Cognitive deficits are not a byproduct of Anxio-depressive symptoms in COVID-19

ABSTRACT

Background: Cognitive deficits and anxio-depressive symptoms have been described in the recovery phase of COVID-19. Their association, or lack thereof, may assist in better understanding the long-term consequences of COVID-19. Methods: Patients underwent neurocognitive and mental health assessment at 2 months after initial SARS-CoV-2 infection as part of the St Vincent's Hospital ADAPT study, a prospective cohort study after COVID-19 disease. Cognition was assessed with the culture fair computerized Cogstate battery. A demographically-corrected composite z-score was created representing global cognitive performance, and then classified as impaired, borderline, and unimpaired. Anxio-depressive symptoms were assessed with the Depression in the Medical Ill scale-10 (DMI-10), the Somatic and Psychological HEalth Report-34 (SHPERE) Psych subscale, and the Impact of Events Scale-Revised (IESR). The scales scores were amenable to a single Principal Component explaining 80% of the variance. Female sex (p<.01) and Non-English-Speaking Background-NESB (p=.02) were associated with greater anxio-depressive symptoms but not age, education. Regression analyses tested sex and NESB unadjusted and adjusted predictions of anxio-depression to cognition. Results: 132 patients (mean age=46±15;40% women, median education=16 years, 10% NESB) were tested after predominantly community-managed COVID-19 (10% hospitalised). 17% had impaired global cognition, and 10% had borderline deficit. 25% had elevated symptoms on the DMI-10 (score>9), 13% on the IESR (score>24) and 35% on the SPHERE Psych scale (score≥2). Anxio-depression was not predictive of cognitive performance (unadjusted p=.43;adjusted p=.98) and of impaired/unimpaired status (unadjusted p=.50;adjusted p=.78). Anxio-depression tended to predict of borderline (vs. unimpaired) performance in unadjusted (p=.08) and adjusted (=.09) analyses. This was explained by the fact that women who had borderline performance tended to report higher anxio-depressive symptoms compared to their peers who were unimpaired (p<.06);further impaired women (vs. unimpaired) tended to report the least anxio-depressive symptoms (p=.09). Conclusion: Cognitive deficits are not a by-product of anxio-depressive symptoms in recovering COVID-19 patients. Women appear to have a higher degree of introspection and reaction to very mild cognitive decline. Cognitive changes appear to be a direct consequence of COVID-19.