Poster Session 09 Program Schedule
02/16/2024
03:30 pm - 04:45 pm
Room: Shubert Complex (Posters 1-60)
Poster Session 09: Epilepsy | Oncology | MS | Infectious Disease
Final Abstract #24
Inpatient Encephalopathy and Neuropsychological Outcome of COVID-19 in a Post-Rehabilitation Sample
Cari Cohen, Rosalind Franklin University of Medicine and Science, North Chicago, United States
Susan Brady, Northwestern Medicine Marianjoy Rehabilitation Hospital, Wheaton, United States
Eric Larson, Northwestern Medicine Marianjoy Rehabilitation Hospital, Wheaton, United States
Category: Infectious Disease (HIV/COVID/Hepatitis/Viruses)
Keyword 1: delirium
Objective:
Alongside cardinal respiratory symptoms of SARS-CoV-2 (COVID-19), the prevalence of neurological complications has been consistently documented in acute and post-acute infections. One of the most highlighted neurological manifestations among patients is altered mental status, termed “COVID-encephalopathy” (CE). The presence of encephalopathy or delirium in similar respiratory illnesses (e.g., ARDS) has been historically associated with poorer functional and cognitive outcomes. Therefore, as research about long-term effects of COVID-19 begins to unfold, it is important to understand the implications in functioning in the context of CE.
To date, few studies have examined neuropsychological outcomes among COVID patients who have recovered from critical illness that required hospitalization. The objectives of the current study were (1) to examine neuropsychological outcomes of discharged COVID-19 patients following acute hospitalization and rehabilitation (2) identify persistent issues associated with history of CE.
Participants and Methods:
A retrospective chart review showed that out of a total of 36 patients who underwent inpatient rehabilitation after a COVID diagnosis,18 had documentation of encephalopathy (CE+) and 18 did not (CE-). At follow-up, mean age was 65.75 years (SD= 10.64) and mean years of education was 14.69 (SD= 2.5). All participants received inpatient rehabilitation after acute care hospitalization for COVID-19 infection between March 2020 – 2021.
Follow-up neuropsychological assessment was conducted at the outpatient center of a freestanding rehabilitation facility between January 2022 and June 2023. Standard battery of tests included: MoCA, TOMM, TOPF, RBANS Form A, Similarities, Digit Span and Matrix Reasoning subtests of the WAIS-IV, Verbal Fluency (FAS/AN), BNT, TMT, Stroop, PHQ-9, PROMIS Fatigue and Anxiety. The Brief Interview for Mental Status (BIMS) was used to assess orientation.
Results:
The overall sample generally performed in the low average to average range compared to the general population across neuropsychological measures. Planned comparisons showed presence of encephalopathy during inpatient care did not predict cognitive performance at follow-up (all p values >.05), but exploratory analyses showed inpatient encephalopathy predicted lower anxiety at follow-up [t(34)= 2.837, p=.008].
Further exploratory analyses revealed other correlates of neuropsychological outcome at follow-up include premorbid functioning, mental status at admission and social determinants of health. High estimated premorbid IQ was associated with better RBANS delayed memory r(36)= .50 and RBANS total scores r(36)= .47, both p<.01; high BIMS performance during inpatient rehab admission was associated with better performance on RBANS delayed memory r(28)= .43 and RBANS total scores r(28)= .48, both p<.05; whereas high socioeconomic hardship was associated with worse performance on RBANS delayed memory r(36)= .52 and RBANS total scores r(36)= .58, both p<.001.
Conclusions:
Overall, it appears that follow-up neuropsychological performance among COVID-19 patients was not discrepant from the general population and cognition was comparable across CE groups. However, it is evident that pre-existing factors besides presence of encephalopathy that predict poorer neuropsychological outcome long-term in this population. Further research is needed to confirm the role of these other variables on cognitive functioning after COVID-19 infection.
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