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 Table of Contents  
Year : 2022  |  Volume : 8  |  Issue : 1  |  Page : 25-28

Alteration of neurocognitive and functional status related to post-COVID infections

1 Department of Psychology, St. Xavier's University, Kolkata, West Bengal, India
2 Department of Psychology, Amity University, Kolkata, West Bengal, India
3 Department of Clinical Psychology, Clinical Psychologist, Kolkata, West Bengal, India

Date of Submission08-Jan-2022
Date of Decision07-Feb-2022
Date of Acceptance14-Feb-2022
Date of Web Publication30-May-2022

Correspondence Address:
Dr. Susmita Halder
St. Xavier's University Kolkata, Action Area III, B, Newtown, Kolkata - 700 160, West Bengal
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/tjp.tjp_2_22

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Background: The impact of COVID-19 on bodily functions is vivid. Acute respiratory distress in individuals infected with COVID-19 may lead to hypoxemia and oxygen deprivation, causing functional difficulties in brain's functioning. Studies on alterations in cognitive functioning of COVID-infected patients are less reported. The present study explored cognitive functions and functional status of COVID-infected individuals post recovery and differences, if any, corresponding to COVID infection severity.
Methods: A total of 32 individuals of both sexes infected with COVID-19 were recruited 3 months post recovery to assess their cognitive functions and functional status across physical, psychological, social, and role function domains. The sample was further divided into two as per the infection severity and compared over differences in cognitive deficits and functional status. To understand the long-term impact, a qualitative interview was taken after 6 months from a total of ten individuals from the primary sample of moderate-to-severe group.
Results: COVID-infected individuals as a whole did not show significant cognitive impairment on Mini–Mental Status Examination. However, the subgroups differed significantly in domains of recent memory and physical, psychological, and role functions. At six-month follow-up, select participants in qualitative interview reported to have deficits in cognitive and psychological domains.
Conclusion: There might be subtle changes in the cognitive functions of COVID-19 patients. The changes might be transient in nature and appear not significant. However, within-group differences in recent memory function and functional status in relation to infection severity stress the need of further exploration of the domain with a larger sample in longitudinal perspective.

Keywords: Cognitive functions, COVID-19, functional status

How to cite this article:
Halder S, Mahato AK, Samajdar S. Alteration of neurocognitive and functional status related to post-COVID infections. Telangana J Psychiatry 2022;8:25-8

How to cite this URL:
Halder S, Mahato AK, Samajdar S. Alteration of neurocognitive and functional status related to post-COVID infections. Telangana J Psychiatry [serial online] 2022 [cited 2022 Jun 30];8:25-8. Available from: https://tjpipstsb.org/text.asp?2022/8/1/25/346235

  Introduction Top

Severe acute respiratory syndrome coronavirus-2 was first identified in December 2019 as the cause of a respiratory illness due to COVID-19 virus. Patients infected with COVID-19 are known to suffer from pulmonary symptoms, with increasing reports of neurological and neuropsychiatric disturbances.[1] Around 78% of the people with acute respiratory distress syndrome (ARDS) reported to have cognitive changes, along with everyday memory difficulties.[2] Further, COVID-19 patients having spent time in intensive care are known to experience lasting cognitive impairment.[3] Impairment in cognitive functioning is known to cause difficulties in performing regular activities of daily living, occupational and social functioning. The underlying causes for these symptoms are related to COVID-19 and the mechanisms involved in potentially prolonged impairments in multifactorial areas.[4] Considering the fact that COVID-19 triggers a wide inflammatory response,[5] COVID-19 infection has a large potential to trigger cognitive decline. A significant link between inflammation and accelerated cognitive decline, in the long run, does exist.[6] There are fewer studies on cognitive changes post-COVID-19 infection and whether the changes differ with symptom severity. The present study aimed to explore cognitive functions and functional status of COVID-infected individuals postrecovery and differences, if any, corresponding to COVID symptom severity.

  Methods Top

The study was carried out during the period May–June 2021, with participants recruited through snowball sampling from Kolkata, India. Initially, 71 COVID-19-infected individuals of both sexes in the age range of 18–60 years were contacted. Further, only those individuals who were tested with the reverse transcription–polymerase chain reaction method with C-reactive protein value were included. Participants who were asymptomatic at the time of infection, with a history of previous neurological, psychiatric, and major physical illness other than preexisting metabolic condition, were excluded. Participants with education below 10th grade were also excluded, bringing the final number of participants to 32.

Data from each participant were collected after a minimum period of 3 months post recovery. The participants were divided into two subgroups, with participants with mild-to-moderate levels of infection in one group (n = 17) and moderate severe-to-severe infection in one group (n = 15). Informed consent was obtained from all participants assuring confidentiality. A total of ten participants from the original sample agreed to participate in a 6-month follow-up. An interview was conducted based on the questions on the status of cognitive, psychological, functional, and social functioning, and the responses were recorded accordingly.

The following measures were used, and data were analyzed using Statistical Package for Social Science Software, Version 17 for Windows ( SPSS, Inc. Chicago, Illinois, USA).

  • Mini–Mental Status Examination[7] (MMSE): The MMSE is one of the most common tools to measure cognitive impairment
  • Brief Cognitive Rating Scale[8] (BCRS): The BCRS was used to assess functional and cognitive abilities providing objective ratings of various cognitive functions. Higher scores on the scale indicate higher cognitive impairment
  • Functional Status Questionnaire[9] (FSQ): The FSQ is a brief, self-administered questionnaire providing a comprehensive assessment of physical, psychological, social, and role function in ambulatory patients. Higher scores indicate better functioning.

  Results Top

Characteristics of the sample suggest that the mean age of the sample (n = 32) was 41.63 years and the average years of education was 16 years, with the majority being in the organized service sector. Majority of them were male (53%) and were treated at home (78%), rest of the sample required hospitalization; however, none required ventilation support. The mean MMSE score of the sample (25.06, standard deviation 2.24) did not suggest any significant cognitive impairment in the sample, though few of them reported memory-related issues.

  Discussion Top

Considering the inflammatory response triggered by the COVID-19 infection, the central nervous system is equally prone to be impacted and eventually affecting cognitive functions. Several studies do suggest evident cognitive deficits post recovery from COVID-19 infection.[10],[11] However, majority of these studies are on hospitalized symptomatic patients and very few on asymptomatic patients. One of the studies suggests cognitive deficits in domains of visuoperception, naming, and fluency in asymptomatic patients too.[12] However, in the present study, the sample performed within the normal range on the MMSE, indicating no significant cognitive impairment. Any expected change in cognitive functions of the sample was not evident, possibly because none of the sample despite having a mild-to-severe infection rate did not have severe respiratory distress or required any ventilation support.

Previous studies[13] suggest that individuals with a high risk of developing Alzheimer's disease may not show significantly low performance on the MMSE yet differ from healthy controls on domains of recent memory, delayed recall, verbal and visual retention, and recognition. On similar lines, the sample subgroups in the present study differed significantly over scores on recent memory, where individuals having mild-to-moderate severity of infection had better recent memory compared to those with severe symptoms [Table 1].
Table 1: Cognitive functioning and functional status of the sample and subgroup comparison between mild-to-moderately infected Group (A) and moderately severe-to-severely infected Group (B)

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This exerts the notion that infection severity of COVID-19 has a subtle impact on the cognitive functions (recent memory), though not established at significant levels. This contrasts with literature reporting cognitive impairment in severe COVID-19 probably linked to critical illness as part of ARDS due to COVID-19 only and not correlating with severity of the acute illness.[14] The present study, however, gets support from other studies reporting no significant difference in COVID-19-recovered patients and matched healthy controls over cognitive functions but a clear correlation between reaction time and continuous performance test scores.[10]

Post-COVID changes in memory functions have been reported by several studies and explained by the vulnerability of the hippocampus area, the area involved in memory functions to respiratory viral infections.[3]

Further comparison of the subgroups on functional status suggests better physical, psychological, and role functioning status among individuals having mild-to-moderate severity of infection than the severe category [Table 1]. This finding was on expected lines considering greater exert of limitation and restrictions on mobility and social interaction in the severely infected patients and supports reduced functioning[15] and compromised quality of life in COVID-recovered patients. Even though some of the participants had preexisting metabolic conditions such as diabetes, they were uniformly present in all groups including follow-up, not impacting the overall findings.

The study findings from the first phase have its own implications in understanding the role of COVID-19 infection in acceleration or early onset of cognitive decline in Alzheimer's disease and the elderly population as suggested by other researchers[16] too but do require longitudinal follow-up for validation.

Keeping this in mind, to see the long-term impact after 6 months, a follow-up study was conducted on ten participants based on qualitative interviews. Qualitative findings suggest that individuals infected at moderate-to-severe levels mostly reported no significant difficulty in performing cognitive and functional tasks; however, most of them reported to have difficulties in concentration, minor forgetfulness, and felt distracted at times. They also reported that after experiencing two waves of COVID pandemic, they developed a kind of apprehensive feeling, got worried easily, and remained apprehensive. Social interaction also got limited due to restrictions, which also made them feel restless and compromised. Among all, very few also reported changes in functional status, they could observe some slowness in their behavior [Table 2].
Table 2: 6-month follow-up data of qualitative responses on the cognitive, psychological, and functional status of participants

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From the overall findings from both phases of data, it has been seen that the severity of COVID-19 infection has a considerable impact over the cognitive and functional status, even after a longer period, and adversely affect the quality of life and functioning.[17] Hence, the overall COVID-19 pandemic situation has an adverse impact over the psychological well-being of almost every individual, irrespective of age, gender, and regions,[18] whereas people who are infected by the COVID-19 virus, they are more vulnerable enough to have cognitive and functional difficulties. Detailed identification of symptoms and impact on psychological, social, functional, and cognitive functioning of all COVID-infected individuals need to be investigated, and if required, proper intervention should be given.

  Conclusion Top

The study had its own limitations, primarily the scope of elaborate neuropsychological assessment of the sample in the pandemic situation was limited. The study findings do warrant the need of longitudinal studies on cognitive deficits in COVID-19-recovered individuals with a larger sample size, broader and uniform neuropsychological measures. More importantly, the late- and middle-aged individuals infected with and recovered from COVID-19 need to be more careful and consider early intervention in the event of noticeable changes in their cognitive functions. COVID-19 appears to have a lasting impact even upon recovery; thus, maintaining COVID safety and hygiene protocols is of utmost importance, considering the alarming rise in the rate of infection.

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Conflicts of interest

There are no conflicts of interest.

  References Top

Varatharaj A, Thomas N, Ellul MA, Davies NW, Pollak TA, Tenorio EL, et al. Neurological and neuropsychiatric complications of COVID-19 in 153 patients: A UK-wide surveillance study. Lancet Psychiatry 2020;7:875-82.  Back to cited text no. 1
Hopkins RO, Weaver LK, Pope D, Orme JF, Bigler ED, Larson-LOHR V. Neuropsychological sequelae and impaired health status in survivors of severe acute respiratory distress syndrome. Am J Respir Crit Care Med 1999;160:50-6.  Back to cited text no. 2
Ritchie K, Chan D, Watermeyer T. The cognitive consequences of the COVID-19 epidemic: Collateral damage? Brain Communications 2020;2:Fcaa069.  Back to cited text no. 3
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Buicu AL, Cernea S, Benedek I, Buicu CF, Benedek T. Systemic inflammation and COVID-19 mortality in patients with major noncommunicable diseases: Chronic coronary syndromes, diabetes and obesity. J Clin Med 2021;10:1545.  Back to cited text no. 5
Walker KA, Gottesman RF, Wu A, Knopman DS, Gross AL, Mosley TH Jr., et al. Systemic inflammation during midlife and cognitive change over 20 years: The ARIC Study. Neurology 2019;92:e1256-67.  Back to cited text no. 6
Folstein MF, Folstein SE, McHugh PR. “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975;12:189-98.  Back to cited text no. 7
Reisberg B, Ferris SH. Brief cognitive rating scale (BCRS). Psychopharmacol Bull 1988;24:629-36.  Back to cited text no. 8
Jette AM, Davies AR, Cleary PD, Calkins DR, Rubenstein LV, Fink A, et al. The Functional Status Questionnaire: Reliability and validity when used in primary care. J Gen Intern Med 1986;1:143-9.  Back to cited text no. 9
Hopkins RO, Weaver LK, Collingridge D, Parkinson RB, Chan KJ, Orme JF Jr. Two-year cognitive, emotional, and quality-of-life outcomes in acute respiratory distress syndrome. Am J Respir Crit Care Med 2005;171:340-7.  Back to cited text no. 10
Zhou H, Lu S, Chen J, Wei N, Wang D, Lyu H, et al. The landscape of cognitive function in recovered COVID-19 patients. J Psychiatr Res 2020;129:98-102.  Back to cited text no. 11
Amalakanti S, Arepalli KV, Jillella JP. Cognitive assessment in asymptomatic COVID-19 subjects. Virusdisease 2021;32:1-4.  Back to cited text no. 12
Halder S, Mahato A. Identifying multiple domain memory impairment in high-risk group for Alzheimer's disorder. J Geriatr Ment Health 2019;6:14-8.  Back to cited text no. 13
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Belli S, Balbi B, Prince I, Cattaneo D, Masocco F, Zaccaria S, et al. Low physical functioning and impaired performance of activities of daily life in COVID-19 patients who survived hospitalization. Eur Respir J 2020;56:2002096.  Back to cited text no. 15
de Erausquin GA, Snyder H, Carrillo M, Hosseini AA, Brugha TS, Seshadri S, et al. The chronic neuropsychiatric sequelae of COVID-19: The need for a prospective study of viral impact on brain functioning. Alzheimers Dement 2021;17:1056-65.  Back to cited text no. 16
Poletti S, Palladini M, Mazza MG, De Lorenzo R; COVID-19 BioB Outpatient Clinic Study group, Furlan R, Ciceri F, Rovere-Querini P, Benedetti F. Long-term consequences of COVID-19 on cognitive functioning up to 6 months after discharge: role of depression and impact on quality of life. Eur Arch Psychiatry Clin Neurosci. 2021 Oct 26:1–10. doi: 10.1007/s00406-021-01346-9. Epub ahead of print. PMID: 34698871; PMCID: PMC8546751.  Back to cited text no. 17
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  [Table 1], [Table 2]


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