Cognitive impairment and functional change in COVID-19 patients undergoing inpatient rehabilitation

  1. Ruchi Patel
  2. Irene Savrides
  3. Christine Cahalan
  4. Gargi Doulatani
  5. Michael W. O’Dell
  6. Joan Toglia
  7. Abhishek Jaywant

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Abstract

Cognitive impairment is increasingly recognized as a sequela of COVID-19. It is unknown how cognition changes and relates to functional gain during inpatient rehabilitation. We administered the Montreal Cognitive Assessment (MoCA) at admission to 77 patients undergoing inpatient rehabilitation for COVID-19 in a large US academic medical center. Forty-five patients were administered the MoCA at discharge. Functional gain was assessed by change in the quality indicator for self-care (QI-SC). In the full sample, 80.5% of patients exhibited cognitive impairment on admission, which was associated with prior delirium. Among 45 patients with retest data, there were significant improvements in MoCA and QI-SC. QI-SC score gain was higher in patients who made clinically meaningful changes on the MoCA, an association that persisted after accounting for age and delirium history. Cognitive impairment is frequent among COVID-19 patients, but improves over time and is associated with functional gain during inpatient rehabilitation.

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  1. Version published to 10.1097/mrr.0000000000000483
  2. Version published to 10.1101/2021.03.15.21253637v2 on medRxiv
  3. ScreenIT

    SciScore for 10.1101/2021.03.15.21253637: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board StatementIRB: All data were extracted from retrospective chart reviews under approval of the Weill Cornell Medicine Institutional Review Board. 19/77 patients underwent a separate neuropsychological evaluation during their admission, the results of which have been published5; the results described here are novel.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    No key resources detected.

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Study Limitations: Discharge cognitive data was not available for 32/77 patients, limiting the ability to determine the true prevalence of cognitive deficits in our sample, although there were no demographic/cliincal differences between the 45 with and 32 without discharge cognitive data. Further research is necessary regarding the underlying etiology of the cognitive deficits as imaging results and the effects of psychiatric illness5 were not addressed in this sample. Finally, this sample included a relatively sick group of patients from the first wave of COVID-19; findings may not apply to milder disease presentations or from subsequent waves of illness.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  4. Version published to 10.1101/2021.03.15.21253637v1 on medRxiv