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1.
Otolaryngology - Head and Neck Surgery ; 167(1 Supplement):P144-P145, 2022.
Article in English | EMBASE | ID: covidwho-2064489

ABSTRACT

Introduction: Olfactory dysfunction is a common symptom associated with COVID-19 infection. While often transient, nearly 1 in 8 patients experience persistent dysfunction after initial infection resolution. Given the known association between impaired olfaction and mild cognitive impairment (MCI), this persistent COVID-19 olfactory dysfunction may impede early detection of cognitive decline. Method(s): Patients with confirmed COVID-19-associated hyposmia (n=73), MCI (n=58), and normal controls (n=86) were prospectively enrolled. Demographic data were collected alongside formal olfactory testing via AROMA (Affordable Rapid Olfaction Measurement Assay) at time of initial enrollment. MCI was assessed via MoCA (Montreal Cognitive Assessment). Multivariate logistic regressions were utilized to evaluate for associations between variables and etiology of olfactory dysfunction. Result(s): After controlling for age and gender, when compared against normal controls, the inability to smell licorice, cinnamon, and lemon at the lowest 3 concentrations increased odds of COVID-19 hyposmia by 10.8 (95% CI, 4.6-25.6), 5.7 (95% CI, 2.7-11.7), and 5.3 (95% CI, 2.6-10.8), respectively. While the inability to smell coffee (9.9 odds ratio [OR];95% CI, 2.02-48.1), eucalyptus (6.7 OR;95% CI, 2.2-20.0), and rose (4.0 OR;95% CI, 1.7-9.7) were associated with MCI, decreased ability to smell licorice, cinnamon, and lemon were not. When combined into a composite score and compared against controls, decreased detection of licorice, cinnamon, and lemon was associated with a 16.5 OR (95% CI, 6.6-41.3) for COVID-19 hyposmia. This composite score was not significantly associated with MCI (1.2 OR;95% CI, 0.6-2.2) and, as such, performed well at discriminating between COVID-19 and MCI patients (receiver operating characteristic area under the curve=0.76). Conclusion(s): Distinct patterns of impaired olfaction were noted for COVID-19. We show that this etiology-specific phenotype has good discriminative performance when differentiating from MCI-associated hyposmia, which may allow for continued utilization of olfactory screening for MCI even among those with previous COVID-19 infection.

2.
Frontiers in Systems Neuroscience ; 16, 2022.
Article in English | EMBASE | ID: covidwho-2043504

ABSTRACT

Psychological distress among healthcare professionals, although already a common condition, was exacerbated by the COVID-19 pandemic. This effect has been generally self-reported or assessed through questionnaires. We aimed to identify potential abnormalities in the electrical activity of the brain of healthcare workers, operating in different roles during the pandemic. Cortical activity, cognitive performances, sleep, and burnout were evaluated two times in 20 COVID-19 frontline operators (FLCO, median age 29.5 years) and 20 operators who worked in COVID-19-free units (CFO, median 32 years): immediately after the outbreak of the pandemic (first session) and almost 6 months later (second session). FLCO showed higher theta relative power over the entire scalp (FLCO = 19.4%;CFO = 13.9%;p = 0.04) and lower peak alpha frequency of electrodes F7 (FLCO = 10.4 Hz;CFO = 10.87 Hz;p = 0.017) and F8 (FLCO = 10.47 Hz;CFO = 10.87 Hz;p = 0.017) in the first session. FLCO parietal interhemispheric coherence of theta (FLCO I = 0.607;FLCO II = 0.478;p = 0.025) and alpha (FLCO I = 0.578;FLCO II = 0.478;p = 0.007) rhythms decreased over time. FLCO also showed lower scores in the global cognitive assessment test (FLCO = 22.72 points;CFO = 25.56;p = 0.006) during the first session. The quantitative evaluation of the cortical activity might therefore reveal early signs of changes secondary to stress exposure in healthcare professionals, suggesting the implementation of measures to prevent serious social and professional consequences.

3.
Journal of the Intensive Care Society ; 23(1):46-47, 2022.
Article in English | EMBASE | ID: covidwho-2042961

ABSTRACT

Introduction: Mental, physical, and cognitive impairments are common after an intensive care unit (ICU) stay. It remains unknown to what extent the extraordinary increase in bed occupancy during the pandemic could be linked to the severity and frequency of patient's impairments. Objective: To determine the frequency, severity, and risk factors for mental, physical, and cognitive impairments at ICU discharge during high and low bed occupancy periods. Methods: Prospective cohort study in seven Chilean ICUs (ClinicalTrials.gov Identifier: NCT04979897). We included adults, mechanically ventilated >48 hours in the ICU who could walk independently prior to admission. Trained physiotherapists assessed the Medical Research Council Sum-Score (MRC-SS), Montreal Cognitive Assessment (MOCA-blind), Hospital Anxiety and Depression Scale (HADS), Impact of Event Scale-Revised (IES-R), and the World Health Organization Disability Assessment Schedule (WHODAS 2.0) at ICU discharge. Pre-admission employment status, educational level, and Clinical Frailty Scale (CFS) were also collected. We compared periods of low and high bed-occupancy, defined as less or more than 90% of staffed ICU beds occupied. We used t-test for normally distributed, Mann-Whitney for those not normally distributed, and chi-square for categorical variables. We explored risk factors for mental, physical, and cognitive impairments using logistic regression adjusted for age, sex, educational level, and bed occupancy. Analyses were performed in Stata/SE 16.0. Results: We included 192 patients with COVID-19 of which 126 [66%] were admitted during a high bedoccupancy period (January to April 2021). Majority were male (137 [71%]) and worked full-time (127 [66%]). Median [P25-P75] age was 57 [47-67], length of ICU stay was 15[ 11-27] days, and duration of mechanical ventilation (MV) was 9 [6-16.5] days. Seven (4%) patients were clinically frail, 65 (34%) had ICUacquired weakness (ICU-AW), 134(70%) had cognitive impairment, 122 (64%) had post-traumatic stress symptoms (PTSS), 53 (28%) had depressive symptoms, 106 (55%) had anxiety symptoms, and 148 (77%) had severe disability. Table 1 shows the combined prevalence of physical and mental health problems. Patients admitted during the high-occupancy period were younger (mean 54, 95% confidence interval [47, 61] vs 61 [58, 64]), more likely to have a higher education qualification(HEQ) (OR 1.67 [0.9, 3.06]), and had a shorter duration of MV (8 [6-13] vs 13 [8-34];p<0.001) and ICU stay (13 [10-19] vs 21.5 [13-42];p<0.001). Mental, physical, and cognitive impairments were similar in low and high occupancy periods. Patients with a HEQ were less likely to have ICU-AW (OR 0.23 [0.11, 0.46]), cognitive impairments (OR 0.26 [0.11, 0.6]), symptoms of depression (OR 0.45 [0.22, 0.9]) or anxiety (OR 0.26 [0.13, 0.5]), and severe disability (OR 0.4 [0.18, 0.94]). Females were more likely to have ICU-AW (OR 2.4 [1.13, 4.93]). Older patients were less likely to suffer PTSS (OR 0.97 [0.94, 0.99] per year old). Conclusions: Majority of patients had at least one mental, physical or cognitive impairment being similar by bed occupancy. Having a higher education qualification was the main protective factor for impairments at ICU discharge. Preventative treatments programmes should target patients with <12 years of education.

4.
EClinicalMedicine ; 53: 101651, 2022 Nov.
Article in English | MEDLINE | ID: covidwho-2031251

ABSTRACT

Background: Reliable estimates of frequency, severity and associated factors of both fatigue and cognitive impairment after COVID-19 are needed. Also, it is not clear whether the two are distinct sequelae of COVID-19 or part of the same syndrome." Methods: In this prospective multicentre study, frequency of post-COVID fatigue and cognitive impairment were assessed in n = 969 patients (535 [55%] female) ≥6 months after SARS-CoV-2 infection with the FACIT-Fatigue scale (cut-off ≤30) and Montreal Cognitive Assessment (≤25 mild, ≤17 moderate impairment) between November 15, 2020 and September 29, 2021 at University Medical Center Schleswig-Holstein, Campus Kiel and University Hospital Würzburg in Germany. 969 matched non-COVID controls were drawn from a pre-pandemic, randomised, Germany-wide population survey which also included the FACIT-Fatigue scale. Associated sociodemographic, comorbid, clinical, psychosocial factors and laboratory markers were identified with univariate and multivariable linear regression models. Findings: On average 9 months after infection, 19% of patients had clinically relevant fatigue, compared to 8% of matched non-COVID controls (p < 0.001). Factors associated with fatigue were female gender, younger age, history of depression and the number of acute COVID symptoms. Among acute COVID symptoms, altered consciousness, dizziness and myalgia were most strongly associated with long-term fatigue. Moreover, 26% of patients had mild and 1% had moderate cognitive impairment. Factors associated with cognitive impairment were older age, male gender, shorter education and a history of neuropsychiatric disease. There was no significant correlation between fatigue and cognitive impairment and only 5% of patients suffered from both conditions. Interpretation: Fatigue and cognitive impairment are two common, but distinct sequelae of COVID-19 with potentially separate pathophysiological pathways. Funding: German Federal Ministry of Education and Research (BMBF).

5.
Annals of the Rheumatic Diseases ; 81:1676, 2022.
Article in English | EMBASE | ID: covidwho-2008964

ABSTRACT

Background: Low back and neck pain is one of the most common health problems in society and one of the top reasons for admission to the hospital (1). Studies show that the level of physical activity decreases in individuals with chronic pain, and the cognitive level and quality of life are negatively affected (2). There are studies examining the effects of the Covid-19 pandemic process on the level of physical activity and cognitive level in various groups. However, the number of studies on how the history of Covid-19 affects individuals with low back and neck pain is limited. Objectives: The aim of this study is to examine the effect of Covid-19 history on cognitive level, pain catastrophe and physical activity level in individuals with chronic low back and neck pain in individuals. Methods: A total of 25 individuals with chronic pain, including 16 with low back pain and 9 with neck pain, were included in the study. Demographic data such as age, gender and body mass index (BMI) were obtained from all individuals. The education levels of the individuals were recorded. Cognitive level was assessed by the Montreal Cognitive Assessment (MoCA)[3], pain severity was assessed by the Visual Analog Scale (VAS), pain catastrophization was assessed by the Pain Catastrophizing Scale (PCS)[4], and physical activity level was assessed by the International Physical Activity Questionnaire-Short Form (IPAQ-SF)[5]. Results: Table 1. Demographic data, VAS, MoCA, PCS, and IPAQ-SF scores are given in Table 1. 7 of the participants had history of Covid-19, 18 did not. The MoCA scores and education levels of individuals with Covid-19 were higher than individuals without history of Covid-19 (p<0.05). There was no difference in physical activity, pain and pain catastrophization levels between the 2 groups (p> 0.05). Conclusion: Surprisingly, individuals who had a history of Covid-19 had higher cognitive levels than individuals without a history of Covid-19. In addition, there was no difference between physical activity and pain catastrophization levels. This may be due to the higher education level of individuals with a history of Covid-19. There is a need for further studies in which education levels are similar, and hospitalization and the Covid-19 positivity process are examined in more detail.

6.
NeuroQuantology ; 20(7):1188-1193, 2022.
Article in English | EMBASE | ID: covidwho-2006536

ABSTRACT

Background: Coronavirus disease 2019 (COVID-19) has imposed a significant impact on populations and healthcare systems. Symptoms of post-COVID syndrome (PCS) persist for at least 12 months following COVID-19 infection leading to significant negative effects on these patients’ cognition, ability to work, physical activity, social interaction, and overall quality of life. Objective: This study aimed to investigate the relation between cognitive deficits, quality of life (QOL) and coping strategies in post COVID-19 survivors. Subjects and Methods: A hundred COVID-19 survivors from both genders participated in this study. Their cognition was evaluated using Montreal Cognitive Assessment (MoCA), the WHO Quality of Life Instrument-Short Form (WHOQOL-BREF) was employed to evaluate patients’ QOL and the Brief Coping Orientation to Problems Experienced (Brief-COPE) was used to assess their coping strategies. Results: A significant positive correlation was found between the scores of MoCA and all HRQOL domains (Physical health, Psychological, Social relationships, Environment, General health and General QOL). Also, a significant negative correlation was noted between scores of MoCA and Brief-COPE (Mal-Adaptive strategies) while no significant correlation was found between MoCA scores and Brief-COPE (Adaptive strategies). Conclusion: There is a relation between cognition deficits, QOL and non-adaptive coping strategies in post COVID-19 survivors, while, there is no relation between cognitive deficits and adaptive coping strategies in PCS patients.

7.
Aging Clin Exp Res ; 34(8): 1873-1883, 2022 Aug.
Article in English | MEDLINE | ID: covidwho-1995921

ABSTRACT

AIM: We estimated the proportion and severity of cognitive disorders in an unselected population of patients referred for transcatheter aortic valve implantation (TAVI). Second, we describe clinical and cognitive outcomes at 1 year. METHODS: Eligible patients were aged ≥ 70 years, with symptomatic aortic stenosis and an indication for TAVI. The Montreal Cognitive Assessment (MoCA) was used to assess cognitive dysfunction (CD), defined as no CD if score ≥ 26, mild CD if 18-25; moderate CD if 10-18, and severe CD if < 10. We assessed survival and in-hospital complications at 6 months and 1 year. RESULTS: Between June 2019 and October 2020, 105 patients were included; 21 (20%) did not undergo TAVI, and thus, 84 were analyzed; median age 85 years, 53.6% females, median EuroScore 11.5%. Median MoCA score was 22 (19-25); CD was excluded in 18 (21%), mild in 50 (59.5%), moderate in 15 (19%) and severe in 1. Mean MoCA score at follow-up was 21.9(± 4.69) and did not differ significantly from baseline (21.79 (± 4.61), p = 0.73). There was no difference in success rate, in-hospital complications, or death across CD categories. CONCLUSION: The clinical course of patients with mild or moderate CD is not different at 1 year after TAVI compared to those without cognitive dysfunction.


Subject(s)
Aortic Valve Stenosis , Cognitive Dysfunction , Heart Valve Prosthesis Implantation , Transcatheter Aortic Valve Replacement , Aged, 80 and over , Aortic Valve/surgery , Aortic Valve Stenosis/surgery , Cognition , Cognitive Dysfunction/epidemiology , Cognitive Dysfunction/etiology , Female , Humans , Male , Prevalence , Risk Assessment , Risk Factors , Severity of Illness Index , Time Factors , Transcatheter Aortic Valve Replacement/adverse effects , Treatment Outcome
8.
Israel Medical Association Journal ; 24(7):482-484, 2022.
Article in English | EMBASE | ID: covidwho-1980591
9.
Gen Hosp Psychiatry ; 78: 80-86, 2022.
Article in English | MEDLINE | ID: covidwho-1966576

ABSTRACT

BACKGROUND: Cognitive complaints are one of the most frequent symptoms reported in post-acute sequelae of COVID-19 (PASC). The Montreal Cognitive Assessment (MoCA) has been used to estimate prevalence of cognitive impairment in many studies of PASC, and is commonly employed as a screening test in this population, however, its validity has not been established. OBJECTIVE: To determine the utility of the MoCA to screen for cognitive impairment in PASC. METHODS: Sixty participants underwent neuropsychological, psychiatric, and medical assessments, as well as the Montreal Cognitive Assessment, 6-8 months after acute COVID-19 infection. RESULTS: The overall sample had a mean score of 26.1 on the MoCA, with approximately one third screening below the cutoff score of 26, similar to the rate of extremely low NP test performance. MoCA score was inversely correlated with fatigue and depression measures and ethnic minority participants scored on average lower, despite similar education and estimated premorbid function. The MoCA had an accuracy of 63.3% at detecting any degree of diminished NP performance, and an accuracy of 73.3% at detecting extremely low NP performance. DISCUSSION/CONCLUSION: The MoCA may not be accurate for detecting neither mild nor more severe degrees of diminished NP test performance in PASC. Therefore, patients with persistent cognitive complaints in the setting of PASC who score in the normal range on the MoCA should be referred for formal NP assessment.


Subject(s)
COVID-19 , Cognitive Dysfunction , Brain , Cognitive Dysfunction/diagnosis , Cognitive Dysfunction/epidemiology , Cognitive Dysfunction/etiology , Ethnicity , Humans , Mental Status and Dementia Tests , Minority Groups , Neuropsychological Tests
10.
Journal of the Academy of Consultation-Liaison Psychiatry ; 63:S7, 2022.
Article in English | EMBASE | ID: covidwho-1966658

ABSTRACT

Background: The University of Colorado (UCH) Consultation-Liaison Psychiatry (CLP) service and Psychiatric Consultation for the Medically Complex clinic (PCMC) are developing a brain health outreach program for those hospitalized with COVID. Patients with COVID have increased risk of cognitive and psychiatric sequelae due to intrinsic viral properties, hyperinflammatory state, and increased disposition to ICU level care (Inoue, 2019;Cothran, 2020). Development of a post COVID brain health program has become paramount and UCH is not alone in creation of new clinic protocols to meet the needs of this population (Rovere Querini, 2020;O'Brien, 2020). Hospitals around the globe are developing new screeners to identify patients at higher risk of neuropsychiatric sequelae and refer them to appropriate resources. Methods: The program makes use of two arms: The first assesses those discharged from the hospital using a screener developed by the UCH post-COVID hospitalization program. The second screens patients currently admitted to the hospital with COVID using psychiatric and neurocognitive screeners. Both allow patients to be referred to PCMC for evaluation and treatment. Evaluation includes psychiatric interview and additional screeners including: Hospital Anxiety and Depression Scale (HADS), Montreal Cognitive Assessment (MoCA) and PTSD Checklist for DSM-5 (PCL-5). Additional neuropsychiatric evaluation via Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), and cognitive rehabilitation referral, are available. Clinic treatment includes pharmaceuticals, individual therapy referral, or referral to the PCMC COVID Survivorship Support Group. Results: To date, 100 patients have been screened in arm 1 (outpatient outreach) and arm 2 (inpatient outreach). In arm 2, about 54% of the population identifies as female, 46% as male, 61% identified as white, and 86% spoke English. Of those in arm 2 that agreed to full participation, 26% agreed to future check-ins and 6% were seen in the clinic. There was a difference in those who did and didn't fully participate based on ethnicity, language, and insurance status;though not of statistical significance. HADs scores demonstrated different trends based on these same demographic factors, though also not statistically significant. Discussion: By using this two-armed approach, the service has been able to more effectively outreach patients and refer them to appropriate care. Though data is not complete, referral needs seem to differ based on demographic data. Conclusions: As data continues to be collected, the clinic model is expanding to outreach high risk patients for neuropsychiatric sequelae. This will strengthen our existing system, with risk of reoccurrence of similar events, and inform a new standard of care for COVID survivors. 1. Cothran, T. P., Tam, J. W.;et.al. (2020). A brewing storm: The neuropsychological sequelae of hyperinflammation due to COVID-19. Brain Behav Immun, 88, 957-958. 2. Inoue, S., Nishida, O, et.al. (2019). Post-intensive care syndrome: its pathophysiology, prevention, and future directions. Acute Med Surg, 6(3), 233-246. 3. O'Brien, H., Hurley, K., et.al. (2020). An integrated multidisciplinary model of COVID-19 recovery care. Ir J Med Sci, 1-8. 4. Rovere Querini, P., Ciceri, F., et.al. (2020). Post-COVID-19 follow-up clinic: depicting chronicity of a new disease. Acta Biomed, 91(9-s), 22-28.

11.
Neurology ; 98(18 SUPPL), 2022.
Article in English | EMBASE | ID: covidwho-1925539

ABSTRACT

Objective: To determine the frequency of post-acute COVID-19 sequelae (PASC) symptoms in an outpatient neurology setting. Background: Symptoms of fatigue, headaches, and memory impairment have been reported in patients with PASC. Design/Methods: This is an observational study of the PASC experience of 98 non-hospitalized COVID-positive patients in neurology outpatient clinics. Participants completed a survey regarding persistent symptoms, after acute infection. Scales of quality of life and cognition were obtained and included the Montreal Cognitive Assessment (MoCA) and Neuro-QOL (Anxiety, fatigue, depression). Results: Of 98 participants recruited, 68% of participants were seen in neurology clinic specifically for PASC while 31% were seen for non-COVID related complaints but had a prior positive COVID-19 test. Mean age was 50.5±15.1 and 65% were female. Median time post-acute infection was 9.0 (IQR 4.7-11.7/range 0.5 - 16.8) months. Of the 93 participants with symptoms after 6 weeks, the most frequent symptoms reported were fatigue (67%), headaches (49%), muscle aches (48%), word-finding difficulty (48%), difficulty sleeping (47%), shortness of breath (47%), and change in memory (46%). The most common pre-morbid conditions were anxiety/depression (32%), hypertension (26%), pulmonary disease (23%), and autoimmune (17%). BMI>25 was present in 68%. 41% had a prior neurological condition with migraines being the most common (18%). There was no statistically significant difference in reported symptoms, pre-morbid conditions, sex, and age between participants who presented with PASC versus other neurological complaints. Patients reporting persistent fatigue (n=64) had a mean Neuro-QOL fatigue score of 53.3±9.9. Normal mean MoCA scores were present in patients reporting word finding difficulty or memory change (19.3±2.4 points) and in participants with abnormal Neuro-QOL scores (19.4±2.1 points). Conclusions: Patients with PASC in a neurology outpatient clinic report persistent neurological, systemic symptoms that affect their quality of life on multiple validated measures. The MoCA test may not be able to detect subtle cognitive deficits in this population.

12.
Neurology ; 98(18 SUPPL), 2022.
Article in English | EMBASE | ID: covidwho-1925494

ABSTRACT

Objective: To phenotype the neurological dysfunction in post-acute sequelae SARS-CoV-2 infection. Background: Neurological complications of SARS-CoV-2 infection can arise acutely but can also emerge and persist weeks and months after acute infection. These symptoms can affect up to 80% of those with post-acute sequelae SARS-CoV-2 infection (PASC). The University of Pennsylvania Neuro-COVID Clinic (PNCC) was established to provide care for patients with PASC and to obtain standardized clinical metrics to better define the neurological complications attributed to PASC. Design/Methods: Retrospective analysis of charts from the first 94 patients seen at the PNCC. Demographics as well as standardized clinical histories were reviewed. Standardized cognitive testing including the Montreal Cognitive Assessment (MOCA version 8.2), Trails A and B, and digit span (forward and reverse) were performed and analyzed with summary statistics. Results: Mean age of this patient population was 50 years (range 21 - 75yrs) and 67% were female. 30% of patients were admitted to inpatient care during their acute infection (4% required ICU level care). The average time from acute infection to first visit at the PNCC was 234 days (range: 40 - 509 days). The most frequent primary neurological complaint was brain fog (68%) and 91% of patients endorsed some level of brain fog. Abnormal testing (> 4 missed points) on MOCA testing was measured in 39% of patients. Abnormal testing on Trails B (below the age-adjusted 9 percentile) was measured in 16% of patients. Conclusions: Neurological manifestations of PASC are common even in non-hospitalized patients and brain fog is a frequent symptom. Discrepancies between subjective experience and standardized cognitive testing suggest a multifactorial cause to brain fog in PASC. Co-occurrence of mood symptoms, poor sleep, and medication side effects may exacerbate more direct effects of COVID-19. The long-term trajectory of neurological symptoms in PASC will be determined with longitudinal follow-up of this patient cohort. th.

13.
Neurology ; 98(18 SUPPL), 2022.
Article in English | EMBASE | ID: covidwho-1925233

ABSTRACT

Objective: To examine the natural history of neurological symptoms in mild COVID-19. Background: Various neurological manifestations have been reported with COVID-19, mostly in retrospective studies of hospitalized patients. There are few data on patients with mild COVID19. Design/Methods: Consenting participants in the ALBERTA HOPE COVID-19 trial( NCT04329611, hydroxychloroquine vs placebo for 5-days), managed as outpatients, were prospectively assessed 3-months and 1-year after their positive test. They completed detailed neurological symptom questionnaires, Telephone Montreal Cognitive Assessment(T-MoCA), Kessler Psychological Distress Scale(K10), and the EQ-5D-3L(quality-of-life). Informants completed the Mild Behavioural Impairment Checklist(MBI-C) and Informant Questionnaire on Cognitive Decline(IQCODE). We tracked healthcare utilization and neurological investigations using medical records. Results: Among 198 patients (median age:45, IQR:37-54, 43.9% female);28(14.1%) had preexisting neurological/psychiatric disorders. Among 179 patients with symptom assessments, 139(77.7%) reported ≥1 neurological symptom, the most common being anosmia/dysgeusia(56.3%), myalgia(42.6%), and headache(41.8%). Symptoms generally began within 1-week of illness(median:6-days, IQR:4-8). Most resolved after 3-months;40 patients(22.3%) reported persistent symptoms at 1-year, with 27(15.1%) reporting no improvement. Persistent symptoms included confusion(50%), headache(52.5%), insomnia(40%), and depression(35%). Body mass index, prior neurologic/psychiatric history, asthma, and lack of full-time employment were associated with presence and persistence of neurological symptoms;only female sex was independently associated on multivariable logistic regression(aOR:5.04, 95%CI:1.58-16.1). Patients with persistent symptoms had more hospitalizations and family physician visits, worse MBI-C scores, and were less often independent for instrumental daily activities at 1-year(77.8% vs 98.2%, p=0.005). Patients with any or persistent neurological symptoms had greater psychological distress defined as K10≥20(aOR:21.0, 95%CI:1.96-225) and worse quality-of-life ratings(mean EQ-5D VAS:67.0 vs 82.8, p=0.0002). 50.0% of patients had T-MoCA<18 at 3-months versus 42.9% at 1-year;patients reporting memory complaints were more likely to have informant-reported cognitive-behavioural decline (aOR[1-year IQCODE>3.3]:12.7, 95%CI:1.08-150). Conclusions: Neurological symptoms were commonly reported in survivors of mild COVID-19 and persisted in one in five patients 1-year later. These symptoms were associated with worse patient-reported outcomes.

14.
Neurology ; 98(18 SUPPL), 2022.
Article in English | EMBASE | ID: covidwho-1925125

ABSTRACT

Objective: To investigate associations of COVID-19 illness severity in individuals who have developed objective or subjective neurologic findings after infection. Background: Following recovery from acute COVID-19 illness many patients report onset of new cognitive and neurological symptoms which can be disabling. Design/Methods: Early in the pandemic, in response to clinical experience and emerging research on post-acute neurological sequelae (PANS) of COVID-19, we created an IRB-approved patient registry in the Department of Neurology. Participants included are both retrospectively identified patients located through a search of all existing patients from Neurology outpatient practices at Columbia University Irving Medical Center with any COVID-19 related diagnosis, plus newly referred patients with PANS. Those included met CDC criteria of either suspected, probable, or confirmed COVID-19 (N=121). Information was obtained retrospectively through chart review and prospectively through symptom questionnaire and mini-MoCA. Analysis was performed with Chi-squared test and Pearson's correlation. Results: Our cohort was 72.7% women, mean age 47.9, 54.2% white, 16.7% Hispanic/Latino, 6.7% Black/African American, and 5% Asian. 55.45% had a prior neurological diagnosis, most commonly headache (23.1%). 68.8% had both clinical and lab definite COVID-19 infection, 23.1% required hospitalization, and 9.1% ICU care. 72.2% reported no worsening of prior neurological symptoms but 81.8% developed new neurological symptoms including general cognitive complaints (47.9%), attention difficulty (42.1%), word finding difficulty (36.4%), vestibular complaints (23.1%), and fatigue (19.8%). Mini-MoCAs were administered to 37 subjects (median score 12/15). Hospitalization for COVID-19 correlated with subjective “brain fog” (p= .009) and attention difficulty (p= .011). ICU requirement correlated with subjective word finding difficulty (p= .049), “brain fog” (p= .034), and attention difficulty (p= .020). There was a relationship between length of hospitalization and mini MoCA score (p= .006). Conclusions: In this patient sample, severity of infection assessed through surrogate measures of hospitalization and ICU requirement are associated with subjective and objective post COVID19 neurological dysfunction.

15.
J Nucl Med ; 63(7): 1058-1063, 2022 07.
Article in English | MEDLINE | ID: covidwho-1923992

ABSTRACT

During the coronavirus disease 2019 (COVID-19) pandemic, Long COVID syndrome, which impairs patients through cognitive deficits, fatigue, and exhaustion, has become increasingly relevant. Its underlying pathophysiology, however, is unknown. In this study, we assessed cognitive profiles and regional cerebral glucose metabolism as a biomarker of neuronal function in outpatients with long-term neurocognitive symptoms after COVID-19. Methods: Outpatients seeking neurologic counseling with neurocognitive symptoms persisting for more than 3 mo after polymerase chain reaction (PCR)-confirmed COVID-19 were included prospectively between June 16, 2020, and January 29, 2021. Patients (n = 31; age, 53.6 ± 2.0 y) in the long-term phase after COVID-19 (202 ± 58 d after positive PCR) were assessed with a neuropsychologic test battery. Cerebral 18F-FDG PET imaging was performed in 14 of 31 patients. Results: Patients self-reported impaired attention, memory, and multitasking abilities (31/31), word-finding difficulties (27/31), and fatigue (24/31). Twelve of 31 patients could not return to the previous level of independence/employment. For all cognitive domains, average group results of the neuropsychologic test battery showed no impairment, but deficits (z score < -1.5) were present on a single-patient level mainly in the domain of visual memory (in 7/31; other domains ≤ 2/31). Mean Montreal Cognitive Assessment performance (27/30 points) was above the cutoff value for detection of cognitive impairment (<26 points), although 9 of 31 patients performed slightly below this level (23-25 points). In the subgroup of patients who underwent 18F-FDG PET, we found no significant changes of regional cerebral glucose metabolism. Conclusion: Long COVID patients self-report uniform symptoms hampering their ability to work in a relevant fraction. However, cognitive testing showed minor impairments only on a single-patient level approximately 6 mo after the infection, whereas functional imaging revealed no distinct pathologic changes. This clearly deviates from previous findings in subacute COVID-19 patients, suggesting that underlying neuronal causes are different and possibly related to the high prevalence of fatigue.


Subject(s)
COVID-19 , Cerebrum , Glucose , COVID-19/complications , COVID-19/psychology , Cerebrum/metabolism , Fatigue , Fluorodeoxyglucose F18/metabolism , Glucose/metabolism , Humans , Middle Aged , Neuropsychological Tests , Positron-Emission Tomography
16.
Vestnik Rossiiskoi Akademii Meditsinskikh Nauk ; 77(2):107-118, 2022.
Article in Russian | EMBASE | ID: covidwho-1918186

ABSTRACT

Background. The COVID-19 pandemic is a major stressor with predictable negative impacts on mental health, especially for vulnerable populations, which include older people. Emotional disorders, a decrease in intellectual, physical, social activity are the risk factors for the development of cognitive decline in older people;in the situation of the COVID-19 pandemic, the influence of all these factors is exacerbated. In this regard, it seems relevant to study the level of emotional disorders and factors affecting the emotional state of patients with mild cognitive impairment (MCI) in the context of the COVID-19 pandemic in comparison with the period before the pandemic. Aims: emotional state assessment in patients over 55 years old with MCI during the COVID-19 pandemic and identification of factors influencing the emotional state of these patients. Materials and methods: A cross-sectional single-center observational study of patients with MCI who applied to the Memory Clinic in the autumn of 2018 (n = 121), 2019 (n = 114), in the autumn of 2020 (n = 70), and in the spring of 2020 (n = 110). Patients were examined using the Hospital Anxiety and Depression Scale (HADS), the Montreal Cognitive Assessment (MoCA), the Mini-Mental State Examination (MMSE), and the Khachinsky Modified Ischemia Assessment Scale. In 2020, in addition to these scales, a questionnaire "Personal experience of COVID-19 pandemic" was applied to assess the experience associated with the new coronavirus infection. Results: The severity of emotional disorders, assessed by HADS scale, did not differ between groups (F = 0.751;p = 0.522 and F = 0.310;p = 0.818 for the HADS anxiety and depression subscales, respectively). Adjustment for covariates (scores on the Khachinsky and/or MoCA and/or MMSE scales) did not affect the significance of differences between groups on the HADS subscales, regardless of the correction for multiple comparisons. Pathway modeling analysis demonstrated the low ability of the models to predict emotional state based on risk factors (age, gender, Khachinsky score) and cognitive symptoms (MoCA and MMSE scores) - all coefficients r < 0.7. A change in intellectual activity (decrease) and subjective impression of the difficulties obtaining medical care were associated with a higher score on the HADS anxiety scale. Decreased physical health and decreased personal communication were associated with higher scores on the HADS depression scale. Clinically pronounced changes in the emotional state were noted only in relation to anxiety, which depended on the changes in intellectual activity. Conclusions: severity of anxiety and depression was not increased in patients with MCI, regardless of the control of additional factors. No differences were found in the contribution of risk factors (age, gender, vascular and atrophic factors of cognitive decline) and cognitive dysfunction to the formation of emotional disorders in comparing with previous years.

17.
Applied Clinical Trials ; 31(6):9-9, 2022.
Article in English | Academic Search Complete | ID: covidwho-1905469

ABSTRACT

The article reports that While the COVID-19 pandemic has undoubtedly catalyzed the adoption of more flexible datacollection approaches within clinical trials, this has been the direction of travel for some time. Rather than bringing participants into sites, allowing them to participate from the safety of their own homes by leveraging remote datacollection methods placed participant preference at the center of the research effort and positively impacted participant engagement.

18.
Brain ; 145(9): 3203-3213, 2022 09 14.
Article in English | MEDLINE | ID: covidwho-1890882

ABSTRACT

While neuropathological examinations in patients who died from COVID-19 revealed inflammatory changes in cerebral white matter, cerebral MRI frequently fails to detect abnormalities even in the presence of neurological symptoms. Application of multi-compartment diffusion microstructure imaging (DMI), that detects even small volume shifts between the compartments (intra-axonal, extra-axonal and free water/CSF) of a white matter model, is a promising approach to overcome this discrepancy. In this monocentric prospective study, a cohort of 20 COVID-19 inpatients (57.3 ± 17.1 years) with neurological symptoms (e.g. delirium, cranial nerve palsies) and cognitive impairments measured by the Montreal Cognitive Assessment (MoCA test; 22.4 ± 4.9; 70% below the cut-off value <26/30 points) underwent DMI in the subacute stage of the disease (29.3 ± 14.8 days after positive PCR). A comparison of whole-brain white matter DMI parameters with a matched healthy control group (n = 35) revealed a volume shift from the intra- and extra-axonal space into the free water fraction (V-CSF). This widespread COVID-related V-CSF increase affected the entire supratentorial white matter with maxima in frontal and parietal regions. Streamline-wise comparisons between COVID-19 patients and controls further revealed a network of most affected white matter fibres connecting widespread cortical regions in all cerebral lobes. The magnitude of these white matter changes (V-CSF) was associated with cognitive impairment measured by the MoCA test (r = -0.64, P = 0.006) but not with olfactory performance (r = 0.29, P = 0.12). Furthermore, a non-significant trend for an association between V-CSF and interleukin-6 emerged (r = 0.48, P = 0.068), a prominent marker of the COVID-19 related inflammatory response. In 14/20 patients who also received cerebral 18F-FDG PET, V-CSF increase was associated with the expression of the previously defined COVID-19-related metabolic spatial covariance pattern (r = 0.57; P = 0.039). In addition, the frontoparietal-dominant pattern of neocortical glucose hypometabolism matched well to the frontal and parietal focus of V-CSF increase. In summary, DMI in subacute COVID-19 patients revealed widespread volume shifts compatible with vasogenic oedema, affecting various supratentorial white matter tracts. These changes were associated with cognitive impairment and COVID-19 related changes in 18F-FDG PET imaging.


Subject(s)
COVID-19 , White Matter , Brain/diagnostic imaging , Brain/pathology , COVID-19/complications , Edema , Fluorodeoxyglucose F18 , Humans , Prospective Studies , Water , White Matter/diagnostic imaging , White Matter/pathology
19.
Cardiometry ; - (21):60-65, 2022.
Article in English | EMBASE | ID: covidwho-1887368

ABSTRACT

The purpose of this work is to identify neuropsychiatric functions in patients at Department No. 1 responsible for medical care of patients with a new coronavirus infection at the Samara City Hospital No. 7. Appropriate scales and questionnaires were used for this purpose. Cognitive impairments were found in 86% of the cases, emotional-affective impairments of varying severity in half of the subjects, an increase in reactive and personal anxiety was revealed, and vegetative disorders were observed in 78% of the subjects. Based on these data, it can be assumed that the new coronavirus infection affects the functioning of the nervous system of patients.

20.
Epidemiology ; 70(SUPPL 1):S245, 2022.
Article in English | EMBASE | ID: covidwho-1854002

ABSTRACT

Background: Cognitive rehabilitation group therapies, such as Motivationally Enhanced Compensatory Cognitive Training for Mild Cognitive Impairment (ME-CCT-MCI), are associated with improvements in cognitive functioning, cognitive complaints, and subjective daily functioning domains. While traditionally delivered via in-person, the COVID-19 pandemic resulted in a transition to video visit delivery by many providers and health organizations, including the VA. However, many older adults are unable to participate in video telehealth due to low technological literacy or lack of internet access. Expanding dissemination approaches to include telephone- based delivery may improve access to cognitive rehabilitation services for many older adults. This study assessed the feasibility, acceptability, and preliminary efficacy of an 8-week, telephone-based ME-CCT-MCI group for older adult veterans without technical literacy during the COVID-19 pandemic. Methods: A convenience sample of eleven older adult veterans (Mage=77.72, SD=4.12) with subjective memory complaints and stated inability to use the VA's Video Connect system for video visits was recruited from geriatric clinics within a Veterans Affairs Medical Center. Two rounds of 8-week ME-CCT-MCI groups were conducted, with each group meeting by telephone for one hour a week. Participants completed a battery of measures before and after participation and change over time was evaluated using paired samples t-tests. Measures included the Montreal Cognitive Assessment - Blind, Multifactorial Memory Questionnaire, Geriatric Depression Scale, Geriatric Anxiety Scale, Short Form Health Survey (SF-12) and a group satisfaction questionnaire. Results: Feasibility was demonstrated through good rates of session attendance (M = 6.72 out of 8 sessions), and acceptability was demonstrated through excellent self-reported measures of group satisfaction (M = 9.18/10). Participants demonstrated significant improvements in cognitive functioning (p = .03), subjective memory satisfaction (p = .01) and subjective memory abilities (p < .01) between pre-test and post-test measures. No differences were found for subjective memory strategies, depression, anxiety, or perceived health. Conclusions: Findings offer preliminary support for the feasibility, acceptability, and efficacy of telephone-based ME-CCT-MCI for technologically unready older veterans.

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