Cognitive Impairment

Sequelae of COVID-19
Lily Guo, Furhan Yucab, Aman Mohapatra
COVID-19
At the end of 2019, a novel coronavirus was identified as the cause of a cluster of pneumonia cases in Wuhan, a city in the
Hubei Province of China. It rapidly spread, resulting in a global pandemic. By November 2021, over 3 billion individuals, or 44
percent of the world’s population, had been infected with SARS-CoV-2 at least once.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which causes COVID-19, results in symptoms that range from
asymptomatic infection to mild respiratory tract symptoms to severe pneumonia with acute respiratory distress syndrome
(ARDS) and multiorgan dysfunction. Direct person-to-person respiratory transmission is the primary means of transmission.

Among patients with advanced age and medical comorbidities, COVID-19 is frequently severe. Males have comprised a
disproportionately high number of critical cases and deaths in multiple cohorts worldwide and Black, Hispanic, and Southern
Asian individuals comprise a disproportionately high number of infections and deaths due to COVID-19 in the United States
and United Kingdom.
Pathophysiology
Coronaviruses are enveloped positive-stranded RNA viruses.

SARS-CoV-2 binds to ACE2 (its receptor) through the

receptor-binding domain of its spike protein, with cellular
protease TMPRSS2 aiding in entry.

Amino acid changes in the spike protein of SARS-CoV-2

[D614G (glycine for aspartic acid) substitution] has become
the dominant polymorphism globally
 Clinical Presentation
COVID19 can present symptomatically or asymptomatically. Symptomatic COVID19 presentation can include: cough,
myalgias, headache, diarrhea, sore throat, taste/smell abnormalities, sneezing and nasal congestion. All these symptoms
can range from mild to severe in intensity.

The most common serious symptom is pneumonia which is fever, cough, dyspnea, and bilateral infiltrates on chest
imaging.

Other severe complications can include heart failure, shock, stroke, seizures, and respiratory failure.

Long-term sequelae can include neurological complications and cognitive dysfunction due to prolonged inflammation.
Diagnosis

Nucleic acid amplification testing (NAAT) is the preferred diagnostic test.

Whom to test: Symptomatic patients. Asymptomatic patients need to be

tested if they have recently been in contact with a confirmed or suspected
case of COVID19 or are at risk for severe disease.
Are patients who were exposed to a COVID infection associated with a rise in cognitive impairment/fatigue?
Study Methods

Systematic searches were conducted and primary research articles which evaluated individuals
at least 12 weeks after confirmed COVID-19 diagnosis and specifically reported on fatigue,
cognitive impairment, inflammatory parameters, and/or functional outcomes were selected.

A meta-analysis of proportions was conducted using the random-effects restricted maximum-

likelihood model.
 Results

The literature search yielded 10,979 studies, and 81 studies were selected for inclusion. The cognitive impairment
meta-analysis comprised 43 studies, and 48 studies were included in the narrative synthesis.
32% of individuals experienced fatigue and 22% of individuals exhibited cognitive impairment 12 or more weeks
following COVID-19 diagnosis (95% CI, 0.17, 0.28; p < 0.001; n = 13,232; I2 = 98.0).
There was a non-significant trend towards a greater proportion of females than males who exhibited cognitive
impairment, however, the subgroup proportion for females was not statistically significant
34 studies investigated functional outcomes, frequently under quality of life (QOL) measures, in COVID-19 patients
12 or more weeks following diagnosis, and demonstrated functional impairment or reduction in at least one QOL
dimensions. Functional impairment post-COVID was exhibited by 21% to 63% of individuals; activity impairment
(including difficulties with performing daily tasks, self-care, and mobility) in 1.0% to 68.4%
References

McIntosh, K., Hirsch, M. S; Bloom, A. (n.d.). COVID-19: Epidemiology, virology, and prevention. uptodate.com.

Post-COVID Syndrome Discussion: Maltezou HC, Pavli A, Tsakris A. Post-COVID Syndrome: An Insight on Its
Pathogenesis. Vaccines (Basel). 2021 May 12;9(5):497. doi: 10.3390/vaccines9050497. PMID: 34066007; PMCID:
PMC8151752.

Article: Ceban F, Ling S, Lui LMW, et al. Fatigue and cognitive impairment in Post-COVID-19 Syndrome: A systematic
review and meta-analysis. Brain Behav Immun. 2022;101:93-135. doi:10.1016/j.bbi.2021.12.020

COVID-19 Treatment Guidelines Panel. Coronavirus Disease 2019 (COVID-19) Treatment Guidelines. National Institutes
of Health. Available at https://www.covid19treatmentguidelines.nih.gov/. Accessed [5/19/22].