Fatigue, Perceived Cognitive Impairment and Mood Disorders Associated with Post-COVID-19 Syndrome

A new study from Mayo Clinic found that patients diagnosed with post-COVID-19 syndrome (PCS), also known COVID-19 long-haul syndrome and post-acute sequalae of SARS COV-2, experience symptoms such as mood disorders, fatigue, and perceived cognitive impairment that can negatively affect returning to work and resuming normal activities.

The study reports on the first 100 patients to participate in Mayo Clinic’s COVID-19 Activity Rehabilitation Program (CARP), which is among the first multidisciplinary programs established to evaluate and treat patients with post-COVID-19 syndrome. Sixty-eight percent of the patients were female with a mean age of 45 years and were evaluated and treated between June 1 and December 31, 2020. They were evaluated a mean of 93 days after infection, according to the study.

The most common symptom of patients seeking evaluation for post-COVID-19 syndrome was fatigue. Out of the patients in the study, 80% reported unusual fatigue, whereas 59% had respiratory complaints and a similar percentage had neurologic complaints. More than one-third of patients reported difficulties performing basic activities of daily living, and only 1 in 3 patients had returned to unrestricted work activity.

"Most patients in the study had no preexisting comorbidities prior to COVID-19 infection, and many did not experience symptoms related to COVID-19 that were severe enough to require hospitalization," said Greg Vanichkachorn, MD, medical director of CARP and first author of the study, in the press release. "Most of the patients had normal or nondiagnostic lab and imaging results, despite having debilitating symptoms. That's among the challenges of diagnosing PCS in a timely way and then responding effectively."

Vanichkachorn added that the symptoms often resulted in significant negative effects as patients tried to return to normal daily activities, including work, with most of the patients who they worked with needing physical therapy, occupational therapy, or brain rehabilitation to address the cognitive impairment.

"While many patients had fatigue, more than half also reported troubles with thinking, commonly known as 'brain fog.' And more than one-third of patients had trouble with basic activities of life,” Vanichkachorn said in the press release. “Many could not resume their normal work life for at least several months."

The Mayo Clinic developed CARP in June 2020 to care for patients experiencing persistent symptoms after COVID-19 infection. The organization is conducting intensive research on post-COVID-19 syndrome, in part to better define how the condition presents across different socioeconomic groups and ethnicities. Prolonged symptoms, such as those experienced with post-COVID-19 syndrome, have been reported in prior epidemics, according to the study authors.

"As the pandemic continues, we expect to see more patients who experience symptoms long after infection, and health care providers need to prepare for this, know what to look for, and know how to best provide for their patients' needs," Vanichkachorn said in the press release.

Vanichkachorn noted that patients who have recovered from acute infection should not wait to be evaluated if they are experiencing prolonged symptoms, although he said providers should be cautious in recommending expensive diagnostic tests, which often are not covered by insurance and do not reveal significant information.

REFERENCE

Fatigue, perceived cognitive impairment and mood disorders associated with post-COVID-19 syndrome. Mayo Clinic. Published May 12, 2021. Accessed May 13, 2021. https://newsnetwork.mayoclinic.org/discussion/fatigue-perceived-cognitive-impairment-and-mood-disorders-associated-with-post-covid-19-syndrome/