Subtle cognitive impairments in memory, attention, and executive functioning in patients with post-COVID syndrome and their relationships with clinical variables and subjective complaints
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Abstract
Background and objectives
Cognitive symptoms persisting beyond three months following COVID-19 present a considerable disease burden. We aimed to establish a domain-specific cognitive profile of post-COVID syndrome (PCS) and relationships with subjective cognitive complaints and clinical variables to provide relevant information for the understanding of cognitive dysfunction and its predictors in a clinical cohort with PCS.
Methods
In this cross-sectional study, we compared cognitive performance on the clinically viable Oxford Cognitive Screen-Plus between a large post-COVID cohort ( n = 282) and a socio-demographically matched healthy control group ( n = 52). We assessed group differences in terms of fatigue and depression as well as relationships between cognitive dysfunction and clinical and patient-reported outcomes.
Results
On a group-level, patients scored significantly lower on delayed verbal memory (non-parametric effect size r = .13), attention ( r = .1), and executive functioning ( r =.1) than healthy controls. In each of these domains, 10-20% of patients performed more than 1.5 SD below the healthy control mean. Delayed Memory was particularly affected and a small proportion of its variance was explained by hospitalisation ( β = -.72, p < .01) and age ( β = -.03, p < .05; R 2 adj. = .08). Attention scores were significantly predicted by hospitalisation ( β = -.78, p < .01) and fatigue ( β = -.04, p < .05; R 2 adj. = .06).
Discussion
PCS is associated with long-term cognitive dysfunction, particularly in delayed verbal memory, attention, and executive functioning. Deficits in delayed memory performance seem to be of particular relevance to patients’ subjective experience of impairment. Initial disease severity, current level of fatigue, and age seem to predict cognitive performance, while time since infection, depression, and pre-existing conditions do not. Longitudinal data are needed to map long-term course of cognitive dysfunction in PCS.
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SciScore for 10.1101/2022.05.23.22275442: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Ethics Consent: Participants were included in this study if they were aged 18-65 years, willing and able to give informed consent, and capable of taking part in the assessment.
IRB: The study was approved by the ethics committee of the Friedrich-Schiller-University [amendment to 5082-02/17].Sex as a biological variable not detected. Randomization not detected. Blinding not detected. Power Analysis not 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 …SciScore for 10.1101/2022.05.23.22275442: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Ethics Consent: Participants were included in this study if they were aged 18-65 years, willing and able to give informed consent, and capable of taking part in the assessment.
IRB: The study was approved by the ethics committee of the Friedrich-Schiller-University [amendment to 5082-02/17].Sex as a biological variable not detected. Randomization not detected. Blinding not detected. Power Analysis not 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:The study has certain strengths and multiple limitations. Strengths include a large sample of well-defined post-COVID patient group, a socio-demograpically matched control group and the use of an innovative and sensitive tablet-based assessment tool with automated scoring. The most critical limitation is that our study cannot inform about whether the identified deficits pre-existed prior to infection. This is true even though we excluded patients with known relevant neurological disorders. Our study is furthermore prone to selection bias. As we tested a clinically referred sample of post-COVID patients, findings might not generalize to all post-COVID patients, but only to those who have symptoms severe enough to visit a specialized clinic. The OCS-Plus testing identified subtle long-term cognitive deficits persisting for more than 3 months in patients with post-COVID syndrome. A relevant next step will be obtain longitudinal data on memory, attention and executive functions from the presented cohort, in order to differentiate between deficits that might improve and those that might become chronic. This will provide specific information on targets for interventions, such as cognitive training. As many patients affected by post-COVID syndrome are living in medically underserved, rural areas, the mobile, cost-effective and highly scalable OCS-Plus assessment could be used for testing patients outside specialized facilities.
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.
- Thank you for including a protocol registration statement.
Results from scite Reference Check: We found no unreliable references.
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