Cognitive Impairment in Paediatric PCNS: A Systematic Review and Meta-analysis

Post-acute sequalae of Coronavirus disease-19 (COVID-19 [PASC]) are defined as the persistence of existing or new symptoms for a period extending beyond initial COVID-19 infection. Post COVID Neurological Syndrome (PCNS) relates to the persistent cognitive and neurological deficits characteristic of PASC. This includes significant changes in attention and memory function in adult and geriatric populations, with such impairments notably impacting quality of life. However, despite reports of similar cognitive changes in paediatric patients, this issue is yet to be systematically investigated. This systematic review and meta-analysis synthesised literature reporting on the prevalence of clinically significant cognitive impairment in paediatric PASC using DSM-5 cognitive domains to categorise study outcomes. Final literature searching was completed on 15 ^th of November, 2024 across four databases combining the following keywords: ‘COVID-19’, ‘cognition’ and ‘paediatric’. Included studies examined standardised psychometric or parent report measures of cognition in children and adolescents with a PASC diagnosis. Studies were excluded if participants had prior cognitive impairments or comorbidities. Risk of bias was assessed using Joanna Briggs Institute Critical Appraisal Tool’s Checklist for Analytical Cross-sectional Studies. Results revealed that between 35-55% of paediatric PASC patients were ‘at risk of impairment’ or showed ‘clinically significant’ impairment in complex attention, learning and memory, working memory and executive function. Further research is needed to assess impacts of infection severity and repeated infection. However, this meta-analysis provides insights into the nature of PCNS-associated complications to aid more detailed management strategies for children and adolescents.