Perceived cognitive deficits associated with post-COVID-19 condition

Patients have reported perceived cognitive deficits in the early stage of COVID-19 infection for some time; however, patients also reported these deficits during post-COVID-19 condition (PCC), according to results of a University of California, Los Angeles study published in Open JAMA Network. Among participants who responded to a survey on perceived cognitive deficits, 36.1% reported cognitive deficit 30 days after infection. According to the authors, these results show that “there may be an affective component to PCC in some patients.”

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The CDC defines persistent symptoms of COVID-19 as symptoms that persist for more than 4 weeks after initial infection. CCP (commonly known as long COVID-19) is associated with symptoms of cognitive impairment, including brain fog, and may be associated with memory problems, difficulty concentrating, impaired concentration, and stress disorder post-traumatic (PTSD). Anxiety and depression have also been commonly reported in patients with PCC.

There are few studies that have assessed possible factors linking cognitive dysfunction and PCC. In the current prospective cohort study, researchers analyzed survey data on perceived cognitive deficits related to COVID-19, assessed the perceived level of cognitive deficit and factors associated with this deficit after the acute infection phase , and assessed the association of deficits with the development of PCC.

The study cohort included 766 patients hospitalized or in outpatient care with SARS-CoV-2 infection between April 2020 and February 2021. These patients were enrolled in the University’s SARS-CoV-2 outpatient program. from California to Los Angeles and responded to surveys of perceived cognitive deficits and symptoms of PCCC at 30, 60, and 90 days after hospital discharge or laboratory-confirmed COVID-19 infection.

There was a greater association between perceived cognitive deficits during the first 4 weeks of infection and PCC symptoms than patients who reported having no perceived cognitive deficits. One month after infection or hospitalization, 42.8% of patients with perceived cognitive deficits reported PCC symptoms, compared to 21.4% of patients without perceived cognitive deficits.

But perceived cognitive deficit was also associated with later reporting of PCC symptoms.

Previous research suggests that cognitive impairment and memory problems were common in patients with acute COVID-19 and/or PCC. A separate study from 2022 showed that nurses stressed before COVID-19 infection were more likely to have persistent COVID-19 symptoms after 4 weeks.

The current study also suggests that there may be an important psychological aspect to the CCP. The researchers observed an association between perceived cognitive deficit and previous cognitive difficulties, diagnosis of a depressive disorder and an anxiety disorder.

Moreover, the PCC has been identified as heterogeneous; while the prevalence of deficits in patients who did not report PCC symptoms decreased, the prevalence of perceived cognitive deficits was stable in patients who reported PCC symptoms at 60 and 90 days.

The study authors noted that the limitations of the study are the lack of objective measures of cognition. Subjective reports of perceived cognitive deficits may not correlate with objective cognitive deficits; there is only clinical encounter data on pre-COVID-19 cognition, depression, and anxiety; the CCP’s definition may be biased; and the results may not be generalizable to other patients with COVID-19.

“These data suggest that the concepts of affect and control play an important role in the development of PCC for at least some patients,” the study authors wrote in the paper. “These data may suggest that early assessment of perceived cognitive deficits could help identify patients with acute COVID-19 who should receive more intensive monitoring for symptom persistence.”

Reference

Liu T, Yoo S, Sim M, et al. Perceived cognitive deficits in patients with symptomatic SARS-CoV-2 and their association with post-COVID-19 status. JAMA Netw Open. 2023;6(5):e2311974. doi:10.1001/jamanetworkopen.2023.11974