Prevalence and Associated Factors of Very Early Cognitive Impairment in COVID-19 Convalescents：a Study Using Data from a Questionnaire Survey

ABSTRACT

【】 Background COVID-19 may impair the central nervous system，but the prevalence and related factors of very early cognitive impairment in discharged COVID-19 convalescents are still unclear. Objective To assess the prevalence of very early cognitive impairment in discharged COVID-19 convalescents，and to identify its influencing factors. Methods This study included 574 COVID-19 convalescents from August 28 to September 30，2020，including individuals who were discharged from designated hospitals for treating COVID-19 in Wuhan from December 2019 to April 2020 randomly selected from the hospital information system，and those with informed consent recruited through news media. According to the Eight-item Informant Interview to Differentiate Aging and Dementia（AD8）score，the subjects were divided into a very early cognitive impairment group（AD8 ≥ 2）and a non-very early cognitive impairment group（AD8<2）. A questionnaire survey was conducted with the subjects by four investigators at Hubei Provincial Hospital of Traditional Chinese ＆amp;Western Medicine，using the General Information Questionnaire to collect demographic information and past disease history of the patients（including gender，age，underlying disease，classification of COVID-19 on admission，interval between discharge and the current survey，and various symptoms present at the time of follow-up），using the Generalized Anxiety Disorder-7（GAD-7），the PTSD Check List–Civilian Version（PCL-C），and the Short Form 36 Health Survey Questionnaire（SF-36）to assess patients' anxiety，post-traumatic stress disorder，and quality of life，respectively. Three hundred and eleven cases finally completed the cognitive function screening. Multiple Logistic regression was used to evaluate the effects of gender，age，underlying disease and admission classification of COVID-19 on very early cognitive impairment. A restricted cubic spline model was used to assess the quantitative relationship between anxiety level and very early cognitive impairment. Results 311（54.18%）who effectively responded to the survey was finally enrolled，including 170（54.7%）with very early cognitive impairment and 141（45.3%）without. 230 （23.9%）had residual symptoms after discharge. Comparisons of gender，age，insomnia，fatigue，chest tightness，shortness of breath，loss of appetite，generalized anxiety disorder，PTSD positive，and the score of each SF-36 entry among COVID-19 convalescents with and without very early cognitive impairment were statistically significant（P<0.05）. Multivariate Logistic regression analysis suggested that females〔OR（95%CI）=2.658（1.528，4.625）〕，advanced age〔OR（95%CI）=3.736（1.083，12.890）〕，and having generalised anxiety disorder〔OR（95%CI）=5.081（1.229，21.008）〕were influential factors in increasing very early cognitive impairment（P<0.05）. Restricted cubic spline models indicated a linear quantitative relationship between anxiety level and very early cognitive impairment，with higher levels of anxiety associated with a greater likelihood of very early cognitive impairment（P for non-linear test =0.132）. Conclusion The incidence of very early cognitive impairment is high in COVID-19 convalescents，and it may be higher in those who are older，female，or have generalized anxiety symptoms. Timely interventions for psychiatric problems and alleviation of anxiety symptoms in COVID-19 convalescents，especially in older women，may help to improve their cognitive function and Alzheimer's disease. © 2023 Chinese General Practice. All rights reserved.