COVID19 and cognitive impairment ‐ A follow‐up study with cognitive and neuroimaging evaluation of the Clinical Hospital of São Paulo

Abstract

AbstractBackgroundPost‐COVID19 syndrome is characterized by signs and symptoms that occur within 3 months of the onset of COVID19 and last for at least 2 months. Cognitive impairment has frequently been associated with COVID19 with descriptions of attentional, executive, memory, and language disorders. Moreover, some morphological and metabolic changes have been described in MRI and FDG PET‐CT, respectively. There is no formal treatment for this condition.MethodWe selected patients less than 65 years of age with COVID19 at least 3 or more months of symptoms and no more than 6 months, no relevant structural brain lesions, no record of neurodegenerative disease. A cross‐over design study was performed with neuropsychological rehabilitation. They were evaluated 3 times by a neurologist (0, 3, and 6 months) with specific cognitive battery tests and questionnaires and then by a neuropsychologist for evaluation and training. Finally, most patients underwent neuroimaging with cranial MRI and FDG PET CT or MRI.Result44 patients performed the first baseline evaluation, 34 matched inclusion criteria and were referred to neuropsychological rehabilitation. 20 underwent functional and structural neuroimaging. This sample had a mean age of 44 (SD8.9) years, 61% of females, 16.1 (SD5.1) years of education, 17.6% of hypertension, 2.9% diabetes, 11.8% dyslipidemia and 23.5% obesity. Cognitive evaluation depicted that 90.6% had memory complaints; MMSE of 27.7 (SD1.8); delayed recall of 8.68 (SD1.6) out 10 in the brief cognitive screening battery; semantic verbal fluency of 18.24 (SD5.1); lexical fluency of 31.7 (SD11.7); forward digit span 6.62 (SD0.7); backward digit span 4.82 (SD 1.3); clock drawing test of 9.12 (SD1.6) and Boston naming test‐15 of 14.06 (SD1.5). 46.9% reported more than 5 points on the depression scale and 41.2% somnolence on the Epworth scale. 60% had abnormal findings (hypometabolism) in brain FDG PET, 16% with frontotemporal involvement, 33% basal ganglia, 8% frontoparietal, 41% cerebellum, 8% parietal only, 8% frontalmedial, and 25% temporal. Some (33%) had mixed patterns.Conclusionpost‐COVID19 syndrome and cognitive impairment are relatively common and we need prospective studies in low and middle‐income countries to understand the cognitive profile, structural and metabolic patterns in neuroimage, and the role of neuropsychological rehabilitation.