Characterization of change in cognition before and after COVID-19 infection in essential workers at midlife

Abstract

BackgroundResearch into COVID-19-related cognitive decline focused on individuals who are cognitively impaired following hospitalization for COVID-19. Thus, our objective was to determine whether cognitive decline emerges with the onset of COVID-19 and if it is more pronounced in patients with Post-Acute Sequelae of SARS-CoV-2 infection (PASC). MethodsWe analyzed longitudinal cognitive data collected during a cohort study of essential workers pre-dating the COVID-19 pandemic. We used longitudinal discontinuity models, a form of causal modeling, to model the change in cognitive performance among 276 participants with COVID-19 in comparison to contemporaneously collected information from 217 participants who did not have COVID-19 across four domains of cognition using data collected before and after the pandemic. Eligible study participants were those with validated COVID-19 diagnoses who were observed before having a verified COVID-19 infection who survived their initial infection, and for whom post-COVID-19 information was also available. ResultsThe mean age of the COVID-19 group was 56.0±6.6 years, while that of the control group was 58.1±7.3 years. Longitudinal models indicated a significant decline in cognitive throughput (β=-0.168, P=.001) following COVID-19, after adjustment for pre-COVID-19 functioning, demographics, and medical factors. Observed changes in throughput were equivalent to 10.6 years of normal aging. COVID-19 was associated with observed cognitive decline and was worse among patients with PASC or severe COVID-19. ConclusionFindings from this longitudinal causal modeling study revealed that COVID-19 and PASC appeared to accelerate cognitive deterioration, especially in executive function.