New Data on Cognitive and Brain Problems After Covid-19

New research shows that patients hospitalized because of Covid-19 experience cognitive and behavioral problems after discharge.

Researchers observed cognitive changes, depression and post-traumatic stress disorder (PTSD) after discharge in Covid-19 patients who had both short and long hospital stays.

At a press conference, researcher Elisa Canu of the Neuroimaging Research Unit, Department of Neuroscience, IRCCS San Raffaele Scientific Institute in Milan, Italy, said: “We showed that cognitive and behavioral changes were associated with Covid-19 infection within 2 months after hospital discharge and that these partly persisted into the post-Covid phase.”

The findings were presented at the European Academy of Neurology (EAN) 2021 Virtual Congress.

Impairment of Executive Cognitive Functions After Covid

Previous research had provided data suggesting that approximately 30% of people who recovered from Covid-19 had cognitive impairments, while 30–40% had psychopathological disorders such as anxiety and depression.

These problems have been associated with the severity of acute respiratory symptoms, infection-triggered neuroinflammation, cerebrovascular changes and/or neurodegeneration. However, it is unclear whether these problems persist in the post-Covid phase.

The researchers examined cognitive and psychopathological characteristics in 49 patients who attended a hospital emergency department and had confirmed Covid-19. They examined these factors at 2 months (the subacute phase) and 10 months (the post-Covid phase).

Participants had a mean age of 61 (40 – 75), and 73% were men. Most had at least one cardiovascular risk factor, such as hypertension (55%), smoking (22%) or dyslipidemia (55%).

At hospital admission, 71% had an abnormal neurological examination, 59% hypogeusia (reduced sense of taste), 45% hyposmia (reduced sense of smell), 39% headache and 20% confusion or drowsiness. During hospitalization, 27% received noninvasive ventilation.

In addition to cognitive and neurological assessments, 2 months after hospital discharge participants underwent MRI (Magnetic Resonance Imaging). The researchers obtained data on gray matter, white matter and total brain volume.

At 2 months after discharge, 53% of patients showed at least one cognitive deficit. Most deficits involved executive functions, including difficulties with planning, attention and problem-solving (16%). Some participants also had memory problems (6%) or visuospatial impairments (6%). Almost a quarter (23%) presented with a combination of symptoms related to executive dysfunction.

More Cognitive Deficits Associated With Low Oxygen

More than a third of patients (16%) showed symptoms of depression and PTSD (18%). Patients younger than 50 had more executive dysfunction, with these symptoms affecting 75% of younger patients. Elisa Canu said: "Our explanation is as follows: younger people are admitted to hospital in more serious conditions". Canu also said that, during their hospital stay, patients could be “continually on alert” and receive structured interventions for cognitive and behavioral problems.

More severe respiratory symptoms at admission were associated with significant deficits during the subacute phase.

Canu: “Low oxygen levels in the brain can cause confusion and headache and may cause the cognitive problems we observed.”

White matter hyperintensities were associated with cognitive deficits at this stage (P < 0.001 for verbal memory and delayed recall).

Canu: "These white matter lesions may have been present beforehand, probably because of the cardiovascular risk factors in this patient group, and may have amplified the memory impairments we saw."

The researchers did not find a significant association between cognitive performance and brain volume. Canu noted that cognitive and psychopathological problems were related. For example, a patient with PTSD or depression might have problems with attention or memory.

In the post-Covid phase, cognitive symptoms decreased from 53% to 36%; again, the most common deficits were symptoms of combined dysfunction. Canu: "We still do not know whether these changes are a consequence of the infection. Nor do we know whether they are reversible or part of a neurodegenerative process."

The researchers plan to follow these patients further. Canu also said: “We certainly need longer follow-up and larger patient groups, if possible, to see whether these cognitive and psychopathological problems improve in some way".

The study results underline the need for neuropsychological and neurological follow-up in Covid-19 patients. Canu added that cognitive stimulation training and physical activity, preferably outdoors, could be beneficial.

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