Sex-Specific Neurocognitive Impairment.

This article explores sex-specific neurocognitive impairment. It first defines relevant terms such as gender and sex. Next, it describes the nature of the problem including under-representation of women and other gender and sexual minorities in neuroscience research, including cognitive studies. A biopsychosocial framework is employed to account for structural and social determinants of health in sex/gender-specific neurocognitive impairment. Issues in assessment including the use of gender/sex-specific normative data are also discussed. Lastly, the article covers the current state of research as it relates to sex/gender-specific neurocognitive impairment across a range of medical conditions including neurodegenerative diseases and coronavirus disease-2019.

Cognitive dysfunction, diabetes mellitus 2 and arterial hypertension: Sequelae up to one year of COVID-19.

BACKGROUND: Covid symptoms reflect its multisystem nature, in addition to its positive relationship between the severity of the condition and the severity of the long COVID. OBJECTIVE: To identify the factors associated with the prevalence of SEQUELAE DUE TO COVID-19 one year after their hospital discharge due to severe pneumonia. METHOD: Longitudinal, analytical, prospective and comparative study. 71 covid-19 pneumonia survivors were followed. Two telephone interviews were conducted to each patient; the first at 5 months of discharge and the second at 12 months from the mentioned date. We included questions of 40 symptoms, in addition to the questioning of diabetes mellitus and/or systemic hypertension with a mentioned onset during the hospitalization or after hospital discharge due to COVID-19. RESULTS: Of the 37 patients without complications and without comorbidities prior to hospitalization, 11 (29.7%) developed arterial hypertension during or after discharge and 17 (45.9%) developed diabetes mellitus before five months. Short-term memory loss was an upward sequel in the two measurements, 24.3% and 41.9% respectively. CONCLUSIONS: Type 2 diabetes mellitus and high blood pressure detected at five months was temporary and reversed in many cases at twelve months. It will be important to deepen the study of brain damage and cognitive dysfunction, characterized by memory loss.

Physical and cognitive impairments in people suffering from long COVID: protocol for a longitudinal population-based cohort study.

INTRODUCTION: Approximately 33% of people who contracted COVID-19 still experience symptoms 12 weeks after infection onset. This persistence of symptoms is now considered a syndrome itself called 'long COVID'. Evidence regarding long COVID and its cognitive and physical impacts is growing, but the literature is currently lacking objectively measured data to guide towards adapted healthcare trajectories. The objectives are to describe the physical and cognitive impairments experienced by individuals living with long COVID using self-reported and clinical objective measures, and to compare the evolution over time of the physical and cognitive state between adults living with long COVID (at least one physical or cognitive COVID-19 symptom for more than 12 weeks following infection; long COVID group), people who developed COVID-19 but did not experience persistent symptoms (short COVID group) and people who did not develop COVID-19 (control group). METHODS AND ANALYSIS: In this longitudinal cohort study, 120 participants will be recruited in each group. Variables will be collected through three evaluation sessions over 6 months (baseline, 3 months, 6 months). Variables include self-administered questionnaires on health-related quality of life, comorbidity, sleep, pain, anxiety, depressive symptoms, fatigue and cognitive function, as well as objective measures of cognitive (attention, memory, executive functioning) and physical (grip strength, balance, gait speed, gait endurance, VO2, frailty) functions. Activity, heart rate and sleep will be monitored with a fitness tracker watch for 7 days following evaluation sessions. Maximum-likelihood analyses of variance (ANOVAs) will be used to compare data at baseline between groups. Repeated measures ANOVAs will be used to compare the longitudinal performance variations across groups of the self-reported and clinical variables. ETHICS AND DISSEMINATION: Ethics committees of the CIUSSS de la Capitale-Nationale and CIUSSS de l'Est-de-l'Île-de-Montréal approved the project. Results will be disseminated through clinical and community platforms as well as through peer-reviewed manuscripts and international conferences. TRIAL REGISTRATION NUMBER: NCT05216536.

Associations of cognitive impairment with self-isolation and access to health and care during the COVID-19 pandemic in England.

This research explored experiences across three cognitive function groups (no impairment, mild impairment, and dementia) with respect to shielding (either self-isolating or staying at home), COVID-19 infection, and access to health/care services during the COVID-19 pandemic. Analyses were conducted using data from the English Longitudinal Study of Ageing (ELSA) COVID-19 sub-study collected in 2020. We report bivariate estimates across our outcomes of interest by cognitive function group along with multivariate regression results adjusting for demographic, socioeconomic, geographic, and health characteristics. Rates of shielding were high across all cognitive function groups and three measured time points (April, June/July, and Nov/Dec 2020), ranging from 74.6% (95% confidence interval 72.9-76.2) for no impairment in Nov/Dec to 96.7% (92.0-98.7) for dementia in April (bivariate analysis). 44.1% (33.5-55.3) of those with dementia experienced disruption in access to community health services by June/July compared to 34.9% (33.2-36.7) for no impairment. A higher proportion of those with mild impairment reported hospital-based cancellations in June/July (23.1% (20.1-26.4)) and Nov/Dec (16.3% (13.4-19.7)) than those with no impairment (18.0% (16.6-19.4) and 11.7% (10.6-12.9)). Multivariate adjusted models found that those with dementia were 2.4 (1.1-5.0) times more likely than those with no impairment to be shielding in June/July. All other multivariate analyses found no statistically significant differences between cognitive function groups. People with dementia were more likely than people with no impairment to be shielding early in the pandemic, but importantly they were no more likely to experience disruption to services or hospital treatment.

Infectious diseases and cognition: do we have to worry?

OBJECTIVES: Age-related physiological changes, particularly immune system decline, may contribute to greater vulnerability to infectious diseases in older individuals. A growing body of evidence shows that both, acute, and chronic infections may be accompanied by cognitive disturbances as part of their manifestations. Given the importance of cognition in aging trajectories, the objective of this article was to review current knowledge on cognitive outcomes of infectious diseases in older adults, and to emphasize the importance of considering cognition as a domain of interest in its own rights in these diseases. METHODS: A MEDLINE/PubMed database search was conducted to identify articles reporting cognitive impairment associated with various severe acute infections and specific chronic infectious conditions such as human immune deficiency virus, the herpes virus family, hepatitis C virus, Lyme borreliosis, Helicobacter pylori, periodontitis, and emerging pathogens like SARS-CoV-2, as well as potentially preventive strategies like vaccination. RESULTS/ CONCLUSIONS: Taken together, the studies examined in the present review emphasize that numerous acute and chronic infectious diseases share mechanisms that, when added to specific risk factors frequently found in older persons, contribute to considerably increase the risk of cognitive outcomes such as cognitive decline and dementia. This review may help to appreciate the role that infectious diseases play in cognitive trajectories and thus promote further investigation on the topic.

Racial, ethnic, and sex disparities in the incidence and cognitive symptomology of long COVID-19.

BACKGROUND: The pandemic has highlighted and exacerbated health inequities in both acute coronavirus disease 2019 (COVID-19) and its longer-term sequelae. Given the heterogeneity in definitions of long COVID and the lack of centralized registries of patients with the disease, little is known about the differential prevalence among racial, ethnic, and sex subgroups. This study examines long COVID among Black, White, Asian, and Hispanic Americans and evaluates differences in the associated cognitive symptomology. METHOD: Data from four releases of the Census Bureau's Household Pulse Survey detailing COVID-19 incidence and the duration and type of symptoms among a nationally representative sample of adults from June 1, 2022, through October 17, 2022, were combined. Binary logistic regression assessed the relative likelihood of long COVID among those who had been diagnosed COVID between racial, ethnic, and sex subgroups. Among those reporting long COVID, differences in the prevalence of difficulty understanding and difficulty remembering were assessed. Empirical models accounted for household, regional, vaccination, and insurance differences between respondents. Two-stage selection models were applied to test the robustness of the results. RESULTS: Among respondents who tested positive for COVID-19, Blacks (OR=1.097, CI=1.034-1.163), females (OR=1.849, CI=1.794-1.907), and Hispanics (OR=1.349, CI=1.286-1.414) were more likely to experience long COVID (symptoms lasting for 3 months or longer) compared to Whites, males, and non-Hispanics respectively. However, those with private health insurance (OR=0.634, CI=0.611-0.658) and who received the COVID vaccine (OR=0.901, CI=0.864-0.94) were less likely to have endured COVID symptoms than their counterparts. Symptoms of long COVID varied significantly between population subgroups. Compared to Whites, Blacks were more likely to have trouble remembering (OR=1.878, CI=1.765-1.808) while Hispanics were more likely to report difficult understanding (OR=1.827, CI=1.413, 2.362). Females, compared to males, were less likely to experience trouble understanding (OR=0.664, CI=0.537, 0.821), but more likely to report trouble remembering (OR=1.34, CI=1.237, 1.451). CONCLUSIONS: Long COVID is more prevalent among Blacks, Hispanics, and females, but each group appears to experience long COVID differently. Therefore, additional research is needed to determine the best method to treat and manage this poorly understood condition.

Association between Sleep Onset Problem and Subjective Cognitive Complaints among Japanese Older Adults during the Coronavirus Disease 2019 Pandemic.

Older adults are more likely to have age-related sleep problems, which may result in the reduction of cognitive functions. This study was designed to examine the relationship between sleep onset problem and subjective cognitive complaints (SCC) among community-dwelling older adults during the coronavirus disease 2019 pandemic. In this study, 186 older adults aged 65 and above were enrolled and were instructed to respond to an online survey. This survey comprised questions regarding sleep quality (four items such as sleep duration, use of sleep medication), SCC (six domains), and sociodemographic information (eight items such as age, gender, stress condition). We classified the participants into two groups according to the presence or absence of sleep onset problem and examined the relationship between each SCC domain. The sleep onset problem (+) (n = 70) group had significantly higher frequency of scheduled memory decline, misplacement, disorientation in time, word recall decline, and forgetfulness. Furthermore, the sleep onset problem affected the participants' scheduled memory after adjusted for potential covariates (OR, 2.28; 95%CI, 1.13-4.73; p = 0.02). Older adults with sleep onset problem may need to be evaluated for SCC and supported in term of both sleep status and SCC.

Accelerated cognitive decline after the COVID-19 pandemic in a community population of older persons with cognitive impairment: A 4-year time series analysis in the Tokyo Metropolis area.

AIM: The coronavirus disease 2019 (COVID-19) pandemic has led to lifestyle restrictions and might be associated with long-term changes in cognitive function. The aim of the present study was to elucidate the overall effect of the COVID-19 pandemic on the cognitive trajectory of a cohort of patients with cognitive impairment. METHODS: We enrolled 160 patients who had been making regular visits to a medical center for dementia. Cognitive function was assessed based on changes in scores on the Mini-Mental State Examination before and during the COVID-19 pandemic throughout a 4-year period. The trajectory of cognitive decline was determined by carrying out a time series analysis using a state-space model. RESULTS: Crude analysis showed that the Mini-Mental State Examination scores decreased from 20.9 ± 4.4 points (mean ± SD) at the time of the initial cognitive assessments to 17.5 ± 5.6 points at the time of the final assessments, and the decline rate was 1.15 ± 1.78 points per year (P < 0.0001). The time series analysis showed an accelerated cognitive trajectory after the COVID-19 outbreak, and the average decline in the Mini-Mental State Examination scores was 0.46 points (95% confidence interval 0.034-0.91) per year before the COVID-19 pandemic, and a steeper decline of 1.87 points (95% confidence interval 1.34-2.67) per year after the outbreak. CONCLUSIONS: The COVID-19 pandemic accelerated the rate of cognitive decline in patients with cognitive impairment fourfold in comparison with before the pandemic. Specific strategies designed for cognitively older people in the "new normal" will reconcile both requirements, reducing the risk of infection, and maintaining their physical and psychological well-being. Geriatr Gerontol Int 2023; 23: 200-204.

Cognitive Decline Before and During COVID-19 Pandemic Among Older People With Multimorbidity: A Longitudinal Study.

OBJECTIVE: To investigate whether older people living with multimorbidity would suffer an accelerated decline in cognition during the COVID-19 pandemic, compared with prepandemic data. DESIGN: A 5-year cohort conducting surveys from year 2016 to 2021, with 2016 to 2019 as the control period and 2019 to 2021 the pandemic period. SETTING AND PARTICIPANTS: In total, 9304 cognitively healthy older participants age ≥50 years were included from the Health and Retirement Study (HRS). METHODS: Multimorbidity was defined as the concurrent presence of 2 or more chronic diseases. A global cognition z score was calculated using memory (immediate and delayed word recall tests) and executive function (counting backwards and the serial sevens tests). Incident dementia was defined using either the reported physician diagnosis or an alternative approach based on cognition summary score. Linear mixed models were used to assess longitudinal changes, while modified Poisson regression models were used to analyze the risk of incident dementia. RESULTS: Of the 9304 participants included, 3649 (39.2%) were men, with a mean age of 65.8 ± 10.8 years. Participants with multimorbidity (n = 4375) suffered accelerated declines of 0.08 standard deviation (95% confidence interval 0.03, 0.13, P = .003) in global cognition and an elevated dementia risk (risk ratio 1.66, 95% confidence 1.05 to 2.61, P = .029), compared with individuals without morbidity (n = 1818) during the pandemic period. After further adjusting sociodemographic characteristics and prepandemic cognitive measurements, these differences remained evident. In contrast, no significant differences in cognitive declines were observed during the control period. CONCLUSIONS AND IMPLICATIONS: During the COVID-19 pandemic, older people with multimorbidity suffered an accelerated decline in cognition and elevated incident dementia risk, while no evident differences in cognitive decline rates were observed before the pandemic. Measures targeting vulnerable older people with multimorbidity could be significant for assisting these individuals to tackle neurocognitive challenges during the pandemic.

Subjective and Objective Cognitive Impairments in Non-Hospitalized Persons 9 Months after SARS-CoV-2 Infection.

Studies on cognitive problems of persons with mild COVID-19 courses are still lacking. This study aimed to determine the frequency and associated factors of subjective and objective cognitive problems after COVID-19 in non-hospitalized persons. Study participants were examined at the University Hospital of Augsburg from 04/11/2020 to 26/05/2021. The Wechsler Adult Intelligence Scale (WAIS) IV digit span, Stroop Color and Word Test (SCWT), Regensburger verbal fluency test (RWT) and, subjective ratings of memory and concentration were applied. Of the 372 participants (mean age 46.8 ± 15.2 years, 54.3% women, median time after infection 9.1 months), 24.9% reported concentration and 21.9% memory problems. Overall, 55.6% of the participants had at least a mild negative alteration in any cognitive test. The strongest impairments were found regarding memory functions (41.1% mild alterations, 6.2% distinct impairments) and verbal fluency (12.4% mild alterations, 5.4% distinct impairments). SCWT showed negative alterations in no more than 3.0% of the participants. Level of school education, age, and depressiveness emerged as significantly related to the cognitive tests. The number of complaints and depressiveness were significantly associated with subjective memory and concentration problems. It is important to identify mild cognitive impairment in non-hospitalized COVID-19 patients early to offer them effective interventions.

The predictive role of fatigue and neuropsychological components on functional outcomes in COVID-19 after a multidisciplinary rehabilitation program.

OBJECTIVE: To verify the impact of altered cognitive functioning and higher levels of mental fatigue, both reported after coronavirus disease 2019 (COVID-19), on rehabilitation treatment outcomes. METHODS: In this real-practice retrospective pre-post intervention cohort study, cognitive functioning, measured through standardized neuropsychological measures, and individual levels of fatigue, depression and anxiety symptoms, were evaluated at admission to a rehabilitation program in individuals who had been hospitalized for COVID-19. The rehabilitation program effectiveness was measured through the Functional Independence Measure. RESULTS: Among the patient sample (n = 66), 87.88% reported experiencing high levels of fatigue at admission, while 16.67% reported depressive symptoms, and 22.73% reported anxiety symptoms. After rehabilitation, the sample displayed a significant decrease in the level of disability, in both the motor and cognitive subscales. Neuropsychological and psychological functioning did not play a predictive role. The 45 patients who received mechanical ventilation during intensive care, representing 68.18% of the sample, benefited more from rehabilitation treatment. CONCLUSIONS: The results support the importance of an early rehabilitation program after COVID-19 infection, independent of the initial neuropsychological and psychological functioning. Respiratory assistance may represent a crucial factor for short-term neuropsychological disease after-effects. Future studies on the long-term neuropsychological effect of COVID-19 infection on individual levels of disability are necessary.

Previously independent patients with mild-symptomatic COVID-19 are at high risk of developing cognitive impairment but not depression or anxiety.

OBJECTIVES: The aim of the study was to explore the cognitive functions of a large sample of hospitalised subjects with mild symptomatic Coronavirus Disease (COVID-19) who were previously independent at home and without neurological diseases. METHODS: Patients admitted in a COVID-19 Unit for Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) infection between November 2020 and March 2021 were recruited. Inclusion criteria were: being independent at home before the infection, radiologically confirmed COVID-19 pneumonia, positive reverse transcriptase-polymerase chain reaction nasopharyngeal swab and no oxygen supplementation at the time of evaluation. EXCLUSION CRITERIA: cognitive impairment or neurological diseases previous to the infection, delirium episodes, and history of any mechanical ventilation use. They were evaluated with Montreal Cognitive Assessment (MoCA), Hamilton Depression Rating Scale (HAM-D) and Hamilton Anxiety Rating Scale (HAM-A). RESULTS: Out of 522 subjects admitted in the COVID-19 Unit, 90 were enrolled [mean age = 68.32(11.99); 46M/44F]. An impaired MoCA (cut-off < 23) was found in 60 subjects (66.66 %). Pathological scores were obtained by 36.7 % of the subjects with <65 years and 78.3 % of those older than 65 years. A high prevalence of executive function and memory impairment was detected. CONCLUSIONS: The results underline a high rate of cognitive impairment in previously independent mild COVID-19 patients. This might represent a potential threat for the everyday independence of these patients due to the consequences on everyday life activities and work following discharge from hospital. These subjects should, therefore, be monitored in order to allow a better understanding of the progression and consequences of the so-called "Long COVID".

Cognitive Decline in Long-term Care Residents Before and During the COVID-19 Pandemic in Ontario, Canada.

This study examines the incidence of cognitive decline among long-term care residents in Ontario before and during the COVID-19 pandemic.

Fatigue and Cognitive Dysfunction Are Associated with Occupational Status in Post-COVID Syndrome.

Post-COVID syndrome (PCS) is a medical condition characterized by the persistence of a wide range of symptoms after acute infection by SARS-CoV-2. The work capacity consequences of this disorder have scarcely been studied. We aimed to analyze the factors associated with occupational status in patients with PCS. This cross-sectional study involved 77 patients with PCS on active work before SARS-CoV-2 infection. Patients were evaluated 20.71 ± 6.50 months after clinical onset. We conducted a survey on occupational activity and cognitive and clinical symptoms. The association between occupational activity and fatigue, depression, anxiety, sleep quality, and cognitive testing was analyzed. Thirty-eight (49.4%) patients were working, and thirty-nine (50.6%) patients were not. Of those not working at the moment of the assessment, 36 (92.3%) patients were on sick leave. In 63 patients (81.8% of the sample), sick leave was needed at some point due to PCS. The mean duration of sick leave was 12.07 ± 8.07 months. According to the patient's perspective, the most disabling symptoms were cognitive complaints (46.8%) and fatigue (31.2%). Not working at the moment of the assessment was associated with higher levels of fatigue and lower cognitive performance in the Stroop test. No association was found between occupational status with depression and anxiety questionnaires. Our study found an influence of PCS on work capacity. Fatigue and cognitive issues were the most frequent symptoms associated with loss of work capacity.

COGNITIVE IMPAIRMENT IN PATIENTS HOSPITALIZED WITH COVID-19 PNEUMONIA: CORRELATION WITH DEMOGRAPHIC, CLINICAL AND EMOTIONAL PROFILE.

OBJECTIVE: The aim: To study the structure of cognitive impairment in patients who were hospitalized with moderate to severe COVID-19 pneumonia. Investigate the correlation with demographic, biochemical parameters, as well as the emotional state of the patient. PATIENTS AND METHODS: Materials and methods: Cognitive functions were assessed using the MOCA test. PHQ-9 depression and GAD-7 anxiety questionnaires were used to study psychopathological symptoms. Demographic, clinical and laboratory data were extracted from medical records. RESULTS: Results: Cognitive performance is impaired in 94% of patients with COVID-19. This allows to suggest that COVID-19 has a serious impact on cognition, especially in elder people. Among different domains only visuospatial and executive functioning, abstract thinking, attention and delayed recall were severely impaired, while other domains stayed relatively intact. Patients after COVID-19 also tend to have a mild depressive and anxiety state. Anxiety levels were higher than depressive levels, but not connected to cognitive functioning. Also, there was seen a positive correlation between anxiety and pO2 and negative between anxiety and comorbid cardiac pathology. However, this requires further studies to reveal. Another interesting finding was non-linear relationship between cognitive performance and depression, that allows to suggest rapidly evolving depressive mood in persons with severe cognitive impairment after COVID-19. Cognitive and emotional state of patients after COVID-19 was also highly connected with working status. CONCLUSION: Conclusion: Significant cognitive impairment was presented in almost all patients with COVID-19. There was a selective impairment in domains of visuospatial/ executive functioning, abstract thinking, attention and delayed recall. Conclusions: Significant cognitive impairment was presented in almost all patients with COVID-19. There was a selective impairment in domains of visuospatial/ executive functioning, abstract thinking, attention and delayed recall.

Subjective cognitive decline and anxious/depressive symptoms during the COVID-19 pandemic: what is the role of stress perception, stress resilience, and ß-amyloid?

BACKGROUND: The COVID-19 pandemic may worsen the mental health of people reporting subjective cognitive decline (SCD) and therefore their clinical prognosis. We aimed to investigate the association between the intensity of SCD and anxious/depressive symptoms during confinement and the underlying mechanisms. METHODS: Two hundred fifty cognitively unimpaired participants completed the Hospital Anxiety and Depression Scale (HADS) and SCD-Questionnaire (SCD-Q) and underwent amyloid-ß positron emission tomography imaging with [18F] flutemetamol (N = 205) on average 2.4 (± 0.8) years before the COVID-19 confinement. During the confinement, participants completed the HADS, Perceived Stress Scale (PSS), Brief Resilience Scale (BRS), and an ad hoc questionnaire on worries (access to primary products, self-protection materials, economic situation) and lifestyle changes (sleep duration, sleep quality, eating habits). We investigated stress-related measurements, worries, and lifestyle changes in relation to SCD. We then conducted an analysis of covariance to investigate the association of SCD-Q with HADS scores during the confinement while controlling for pre-confinement anxiety/depression scores and demographics. Furthermore, we introduced amyloid-ß positivity, PSS, and BRS in the models and performed mediation analyses to explore the mechanisms explaining the association between SCD and anxiety/depression. RESULTS: In the whole sample, the average SCD-Q score was 4.1 (± 4.4); 70 (28%) participants were classified as SCD, and 26 (12.7%) were amyloid-ß-positive. During the confinement, participants reporting SCD showed higher PSS (p = 0.035) but not BRS scores (p = 0.65) than those that did not report SCD. No differences in worries or lifestyle changes were observed. Higher SCD-Q scores showed an association with greater anxiety/depression scores irrespective of pre-confinement anxiety/depression levels (p = 0.002). This association was not significant after introducing amyloid-ß positivity and stress-related variables in the model (p = 0.069). Amyloid-ß positivity and PSS were associated with greater HADS irrespective of pre-confinement anxiety/depression scores (p = 0.023; p < 0.001). The association of SCD-Q with HADS was mediated by PSS (p = 0.01). CONCLUSIONS: Higher intensity of SCD, amyloid-ß positivity, and stress perception showed independent associations with anxious/depressive symptoms during the COVID-19 confinement irrespective of pre-confinement anxiety/depression levels. The association of SCD intensity with anxiety/depression was mediated by stress perception, suggesting stress regulation as a potential intervention to reduce affective symptomatology in the SCD population in the face of stressors.

Cognitive function in non-hospitalized patients 8-13 months after acute COVID-19 infection: A cohort study in Norway.

Studies have reported reduced cognitive function following COVID-19 illness, mostly from hospital settings with short follow-up times. This study recruited non-hospitalized COVID-19 patients from a general population to study prevalence of late cognitive impairment and associations with initial symptoms. We invited patients with PCR-confirmed COVID-19. A postal questionnaire addressed basic demographics, initial COVID-19 symptoms and co-morbidity about 4 months after diagnosis. About 7 months later, we conducted cognitive tests using the Cambridge Neuropsychological Test Automated Battery, comprising four tests for short-term memory, attention and executive function. We present descriptive statistics using z-scores relative to UK population norms and defined impairment as z-score <-1.5. We used multivariable logistic regression with impairment as outcome. Continuous domain scores were analysed by multiple linear regression. Of the initial 458 participants; 305 were invited, and 234 (77%) completed cognitive testing. At median 11 (range 8-13) months after PCR positivity, cognitive scores for short term memory, visuospatial processing, learning and attention were lower than norms (p≤0.001). In each domain, 4-14% were cognitively impaired; 68/232 (29%) were impaired in ≥ 1 of 4 tests. There was no association between initial symptom severity and impairment. Multivariable linear regression showed association between spatial working memory and initial symptom load (6-9 symptoms vs. 0-5, coef. 4.26, 95% CI: 0.65; 7.86). No other dimension scores were associated with symptom load. At median 11 months after out-of-hospital SARS-Cov-2 infection, minor cognitive impairment was seen with little association between COVID-19 symptom severity and outcome.

Prevalence and severity of cognitive dysfunction in patients referred for transcatheter aortic valve implantation (TAVI): clinical and cognitive impact at 1 year.

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.

Screening for brain fog: Is the montreal cognitive assessment an effective screening tool for neurocognitive complaints post-COVID-19?

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.