Perceived cognitive deficits in first 4 weeks of COVID-19 could predict long COVID

Key takeaways:

• Of the 766 patients with COVID-19, 36.1% perceived a cognitive deficit.
• Those who reported perceived cognitive deficits in the first 4 weeks of infection were more likely to report long COVID symptoms.

Patients who reported cognitive deficits in the first month of a COVID-19 diagnosis were more likely to develop long COVID than those without perceived deficits, according to study results published in JAMA Network Open.

Those who are in the acute phase of SARS-CoV-2 infection or have long COVID commonly face neuropsychiatric symptoms, Teresa C. Liu, MD, MPH, a primary care fellow at the University of California, Los Angeles, and colleagues wrote, but not much is known about the connections between early-presenting neuropsychiatric symptoms and long COVID.

“So-called brain fog in particular has been a common and debilitating symptom affecting all age groups. Other neurocognitive symptoms associated with long COVID include memory problems, difficulty concentrating, trouble focusing, and posttraumatic stress disorder,” Liu and colleagues wrote. “Given the potential long-term impact of neurocognitive deficits on quality of life and productivity, it is important to understand potential factors associated with cognitive dysfunction during the acute phase of SARS-CoV-2.”

The researchers conducted a prospective cohort study in which they explored perceived levels of cognitive deficit, factors associated with those deficits in the acute phase of SARS-CoV-2 infection and the associations between those deficits and long COVID.

The analysis included 766 adults with a laboratory-confirmed symptomatic SARS-CoV-2 infection who were enrolled in the UCLA‘s SARS-CoV-2 Ambulatory Program. The participants answered survey questions regarding perceived cognitive deficits modified from the Perceived Deficits Questionnaire, Fifth Edition, and scored perceived cognitive deficits on a scale from 0 to 4. They also answered questions on long COVID symptoms at 30, 60 and 90 days after hospital discharge or initial laboratory-confirmed infection. They determined long COVID development by patients' reports of persistent symptoms 60 or 90 days after initial infection or hospital discharge.

Of the 766 participants, Liu and colleagues reported that 36.1% perceived a cognitive deficit, with 14.6% having a mean score greater than 1.5 and 21.4% having a mean score between 0 and 1.5. Diagnosis of depressive disorder (OR =1.51; 95% CI, 1.23-1.86) and prior cognitive difficulties (OR = 1.46; 95% CI, 1.16-1.83) were associated with reports of a perceived cognitive deficit.

Notably, 42.8% of patients who reported perceived cognitive deficits in the first 4 weeks of their infection reported long COVID symptoms compared with 21.4% of those without perceived cognitive deficits (P < .001).

“To some degree, these findings may help us disentangle the complex construct that is long COVID,” Liu and colleagues wrote.

After adjusting for demographic and clinical factors, the researchers wrote that, compared with no perceived cognitive deficits, perceived cognitive deficits in the first 4 weeks of SARS-CoV-2 were associated with long COVID symptoms. Patients with a cognitive deficit score of 0 to 1.5 had an OR of 2.42 (95% CI, 1.62-3.6) and patients with cognitive deficit score of greater than 1.5 had an OR of 2.97 (95% CI, 1.86-4.75).

“These data suggest that the constructs of affect and control play a substantial role in the development of long COVID for at least some patients,” Liu and colleagues wrote. “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.”