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

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The CDC define persistent COVID-19 symptoms as symptoms that continue more than 4 weeks after initial infection. PCC (commonly referred to as long COVID-19) is associated with symptoms of cognitive impairment, including brain fog, and may be associated with memory problems, difficulty concentrating, trouble focusing, and posttraumatic stress disorder (PTSD). Anxiety and depression have also been commonly reported among patients with PCC.

There are few studies which have assessed the possible factors linking cognitive disfunction and PCC. In the current prospective cohort study, investigators analyzed data from surveys about perceived cognitive deficits related to COVID-19, evaluated perceived level of cognitive deficit and factors associated with this deficit following the acute infection phase, and assessed the association of deficits with the development of PCC.

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

There was a larger association between perceived cognitive deficits within the first 4 weeks of infection and PCC symptoms than patients who reported having no perceived cognitive deficits. At 1-month post-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 associated with reporting symptoms of PCC later on as well.

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

The current study also suggests there could be a strong psychological aspect to PCC. Investigators observed an association between perceived cognitive deficit and prior cognitive difficulties, diagnosis of a depressive disorder, and an anxiety disorder.

In addition, PCC was identified as heterogeneous; while the prevalence of deficits among patients who did not report PCC symptoms declined, prevalence of perceived cognitive deficits was stable in patients who reported PCC symptoms at 60 and 90 days.

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

“These data suggest that the constructs of affect and control play a substantial role in the development of PCC for at least some patients,” study authors wrote in the article. “These data might suggest that early evaluation of perceived cognitive deficits might help in identification of patients with acute COVID-19 who should receive more intensive monitoring for persistence of symptoms.”

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 Condition. JAMA Netw Open. 2023;6(5):e2311974. doi:10.1001/jamanetworkopen.2023.11974