Neurological impacts after COVID-19: cognitive impairment and risk factors
DOI:
https://doi.org/10.11606/issn.1679-9836.v104i6e-234324Keywords:
Elderly, Risk Factors, Cognitive Rehabilitation, Cognitive Dysfunction, COVID-19Abstract
Introduction: SARS-CoV-2, which causes COVID-19, has caused a global pandemic since 2019, affecting multiple systems in addition to the respiratory system. Post-COVID-19 patients often experience neurological and cognitive sequelae. The virus can invade the central nervous system, triggering neuroinflammation and brain damage. Anxiety, depression, and cognitive deficits are common, especially in severe cases. Objective: To evaluate neurological impairment after COVID-19 and the predisposing and triggering factors for cognitive symptoms. Methods: A qualitative review of the literature on the cognitive impact of COVID-19 was carried out, consulting PubMed, MEDLINE, IBECS and LILACS via VHL. Studies from the last five years, in English, Portuguese or Spanish, on patients with post-infection cognitive symptoms were included. The selection followed strict criteria, with independent review by two authors. Results: 18 studies on the impacts of COVID-19 on cognition were analyzed. The majority revealed cognitive deficits, especially in the elderly and patients with comorbidities. Furthermore, the symptoms described in the literature seem to be associated with structural changes in the brain and neuropsychiatric manifestations, such as anxiety and depression, and are also frequently reported. The findings reinforce the need for neuropsychological monitoring, especially for moderate and severe cases. Conclusion: COVID-19 significantly impacts cognition, with persistent sequelae, especially in severe cases. Multidisciplinary monitoring is essential for the neurocognitive and psychosocial rehabilitation of survivors.
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Rasulo FA, Piva S, Latronico N. Long-term complications of COVID-19 in ICU survivors: what do we know? Minerva Anestesiol. 2022;88(1-2):72-9. Doi:10.23736/S0375-9393.21.16032-8.
Serrano-Castro PJ, Estivill-Torrús G, Cabezudo-García P, Reyes-Bueno JA, Ciano Petersen N, Aguilar-Castillo MJ, ET AL. Impact of SARS-CoV-2 infection on neurodegenerative and neuropsychiatric diseases: a delayed pandemic? Neurologia (Engl Ed). 2020;35(4):245-51. Doi: 10.1016/j.nrl.2020.04.002
Jesuthasan A, Massey F, Manji H, Zandi MS,WiethoffS. Emerging potential mechanisms and predispositions to the neurological manifestations of COVID-19. J Neurol Sci. 2021;428:117608. Doi:10.1016/j.jns.2021.117608.
Shukla A, Misra S. An overview of post COVID sequelae. J Basic Clin Physiol Pharmacol. 2022;33(6):715-26. Doi: 10.1515/jbcpp-2022-0057.
Pyne JD, Brickman AM. The Impact of the COVID-19 Pandemic on Dementia Risk: Potential Pathways to Cognitive Decline. Neurodegener Dis. 2021;21(1-2):1-23. Doi: 10.1159/000518581.
Azkargorta MA, Sánchez-Saudinós M, Lleó A. Cognitive symptoms after COVID-19. Neurol Perspect. 2021;1:S16-S24. Doi: 10.1016/j.neurop.2021.10.005.
D'Arcy RCN, Sandhu JK, Marshall S, Besemann M. Mitigating Long-Term COVID-19 Consequences on Brain Health. Front Neurol. 2021;12:630986. Doi: 10.3389/fneur.2021.630986.
Pantelis C, Jayaram M, Hannan AJ, Wesselingh R, Nithianantharajah J, Wannan CM, et al. Neurological, neuropsychiatric and neurodevelopmental complications of COVID-19. Aust N Z J Psychiatry. 2021;55(8):750-62. Doi: 10.1177/0004867420961472
Poletti S, Palladini M, Mazza MG, De Lorenzo R, Bollettini I, Sara B, et al. 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. 2022;272(5):773-82. Doi:10.1007/s00406-021-01346-9.
Lamontagne SJ, Winters MF, Pizzagalli DA, Olmstead MC. Post-acute sequelae of COVID-19: Evidence of mood & cognitive impairment. Brain Behav Immun Health. 2021;17:100347. Doi: 10.1016/j.bbih.2021.100347.
Kanberg N, Simrén J, Edén A, Andersson LM, Nilsson S, Ashton NJ, et al. Neurochemical signs of astrocytic and neuronal injury in acute COVID-19 normalizes during long-term follow-up. EBioMedicine. 2021;70:103512. Doi: 10.1016/j.ebiom.2021.103512.
Ramírez-Moreno JM, Muñoz-Sanz A, Vaz-Leal FJ. Cognitive Function and Neuropsychiatric Disorders after COVID-19: A Long Term Social and Clinical Problem? BioMed. 2022;2:50-9. Doi:10.3390/biomed2010005.
Kumar S, Veldhuis A, Malhotra T. Neuropsychiatric and Cognitive Sequelae of COVID-19. Front Psychol. 2021;12:577529. Doi:10.3389/fpsyg.2021.577529.
García-Sánchez C, Calabria M, Grunden N, Pons C, Arroyo JA, Gómez-Anson B, et al. Neuropsychological deficits in patients with cognitive complaints after COVID-19. Brain Behav. 2022;12(3):e2508. Doi: 10.1002/brb3.2508.
Liu YH, Chen Y, Wang QH, Wang LR, Jiang L, Yang Y, et al. One-Year Trajectory of Cognitive Changes in Older Survivors of COVID-19 in Wuhan, China: A Longitudinal Cohort Study. JAMA Neurol. 2022;79(5):509-17. Doi: 10.1001/jamaneurol.2022.0461.
Cristillo V, Pilotto A, Cotti Piccinelli S, Bonzi G, Canale A, Gipponi S, et al. Neuro Covid Next Study group. Premorbid vulnerability and disease severity impact on Long-COVID cognitive impairment. Aging Clin Exp Res. 2022;34(1):257-60. Doi: 10.1007/s40520-021-02042-3.
Francis G, Thunell E. COVID-19 infection does not seem to affect cognition in college students. Conscious Cogn. 2023;108:103464. Doi: 10.1016/j.concog.2023.103464.
Alemanno F, Houdayer E, Parma A, Spina A, Del Forno A, Scatolini A, et al. Déficits cognitivos de COVID-19 após assistência respiratória na fase subaguda: uma experiência em unidade de reabilitação de COVID. PLoS One. 2021;16(2):e0246590. Doi: 10.1371/journal.pone.0246590.
Bulla R, Rossi L, Furlanis G, Agostinis C, Toffoli M, Balduit A, et al. A likely association between low mannan-binding lectin level and brain fog onset in long COVID patients. Front Immunol. 2023;14:1191083. Doi: 10.3389/fimmu.2023.1191083.
Damiano RF, Rocca CCA, Serafim AP, Loftis JM, Talib LL, Pan PM, et al. Comprometimento cognitivo na longa COVID e sua associação com desregulação persistente em marcadores inflamatórios. Front Immunol. 2023;14:1174020. Doi:10.3389/fimmu.2023.1174020.
Dondaine T, Ruthmann F, Vuotto F, Carton L, Gelé P, Faure K, Deplanque D, Bordet R. Long-term cognitive impairments following COVID-19: a possible impact of hypoxia. J Neurol. 2022 Aug;269(8):3982-3989. doi: 10.1007/s00415-022-11077-z
Marques AJ, Costa A, Almendra R, Maia L, Magalhães R, Cavaco S, et al. Long-Term Headache and Cognitive Complaints Among Health Care Workers Who Acquired SARS-CoV-2. Perm J. 2023;27(3):14-21. Doi: 10.7812/TPP/22.171.
Santoyo-Mora M, Villaseñor-Mora C, Cardona-Torres LM, Martínez-Nolasco JJ, Barranco-Gutiérrez AI, Padilla-Medina JA, et al. COVID-19 Long-Term Effects: Is There an Impact on the Simple Reaction Time and Alternative-Forced Choice on Recovered Patients? Brain Sci. 2022;12(9):1258. Doi: 10.3390/brainsci12091258.
Vakani K, Ratto M, Sandford-James A, Antonova E, Kumari V. COVID-19 and cognitive function: Evidence for increased processing speed variability in COVID-19 survivors and multifaceted impairment with long-COVID symptoms. Eur Psychiatry. 2023;66(1):e43. Doi: 10.1192/j.eurpsy.2023.25.
Poletti S, Palladini M, Mazza MG, De Lorenzo R, COVID-19 BioB Outpatient Clinic Study Group, Furlan R, et al. 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. 2022;272(5):773-82. Doi:10.1007/s00406-021-01346-9.
Douaud G, Lee S, Alfaro-Almagro F, Arthofer C, Wang C, McCarthy P, et al. SARS-CoV-2 is associated with changes in brain structure in UK Biobank. Nature. 2022;604(7907):697-707. Doi: 10.1038/s41586-022-04569-5.
Paolini M, Palladini M, Mazza MG, Colombo F, Vai B, Rovere-Querini P, et al. Brain correlates of subjective cognitive complaints in COVID-19 survivors: A multimodal magnetic resonance imaging study. Eur Neuropsychopharmacol. 2023;68:1-10. Doi: 10.1016/j.euroneuro.2022.12.002..
Méndez R, Balanzá-Martínez V, Luperdi SC, Estrada I, Latorre A, González-Jiménez P, et al. Short-term neuropsychiatric outcomes and quality of life in COVID-19 survivors. J Intern Med. 2021;290(3):621-31. Doi: 10.1111/joim.13262.
Pilotto A, Cristillo V, Cotti Piccinelli S, Zoppi N, Bonzi G, Sattin D, et al. Long-term neurological manifestations of COVID-19: prevalence and predictive factors. Neurol Sci. 2021;42(12):4903-7. Doi: 10.1007/s10072-021-05586-4.
Klinkhammer S, Horn J, Duits AA, Visser-Meily JMA, Verwijk E, Slooter AJC, et al. Neurological and (neuro)psychological sequelae in intensive care and general ward COVID-19 survivors. Eur J Neurol. 2023;30(7):1880-90. Doi: 10.1111/ene.15812.
Winter D, Braw Y. COVID-19: Impacto da ameaça de diagnóstico e sugestionabilidade em queixas cognitivas subjetivas. Rev Int Psicol Clín Saúde. 2022;22(1):100253. Doi: 10.1016/j.ijchp.2021.100253.
Guido CA, Lucidi F, Midulla F, Zicari AM, Bove E, Avenoso F, et al. Efeitos neurológicos e psicológicos da COVID longa em uma população jovem: um estudo transversal. Front Neurol. 2022;13:925144. Doi: 10.3389/fneur.2022.925144.
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