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COVID-19 patients could have objective cognitive deficits, according to the results of a recent study published in the journal New England Journal of Medicine. Contracting an earlier variant of COVID-19, having prolonged symptoms, or being hospitalized due to the disease were the factors most strongly associated with global cognitive deficit.
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There is little objective data measuring the impact of COVID-19 on cognitive performance and its duration, although many patients report worse memory and difficulty thinking or concentrating (also called brain fog) after infection. Therefore, researchers conducted a large community-based study to understand the impact of COVID-19 on objectively measurable cognitive deficits.
Participants (n=112,964) completed an 8-task online assessment so researchers could measure cognitive function; This cohort was originally part of a study of 800,000 people in England. The researchers hypothesized that people with persistent COVID-19 symptoms, or symptoms lasting 12 weeks or longer, would have objective global cognitive deficits in memory and impaired executive functioning.
Patients hospitalized with this virus had medium to large-scale cognitive deficits compared to patients who were not hospitalized. Additionally, patients with persistent symptoms had an objective cognitive deficit compared to people who never had COVID-19.
The researchers had hypothesized that patients with persistent symptoms would score worse on memory and executive function tasks, and they observed just that. People with persistent symptoms had difficulty with tasks related to memory, executive functioning, and reasoning. These patients had lower scores related to the accuracy of verbal analogical reasoning, the maximum span of spatial working memory, and the accuracy of immediate memory.
“We found small associations between specific task scores and reports of poor memory or mental confusion in the previous two weeks,” the authors wrote in the paper.
Individuals who were infected with the wild-type or alpha variants also had greater objective cognitive deficits than individuals infected with newer variants. Furthermore, it is interesting to note that patients with rapid recovery from symptoms still appeared to experience acute cognitive deficits.
Those who recovered from COVID-19 in less than 4 weeks (or 12 weeks) experienced small deficits in global cognition; however, these deficits were similar to those observed in people who never had COVID-19 or had an unconfirmed infection (-0.23 SD [95% confidence interval {CI}, −0.33 to −0.13] and −0.24 SD [95% CI, −0.36 to −0.12]respectively).
“[This] “suggests that people with persistent unresolved symptoms may have some cognitive improvement once symptoms resolve,” the authors wrote in the article.
Limitations of the trial include participant self-selection bias, subjective reporting of symptoms, lack of an established long-COVID diagnosis, lack of assessment of cognitive change, and overrepresentation of certain groups (mainly women, older people, and white participants). More research is needed to evaluate global cognitive deficits associated with infection.
“The implications of long-term persistence of cognitive deficits and their clinical relevance remain unclear and warrant continued surveillance,” the authors wrote in the article.
REFERENCE
Hampshire A, Azor A, Atchison C, et al. Cognition and memory after Covid-19 in a large community sample. N Engl J Med 2024; 390:806-818, DOI: 10.1056/NEJMoa2311330