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One-Year Trajectory of Cognitive Changes in Older Survivors of COVID-19 in Wuhan, China: A Longitudinal Cohort Study.
Liu, Yu-Hui; Chen, Yang; Wang, Qing-Hua; Wang, Ling-Ru; Jiang, Li; Yang, Ying; Chen, Xian; Li, Ying; Cen, Yuan; Xu, Cheng; Zhu, Jie; Li, Wei; Wang, Ye-Ran; Zhang, Li-Li; Liu, Juan; Xu, Zhi-Qiang; Wang, Yan-Jiang.
  • Liu YH; Department of Neurology and Centre for Clinical Neuroscience, Daping Hospital, Third Military Medical University, Chongqing, China.
  • Chen Y; Department of Neurology and Centre for Clinical Neuroscience, Daping Hospital, Third Military Medical University, Chongqing, China.
  • Wang QH; Department of Neurology and Centre for Clinical Neuroscience, Daping Hospital, Third Military Medical University, Chongqing, China.
  • Wang LR; Department of Neurology and Centre for Clinical Neuroscience, Daping Hospital, Third Military Medical University, Chongqing, China.
  • Jiang L; Department of Neurology and Centre for Clinical Neuroscience, Daping Hospital, Third Military Medical University, Chongqing, China.
  • Yang Y; Department of Neurology and Centre for Clinical Neuroscience, Daping Hospital, Third Military Medical University, Chongqing, China.
  • Chen X; Department of Anaesthesiology, Daping Hospital, Third Military Medical University, Chongqing, China.
  • Li Y; Department of Ophthalmology, Daping Hospital, Third Military Medical University, Chongqing, China.
  • Cen Y; Department of Orthopedics, Daping Hospital, Third Military Medical University, Chongqing, China.
  • Xu C; Department of Oncology, General Hospital of the Central Theatre Command of the People's Liberation Army, Wuhan, China.
  • Zhu J; Department of Neurology and Centre for Clinical Neuroscience, Daping Hospital, Third Military Medical University, Chongqing, China.
  • Li W; Department of Neurology and Centre for Clinical Neuroscience, Daping Hospital, Third Military Medical University, Chongqing, China.
  • Wang YR; Department of Neurology and Centre for Clinical Neuroscience, Daping Hospital, Third Military Medical University, Chongqing, China.
  • Zhang LL; Department of Neurology and Centre for Clinical Neuroscience, Daping Hospital, Third Military Medical University, Chongqing, China.
  • Liu J; Department of Neurology and Centre for Clinical Neuroscience, Daping Hospital, Third Military Medical University, Chongqing, China.
  • Xu ZQ; Department of Neurology and Centre for Clinical Neuroscience, Daping Hospital, Third Military Medical University, Chongqing, China.
  • Wang YJ; Department of Neurology and Centre for Clinical Neuroscience, Daping Hospital, Third Military Medical University, Chongqing, China.
JAMA Neurol ; 79(5): 509-517, 2022 05 01.
Article in English | MEDLINE | ID: covidwho-1729079
ABSTRACT
Importance Determining the long-term impact of COVID-19 on cognition is important to inform immediate steps in COVID-19 research and health policy.

Objective:

To investigate the 1-year trajectory of cognitive changes in older COVID-19 survivors. Design, Setting, and

Participants:

This cohort study recruited 3233 COVID-19 survivors 60 years and older who were discharged from 3 COVID-19-designated hospitals in Wuhan, China, from February 10 to April 10, 2020. Their uninfected spouses (N = 466) were recruited as a control population. Participants with preinfection cognitive impairment, a concomitant neurological disorder, or a family history of dementia were excluded, as well as those with severe cardiac, hepatic, or kidney disease or any kind of tumor. Follow-up monitoring cognitive functioning and decline took place at 6 and 12 months. A total of 1438 COVID-19 survivors and 438 control individuals were included in the final follow-up. COVID-19 was categorized as severe or nonsevere following the American Thoracic Society guidelines. Main Outcomes and

Measures:

The main outcome was change in cognition 1 year after patient discharge. Cognitive changes during the first and second 6-month follow-up periods were assessed using the Informant Questionnaire on Cognitive Decline in the Elderly and the Telephone Interview of Cognitive Status-40, respectively. Based on the cognitive changes observed during the 2 periods, cognitive trajectories were classified into 4 categories stable cognition, early-onset cognitive decline, late-onset cognitive decline, and progressive cognitive decline. Multinomial and conditional logistical regression models were used to identify factors associated with risk of cognitive decline.

Results:

Among the 3233 COVID-19 survivors and 1317 uninfected spouses screened, 1438 participants who were treated for COVID-19 (691 male [48.05%] and 747 female [51.95%]; median [IQR] age, 69 [66-74] years) and 438 uninfected control individuals (222 male [50.68%] and 216 female [49.32%]; median [IQR] age, 67 [66-74] years) completed the 12-month follow-up. The incidence of cognitive impairment in survivors 12 months after discharge was 12.45%. Individuals with severe cases had lower Telephone Interview of Cognitive Status-40 scores than those with nonsevere cases and control individuals at 12 months (median [IQR] severe, 22.50 [16.00-28.00]; nonsevere, 30.00 [26.00-33.00]; control, 31.00 [26.00-33.00]). Severe COVID-19 was associated with a higher risk of early-onset cognitive decline (odds ratio [OR], 4.87; 95% CI, 3.30-7.20), late-onset cognitive decline (OR, 7.58; 95% CI, 3.58-16.03), and progressive cognitive decline (OR, 19.00; 95% CI, 9.14-39.51), while nonsevere COVID-19 was associated with a higher risk of early-onset cognitive decline (OR, 1.71; 95% CI, 1.30-2.27) when adjusting for age, sex, education level, body mass index, and comorbidities. Conclusions and Relevance In this cohort study, COVID-19 survival was associated with an increase in risk of longitudinal cognitive decline, highlighting the importance of immediate measures to deal with this challenge.
Subject(s)

Full text: Available Collection: International databases Database: MEDLINE Main subject: Cognitive Dysfunction / COVID-19 Type of study: Cohort study / Observational study / Prognostic study Topics: Long Covid Limits: Aged / Female / Humans / Male Language: English Journal: JAMA Neurol Year: 2022 Document Type: Article Affiliation country: Jamaneurol.2022.0461

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Cognitive Dysfunction / COVID-19 Type of study: Cohort study / Observational study / Prognostic study Topics: Long Covid Limits: Aged / Female / Humans / Male Language: English Journal: JAMA Neurol Year: 2022 Document Type: Article Affiliation country: Jamaneurol.2022.0461