children, using multilevel analysis. METHODS: The present study was initiated in a Dutch primary school in October 2019. The BST was administered as part of a larger neuropsychological assessment. The outbreak of Covid-19 and the subsequential lockdown in the Netherlands led to a premature termination of the study in March 2020. Data of 38 children were available. This dataset was analyzed and labeled as pilot. RESULTS: Significant main effects of age, time components, levels, correct answer, and several interactions were found on the reaction time in the predicted direction. Random effects could also be modeled. A final statistical combination model is described. CONCLUSION: Despite the small study sample, it seems to be justified to conclude that the BST is a potentially valuable instrument to test interference suppression in 5-11-year-old children. In the analysis of the BST, multilevel analysis has proven to be very rewarding. Since the present study only examined a small part of reliability and validity aspects, further psychometric research is desired.

Neuropsychological impairment in post-COVID condition individuals with and without cognitive complaints.

One of the most prevalent symptoms of post-COVID condition is cognitive impairment, which results in a significant degree of disability and low quality of life. In studies with large sample sizes, attention, memory, and executive function were reported as long-term cognitive symptoms. This study aims to describe cognitive dysfunction in large post-COVID condition individuals, compare objective neuropsychological performance in those post-COVID condition individuals with and without cognitive complaints, and identify short cognitive exams that can differentiate individuals with post-COVID symptoms from controls. To address these aims, the Nautilus project was started in June 2021. During the first year, we collected 428 participants' data, including 319 post-COVID and 109 healthy controls (18-65 years old) from those who underwent a comprehensive neuropsychological battery for cognitive assessment. Scores on tests assessing global cognition, learning and long-term memory, processing speed, language and executive functions were significantly worse in the post-COVID condition group than in healthy controls. Montreal Cognitive Assessment, digit symbol test, and phonetic verbal fluency were significant in the binomial logistic regression model and could effectively distinguish patients from controls with good overall sensitivity and accuracy. Neuropsychological test results did not differ between those with and without cognitive complaints. Our research suggests that patients with post-COVID conditions experience significant cognitive impairment and that routine tests like the Montreal Cognitive Assessment, digit symbol, and phonetic verbal fluency test might identify cognitive impairment. Thus, the administration of these tests would be helpful for all patients with post-COVID-19 symptoms, regardless of whether cognitive complaints are present or absent. Study registration: www.ClinicalTrials.gov, identifiers NCT05307549 and NCT05307575.

Cognitive Digital Intervention for Older Patients with Parkinson's Disease during COVID-19: A Mixed-Method Pilot Study.

Mild cognitive impairment is frequent among people with Parkinson's disease. Cognitive training seems effective for cognitive status and for mitigating anxiety and depression. With the COVID-19 outbreak, such therapeutic interventions were delivered online. This longitudinal mixed-method study was aimed at evaluating the effectiveness of an online cognitive treatment, carried out during COVID times and based on Parkinson's-Adapted Cognitive Stimulation Therapy, on cognitive domains and mood of 18 older people with Parkinson's disease. After screening, the cognitive status and mood were assessed three times by Addenbrooke's Cognitive Examination-Revised scale and the Geriatric Depression Scale-Short Form. At the follow-up, patients were also interviewed for understanding their experience with the technology. Such treatment was effective on the participants' cognitive functions, but not on their mood. Despite some initial problems with the technology, the online intervention was experienced as a way of not being 'left behind', staying in contact with others, and being safe during the lockdown. This suggests that online cognitive treatment can be adopted to integrate face-to-face interventions by increasing their efficacy, accessibility, and long-term outcomes. Suggestions for future research are given.

Donepezil Beyond Alzheimer’s Disease? A Narrative Review of Therapeutic Potentials of Donepezil in Different Diseases

Donepezil hydrochloride is an acetylcholine esterase inhibitor studied and approved to treat Alzheimer’s disease (AD). However, this drug can have positive therapeutic potential in treating different conditions, including various neurodegenerative disorders such as other types of dementia, multiple sclerosis, Parkinson’s disease, psychiatric and mood disorders, and even infectious diseases. Hence, this study reviewed the therapeutic potential of this drug in treating Alzheimer’s and other diseases by reviewing the articles from databases including Web of Science, Scopus, PubMed, Cochrane, and Science Direct. It was shown that donepezil could affect the pathophysiology of these diseases via mechanisms such as increasing the concentration of acetylcholine, modulating local and systemic inflammatory processes, affecting acetylcholine receptors like nicotinic and muscarinic receptors, and activating various cellular signaling via receptors like sigma-1 receptors. Despite many therapeutic potentials, this drug has not yet been approved for treating non-Alzheimer’s diseases, and more comprehensive studies are needed.

COGNITIVE and PSYCHOSOCIAL OUTCOME in CHILDREN with MULTISYSTEM INFLAMMATORY SYNDROME FOLLOWING SARS-COV-2 INFECTION

Background: Despite the low rate of neurological defcits following the SARS-COV-2 infection in the pediatric population, children and adolescents who develop multisystem infammatory syndrome (MIS-C) after being infected with SARS-COV-2 are at a higher risk for neurological abnormalities and brain injury, increasing the risk of adverse cognitive and psychiatric outcome. Objectives: Given the increased risk of central nervous system impairment we chose to conduct a prospective study looking at the cognitive and psychosocial outcome of patients with MIS-C. Methods: Our study included 27 of the 29 patients between 2 to 18 years of age (M = 11.1, SD = 4.4) who were treated for MIS-C from the onset of the SARS-COV-2 pandemic until the beginning of May 2021 at the only tertiary care pedi-atric immunology center in Slovenia. We assessed these patients 6 months after diagnosis using the age-appropriate Wechsler intelligence scales and a battery of neuropsychological test measuring attention, executive function, memory and fne motor skills. We also asked parents to report on patients' psychosocial outcome using the Achenbach Child Behavior Checklist. Results: By using Bayesian statistics to take into account parental education and any potential pre-morbid learning difficulties we found no evidence of impairment on measures of intelligence. However, the posterior distribution of scores on neuropsychological measures indicated that a signifcant proportion of patients scored 1SD bellow expected levels on measures of attention (31%), executive function (28%) and visual memory (35%). Increased symptoms of depression, anxiety and attention difficulties were also reported by parents, although their extent did not rise to a clinically signifcant level. Conclusion: The fndings from our cohort suggest that the cognitive and psychosocial outcome of patients with MIS-C is generally favorable, although up to 35% may experience specifc neuropsychological defcits more than 6 months after diagnosis. The most commonly impaired cognitive domains seem to be attention, executive function and visual memory.

The relationship between cognitive flexibility, depression, and work performance: Employee assessments using cognitive flexibility tests

Background Cognitive flexibility is a frontal lobe function, and some scholars have indicated that it is linked to depression. The Cognitive Flexibility Test (CFT) is a neuropsychological test that can easily and promptly measure cognitive flexibility within a short amount of time. This study focuses on healthy younger workers to determine the associations between their cognitive flexibility, depression, and performance at work. Methods The absolute absenteeism and the absolute presenteeism of a group of 80 regular employees were measured, and the employees were administered the Verbal Fluency Test (VTF), the CFT-A and CFT-B, the Beck Depression Inventory-II (BDI-2), and the World Health Organization Health and Work Performance Questionnaire (WHO-HPQ). Google Forms were used to measure the BDI-2, absolute absenteeism, and absolute presenteeism, and online interviews were conducted on Zoom to collect answers to the CFT and the Verbal Fluency Test (VFT). Results No significant age-related differences appeared in the number of responses obtained for the CFT-A and CFT-B from subjects grouped according to the decades they represented, ranging from the 20s to the 50s. In addition, the CFT-A and CFT-B did not indicate significant correlations between the BDI-2 and absenteeism and presenteeism. Limitations Small sample, online vs. in person assessments due to COVID-19. Conclusion The results suggest that the function of cognitive flexibility is relatively stable and is unaffected by age brackets. The study also found no links between the cognitive flexibility of healthy young workers, the state of depression, or their work performance.

Longitudinal Evaluation of Neuro-PASC Symptoms

Objective: A longitudinal study (NeuCovid) was created at UC San Diego to compare the long-term neurological outcomes of SARS-CoV-2 infection in two cohorts, patients with and without prior neurologic disease. Background: While cross-sectional analyses have demonstrated the prevalence of neurological symptoms in the Post-Acute Sequelae of SARS-CoV-2 infection (PASC), the evolution of these symptoms over time has not yet been well-described. Design/Methods: Participants with neurological symptoms post-acute infection with SARS-CoV-2 were recruited. Team members conducted assessments including a detailed SARS-CoV-2 infection history, neurologic review of systems (scored on 10-point severity scale), neurologic exam, MoCA exam, and self-reported neuropsychiatric questionnaires, at baseline (conducted after acute infection resolved) and at 3-,6-, and 12-month follow-ups. As appropriate, participants were referred for imaging and neuropsychological testing. We report 6-month data, but 12-month data will be available in 2022. Results: 61 participants (69% female, mean age 50.2 years) were enrolled, 18 with prior known neurological disease. Acute COVID-19 disease severity was largely described as mild (44.4%) or moderate (48.1%). To date, 27 participants (74% female, mean age 52.6 years) completed baseline and 6-month follow-up visits. At baseline, the most common symptoms included fatigue (85.2%), headaches (74.1%), memory impairment (59.3%), insomnia (55.6%), and decreased concentration (48.1%). Complete symptom resolution was reported in 33.3% at 6-month follow-up. In the remaining participants at 6 months, persistent memory impairment (68.8%), decreased concentration (61.5%), fatigue (52.2%), insomnia (46.7%), and headache (45.0%) were reported. Average severity score decreased for fatigue (69.4%), headache (64.3%), insomnia (51.3%), decreased concentration (47.6%), and memory impairment (38.6%). Average MoCA scores improved from baseline (n=19, 26.4 to 28.0). Conclusions: Early in neuro-PASC, fatigue and headache were the most common reported symptoms. At 6-month follow-up, memory impairment and decreased concentration were most prominent. Only a third of participants had complete resolution of neuro-PASC symptoms at 6 months.

18fluorodeoxyglucose (FDG) brain PET/CT as the only diagnostic tool able to identify early cognitive impairment in a covid-19 patient: a case-report

Background-Aim: Cognitive impairment may represent a long lasting symptom after COVID-19 resolution and FDG brain PET is useful to evaluate if brain metabolic changes are transient or long lasting. Hypometabolism was shown in many brain areas, i.e. cingulate cortex, bilateral gyrus rectus, prefrontal and orbitofrontal cortex and cerebellar vermis. Methods: We report the case of a 62 years old man with type 2 diabetes, affected by COVID-19 infection in October 2020. After resolution, the patient had short-term memory loss and speech deficit affecting daily living and working activities and referred to the Gerontology and Geriatrics Institute (Univ. of Perugia). Neurological examination and neuropsychological tests were carried out and no alterations were found. In October 2021, the neurological examination was still normal, as well as neuropsychological tests. Brain MRI showed only two small chronic ischemic foci without bi-hemispheric white matter clinically significant abnormalities. In November 2021, the patient underwent FDG brain PET/CT (discovery ST, G.E.) according to standard protocols and images were evaluated both qualitatively and semiquantitatively. Results: An area of moderate significant hypometabolism was identified in the precuneus (predominant on the right side) and others multiple small and mild hypometabolic regions were localized in bilateral pre-frontal cortex, sensorimotor and parietal cortex both on left hemisphere. PET and MRI fusion images (Syngo.via VB10B image processing software, Siemens) showed that hypometabolic areas corresponded to structurally intact parenchyma at MRI. In January 2022 clinical and neuropsychological follow up did not evidence cognitive impairment, although the patient still felt depressed and impaired in memory, attention and daily living activities. Conclusions: In this case, FDG brain PET/CT was the only diagnostic procedure showing findings consistent with patient symptoms. In particular, precuneus hypometabolism may represent in this patient an early hallmark of dementia (i.e. Alzheimer's disease-AD), although other characteristic brain areas are not significantly impaired (i.e. cingulate cortex). In this case, FDG brain PET use, during follow up, could be crucial to evaluate if the metabolic changes may evolve into a chronic state, thus supporting mild cognitive impairment clinical suspect due to AD or confirming a stable COVID related neuronal damage. Furthermore, a second normal FDG brain PET/CT scan may suggest a post-acute infection transient phase, preluding to normal functional status. In conclusion, FDG brain PET/CT may represent an important diagnostic tool in modifying subsequent diagnostic assessment suggesting or routinely clinical follow up or other investigations for dementia (i.e. amyloid PET, amyloid and Tau protein liquor measurement). In our study, fused PET and MRI images were used, although hybrid PET/MRI system could be the choice option if available.

SPM analysis of a brain 18F-FDG PET/CT in a patient with neurological impairment after covid-19 infection

Background-Aim: A 46 years old housewife patient with a bachelor's degree in Law contracted Covid-19 at the end of March 2021. She had a flu-like form with associated asthenia and drowsiness and no lack of sense of smell. It has been resolved in 25 days. Later, she developed progressive immediate memory loss, word-finding issues, motor and thinking slowing down. Methods: CT brain scan appeared as within the norm as well as liver enzymes, TSH, Vitamin B12, Folate and Rapid Plasma Reagine. Anti- ENA DNA ANA HIV TPO TG were negative too. In October, the patient had a further neuropsychological assessment that showed an overall picture characterized by partial orientation to space, working memory disorders, writing and comprehension (of complex tasks) issues, and immediate memory loss (possible sign both of attention span and concentration reduction). The auto-antibodies were assessed in November and they resulted negative. Moreover, the brain MRI scan and EEG (dated at the end of November) were both within the range. CSF neurodegenerative biomarkers and anti-neuronal antibodies appeared in the norm too. Results: Ultimately, in December 2021 she underwent an 18F-FDG PET brain scan and the SPM analysis showed an extensive hypometabolism in the bilateral frontal cortex and bilateral straight gyrus. Spared the cingulate cortex. Conclusions: The patient contracted Covid in March 2021. She developed neurological deterioration identified by FDG-PET. Negative autoantibodies and CSF biomarkers. PET scan was the only exam to define the brain damage in the patient above. Symmetrical bilateral frontal cortex and bilateral straight gyrus hypo-metabolism have been observed, the last one at the direct level of the olfactory bulb. In this area, in patients who died from Covid-19 it has been histologically demonstrated (data to be published) the presence of cellular inclusions named Corpore Amylacea. They would be a small hyaline mass that functions as a waste container that accumulates in the human brain in aging and in neurodegenerative and infectious processes. It is hypothesized to be that it can be involved in a sort of brain cleaning process1. Recently it has been described that they contain some neoepitopes that are recognized by natural IgMs, revealing a possible link between them and the natural immune system2. However, to now in our patient, the only diagnostic tool to evaluate the brain condition has been the 18F-FDG PET.

NEUROPSYCHOLOGIC PERFORMANCE FOLLOWING COVID-19: PREVALENCE and PREDICTORS

Background: Insomnia, mood decline, anxiety, and cognitive impairment are described following COVID-19, and the mechanisms underlying these symptoms are not fully clarified. Aims of this analysis were to describe prevalence and predictors of impaired neuropsychological performance after COVID-19. Methods: We included patients referred to the post-COVID19 service with and without a previous hospitalization (PH and nPH, respectively) assessed at 3,6 and 12 months (3M,6M,12M) post-COVID19. Patients underwent to a comprehensive neuropsychological assessment using a standardized battery of 10 tests across 4 domains (speed of information processing, /executive, attention/working memory, memory). Neurocognitive impairment (NCI) was defined by: score >1 standard deviation (SD) below the mean on at least 2 tests, or >2 SD below 1 test. Change in NPZ-10 (mean, SD) was analyzed as an outcome. In addition, the Beck Anxiety Inventory (BAI), the Beck Depression Inventory (BDI) and the Pittsburgh Sleep Quality Index (PSQI) were administered. Mann-Whitney and Chi-square tests were used for comparisons, and logistic and linear regression were used to identify factors associated with test results. Results: N=302 participants: median age of 55 years (IQR 47-61), 52% female, median education of 13 yrs (13-18), 63% with >1 comorbidity, 58% PH (mainly males, higher age and higher BMI vs nPH). Overall, the prevalence of NCI was 42%, higher in PH vs nPH (46% vs 36%;p=0.07) (Figure 1a) with a not statistically significant mean decrease of NPZ10 [-0.12 (0.49)]. More in detail, we observed a significant decrease of z-score in the speed of information processing domain in PH vs nPH [-0.29(0.48) vs-0.12(0.31);p<0.001]. NCI prevalence resulted significantly higher in PH vs nPH only at 3M (Figure 1b). A higher proportion of nPH vs PH complained anxiety (BAI>85%) at 3M [55.6% vs 31.4%);p=0.028], sleep disturbances were more frequent in PH vs nPH at 3 and 12M (Figure 1d,c). Male gender appear to be the only associated factor with a lower alteration of BAI>85% and PSQI>5 [OR 0.28 (0.12-0.65);p=0.003;0.22 (0.09-0.52);p=0.001;respectively]. No predictors of NCI or BDI>85% were found. Conclusion: Our preliminary data show a consistent prevalence of NCI, significantly higher in PH vs nPH. This finding remains quite stable up to 12 months of observation. Also a worse sleep quality in PH was observed. Women seem to be at higher risk of anxiety-depressive and sleep disorders than men.

Covid-19 and Children's Social Development Changes in cognitive functioning after COVID-19: A systematic review and meta-analysis

Summary In this chapter, the authors focus on disruptions to children's lives at home and at school (including early childhood care and education programs [ECCE] and primary schooling) as critical settings for healthy development. The Covid-19 pandemic has upended children's lives in myriad ways, including disruptions in the family system due to illness or death, financial instability tied to job loss, and educational disruptions as a result of closures of child care facilities and schools. In considering how the Covid-19 pandemic is shaping children's social development, the authors attend to how interactions with others and socialization processes within families and schools may buffer or exacerbate the pandemic's negative impact. Developmental scientists are well positioned to research how macro-level shocks such as the coronavirus pandemic affect children's developmental trajectories, and the life-course perspective can guide and inform that investigation. Introduction We conducted a systematic review and meta-analysis of the cognitive effects of coronavirus disease 2019 (COVID-19) in adults with no prior history of cognitive impairment. Methods Searches in Medline/Web of Science/Embase from January 1, 2020, to December 13, 2021, were performed following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.  A meta-analysis of the Montreal Cognitive Assessment (MoCA) total score comparing recovered COVID-19 and healthy controls was performed. Results Oof 6202 articles, 27 studies with 2049 individuals were included (mean age = 56.05 years, evaluation time ranged from the acute phase to 7 months post-infection). Impairment in executive functions, attention, and memory were found in post-COVID-19 patients.  The meta-analysis was performed with a subgroup of 290 individuals and showed a difference in MoCA score between post-COVID-19 patients versus controls (mean difference = ?0.94, 95% confidence interval [CI] ?1.59, ?0.29;P = .0049). Discussion Patients recovered from COVID-19 have lower general cognition compared to healthy controls up to 7 months post-infection.

Changes in cognitive functioning after COVID-19: A systematic review and meta-analysis.

INTRODUCTION: We conducted a systematic review and meta-analysis of the cognitive effects of coronavirus disease 2019 (COVID-19) in adults with no prior history of cognitive impairment. METHODS: Searches in Medline/Web of Science/Embase from January 1, 2020, to December 13, 2021, were performed following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.  A meta-analysis of the Montreal Cognitive Assessment (MoCA) total score comparing recovered COVID-19 and healthy controls was performed. RESULTS: Oof 6202 articles, 27 studies with 2049 individuals were included (mean age = 56.05 years, evaluation time ranged from the acute phase to 7 months post-infection). Impairment in executive functions, attention, and memory were found in post-COVID-19 patients.  The meta-analysis was performed with a subgroup of 290 individuals and showed a difference in MoCA score between post-COVID-19 patients versus controls (mean difference = -0.94, 95% confidence interval [CI] -1.59, -0.29; P = .0049). DISCUSSION: Patients recovered from COVID-19 have lower general cognition compared to healthy controls up to 7 months post-infection.

Prevalence of Cognitive Impairment before Prostate Cancer Treatment.

Cognitive impairment is common among patients with different types of cancer, even before cancer treatment, but no data were reported among patients with prostate cancer (PCa), who may be at high risk due to advanced age. This study aims to estimate the prevalence of cognitive impairment before PCa treatment. Between February 2018 and April 2021, the NEON-PC cohort recruited 605 patients with PCa proposed for treatment at the Portuguese Institute of Oncology of Porto. The Montreal Cognitive Assessment (MoCA) was used to assess cognitive performance. Participants with a MoCA < 1.5 standard deviations (SD) of age- and education-specific normative values were considered to have probable cognitive impairment (PCI) and were referred for a comprehensive neuropsychological assessment. Data from the population-based cohort EPIPorto (n = 351 men aged ≥40 years, evaluated in 2013-2015) were used for comparison. The prevalence of PCI was 17.4% in EPIPorto and 14.7% in NEON-PC (age- and education-adjusted odds ratio: 0.82, 95%CI: 0.58,1.18). Neuropsychological assessment was performed in 63 patients with PCa: 54.0% had cognitive impairment. These results suggest that the impact of PCa on cognitive performance could be negligible in the short term, contrary to what other studies have reported regarding other types of cancer.

The neurological consequences of contracting covid-19

Since the first confirmed case in Wuhan, China on December 31, 2019, the novel coronavirus (SARS-CoV-2) has spread quickly, infecting 165 million people as of May 2021. Since this first detection, research has indicated that people contracting the virus may suffer neurological and mental disorders and deficits, in addition to the respiratory and other organ challenges caused by COVID-19. Specifically, early evidence suggests that COVID-19 has both mild (e.g., loss of smell (anosmia), loss of taste (ageusia), latent blinks (hete-rophila), headaches, dizziness, confusion) and more severe outcomes (e.g., cognitive impairments, seizures, delirium, psychosis, strokes). Longer-term neurological challenges or damage may also occur. This knowledge should inform clinical guidelines, assessment, and public health planning while more systematic research using biological, clinical, and longitudinal methods provides further insights.

Randomized controlled trial on neuropsychological rehabilitation for patients with drug refractory epilepsy: Challenges, adaptations & findings

Purpose: Reviews of neuropsychological rehabilitation literature in epilepsy outnumber the original studies with one Randomized Controlled Trial (RCT) reported till date. A home-based neuropsychological rehabilitation program was developed for patients with Drug Refractory Epilepsy (DRE) [Post-Operative (PO) & Not Cleared for Surgery (NCS)]. The COVID-19 pandemic posed challenges of follow-up and tele- assessment. Adaptations were made to the ongoing study and solutions were found based on available literature and focus group discussions with experts in the field of neuropsychology and epileptology. The efficacy was studied. Method: 27 consenting adults with DRE were recruited in a single blind RCT (CTRI/2019/10/021777) with 14 patients in the Intervention (IG) (PO = 13, NCS = 1), and 13 in the Treatment As Usual (TAU) (PO = 11, NCS = 2) groups. They were of any gender, aged 18-45 years diagnosed with DRE atleast 1 year back, with minimum primary level of education, IQ > 80, having an available primary caregiver. At 3 months, reasons for non-compliance to rehabilitation due to COVID-19 were noted and a booster session was given. Pre-post neuropsychological assessment included Auditory Verbal Learning Test and Everyday Memory Questionnaire (EMQ). All follow-ups were done through tele-assessment at 6 months and coded for validity on a 3-point scale. The 6-week neuropsychological rehabilitation program included psychoeducation, compensatory training and cognitive retraining aimed at improving memory. The booster session focused on internal and external aids. Result: Themes of non-compliance included 1) Non-availability of time due to shift to virtual work/study 2) Increased household work. Mann-Whitney test of the absolute differences of the test scores (follow-up score- baseline score) between two groups revealed significant differences in immediate recall (P = 0.002), delayed recall (p <0.001), long term retention (P = 0.024), patient reported EMQ (p <0.001) and caregiver reported EMQ (p <0.001) with IG showing improvement. Conclusions: Despite challenges of the pandemic, efficacy of the rehabilitation was observed.