Cognitive, behavioral, and psychological manifestations of COVID-19 in post-acute rehabilitation setting: preliminary data of an observational study

Silvia Bonizzato,Emanuela Galante,Francesco Ferraro,Ada Ghiggia

doi:10.1007/s10072-021-05653-w

Abstract

Psychological, emotional, and behavioral domains could be altered in COVID-19 patients and measurement of variables within these domains seems to be mandatory. Neuropsychological assessment could detect possible cognitive impairment caused by COVID-19 and the choice of appropriate tools is an important question. Aim of this exploratory study was to verify the effectiveness of an assessment model for patients with COVID-19. Twelve patients were enrolled and tested with Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), Anxiety and Depression Short Scale (AD-R), and the Neuropsychiatry Inventory (NPI), at the time of their entrance (T0) and discharge (T1) from a rehabilitative unit. Moreover, a follow-up evaluation after 3 months (T2) has been conducted on eight patients. Results showed that at baseline (T0), 58.3% of the patients reported a score below cut-off at MMSE and 50% at MoCA. Although a significant amelioration was found only in NPI scores, a qualitative improvement has been detected at all tests, except for MoCA scores, in the T0-T1 trend analysis. A one-way repeated measures analysis of variance showed a significant variation in AD-R depression score, considering the three-assessment time (T0, T1, and T2). The evaluation and tracking over time of the impact of COVID-19 on cognitive, psychological, and behavioral domains has relevant implications for rehabilitation and long-term assistance needs planning. The choice of assessment tools should consider patients vulnerability and match the best compromise among briefness, sensitivity, and specificity.

Highlights

Severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) is the cause of the coronavirus disease 2019 (COVID-19), mainly characterized by respiratory illness
Twelve patients with COVID-19 were included in the study; they were transferred to the Physical Therapy Department of the Carlo Poma Hospital in Mantua (Italy) after hospitalization for COVID-19
Our results show an improvement of Neuropsychiatry Inventory (NPI) and AD-R depression scores during hospitalization

Summary

Introduction

Severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) is the cause of the coronavirus disease 2019 (COVID-19), mainly characterized by respiratory illness. It emerged in Wuhan, China, in December 2019 and caused a pandemic outbreak, according to the World Health Organization (WHO). The central (CNS) and peripheral nervous system (PNS) involvement may be related to hypoxia and endothelial damage, uncontrollable immune reaction and inflammation, electrolyte imbalance, hypercoagulable state and disseminated intravascular coagulation, septic shock, and/or multiple organ failure [5, 6]. COVID-19 can complicate or co-exist with cerebrovascular disease [8] or other neurological disease like multiple sclerosis [9], Alzheimer’s disease [10], and Parkinson’s disease [7] suggesting CNS involvement and complex neurological clinical complications

Methods

Discussion

Conclusion