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Perceived Cognitive Deficits in Patients With Symptomatic SARS-CoV-2 and Their Association With Post-COVID-19 Condition
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Teresa C. Liu, MD, MPH1; Sun M. Yoo, MD, MPH1; Myung S. Sim, DrPH2; et al
May 5, 2023
Patients reporting perceived cognitive deficits in the first 4 weeks of SARS-CoV-2 infection were more likely to report symptoms of PCC than those without perceived cognitive deficits (118 of 276 patients [42.8%] vs 105 of 490 patients [21.4%]; Ļ‡21, 38.9; Pā€‰<ā€‰.001).
Conclusions and Relevance These findings suggest that patient-reported perceived cognitive deficits in the first 4 weeks of SARS-CoV-2 infection are associated with PCC symptoms and that there may be an affective component to PCC in some patients. The underlying reasons for PCC merit additional exploration.
Key Points
Question Among hospitalized and ambulatory patients with SARS-CoV-2 infection, how many perceived cognitive deficits early in the course of their infection and were these perceived deficits associated with post-COVID-19 condition (PCC)? Findings In this cohort study of 766 patients with SARS-CoV-2 infection, 276 patients (36.1%) perceived cognitive deficits within 4 weeks of hospital discharge or outpatient infection, and patients with perceived cognitive deficits at 30 days were twice as likely as patients without perceived deficits to report symptoms of PCC at 60 to 90 days. Severity and persistence of perceived cognitive deficits were associated with symptoms of PCC.
Meaning These findings of perceived cognitive deficits early during the course of SARS-CoV-2 infection suggest that there is an affective component to PCC in some patients.
In this cohort study, more than one-third of patients with SARS-CoV-2 perceived cognitive deficits on the 30-day survey after hospitalization or outpatient infection. Report of perceived cognitive deficit was associated with later reporting of PCC symptoms. To some degree, these findings may help us disentangle the complex construct that is PCC. Prior use of these survey items demonstrates that perceived cognitive deficit is not associated with objective deficient cognition; instead, they are associated with depression, anxiety, and lower perceived functional ability and control.28,29 Those findings are consistent with the findings in this cohort study showing that perceived cognitive deficits were associated with a history of anxiety disorder and depressive disorder, although we also found an association with prior cognitive difficulties. These findings suggest a substantial psychological component for long lasting SARS-CoV-2 symptoms for at least some patients.
Many reports show that cognitive impairment and memory difficulty are common among patients with acute SARS-CoV-2,17,32 and among those with PCC.2,8,11-14 However, many studies use convenience samples or have no longitudinal data. A 2022 report23 of a large sample of nurses (albeit with little gender or race heterogeneity) demonstrated that pre-SARS-CoV-2 distress, both general distress and COVID-19-related distress, was associated with greater likelihood of COVID-19 symptoms persisting for 4 or more weeks. Our findings come from a single health system continuity sample, and we are able to adjust the diverse cohort for demographic and clinical characteristics.24
The finding that more than one-half of patients with PCC perceived cognitive deficits early during the condition is provocative, yet these data likely create more questions than they answer. Do the reported cognitive deficits influence the content or quality of responses to later surveys? Are the early reported cognitive deficits related to the SARS-CoV-2 infection consistent with imaging changes that have been found ?33,34 If so, why are these symptoms related to a history of depressive disorder, anxiety disorder, and cognitive difficulties? These data suggest that the constructs of affect and control play a substantial role in the development of PCC for at least some patients. From a clinical perspective, 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 and perhaps for a focus on intervention.

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