INS NYC 2024 Program

Poster	Poster Session 09 Program Schedule 02/16/2024 03:30 pm - 04:45 pm Room: Majestic Complex (Posters 61-120) Poster Session 09: Epilepsy \| Oncology \| MS \| Infectious Disease Final Abstract #103 0%-100% Prevalence of Cognitive Impairment Post-Covid-19 Infection: A Cautionary Tale Victoria Sanborn, Brown University/Rhode Island Hospital - Lifespan, Providence, United States Mary Simons, Marquette University, Milwaukee, United States James Hoelzle, Marquette University, Milwaukee, United States David Marra, Veterans Affairs Boston Healthcare System, Boston, United States Category: Infectious Disease (HIV/COVID/Hepatitis/Viruses) Keyword 1: infectious disease Keyword 2: cognitive screening Objective: According to the World Health Organization, over 769 million people globally have been infected by the SARS-CoV-2 virus, resulting in Covid-19. There is widespread interest in the impact of Covid-19 on the brain and cognitive functions. However, a thorough literature review raises important questions about how post-Covid-19 cognitive impairment (CI) has been evaluated and interpreted. We aim to provide a qualitative overview of the research on CI following Covid-19 infection. Participants and Methods: We conducted a systematic review using search terms such as “Covid-19” and “neuropsychological assessment” through PubMed in March 2022. We included peer-reviewed articles written or translated to English that examined adult samples (age 18+) with PCR-confirmed Covid-19 infection who were administered well-established neuropsychological measures. We extracted data regarding prevalence of CI, how CI was defined by the authors, as well as types of cognitive measures. We also extracted variables that may influence cognitive performance (e.g., age, disease severity, time since infection, prevalence of mood symptoms, utilization of performance validity tests). Results: 146 articles were screened for relevance and 48 met inclusion criteria. Five studies examined outcomes based on Covid-19 severity subgroups and, as such, 58 total samples were included in the qualitative review. Sample sizes ranged from 8-740 (M=93.94, SD=115.19). Mean age of patients ranged from 35-72 years (M=58.49, SD_means=7.96). Twenty-nine studies reported mood/psychological symptoms which ranged from 2-97% prevalence, though assessments and interpretations varied. Time since infection ranged from 0 to 393 days (M=123.51, SD=93.20). There was striking variability in how CI was evaluated across studies, ranging from the use of 1 brief cognitive screener to 11 neuropsychological tests. Interpretation of CI also varied, even when using common assessments with established cutoff scores (e.g., MoCA cutoff scores of <15.5 to <26). Rates of CI evidenced by impaired performance in ≥1 cognitive domain ranged from 0-100% (M = 41.49%, SD = 24.21%). There was also a wide range of reported CI prevalence across Covid-19 severity subgroups. One of the fifty-eight samples included patients who were asymptomatic (CI = 7.7%), six samples with mild symptoms only (CI = 3-85.7%), three with mild-to-moderate symptoms (CI = 15-100%), twelve with mixed severity of symptoms (CI = 15-73.2%), five with moderate symptoms only (CI = 18-62.5%), sixteen with moderate-to-severe symptoms (CI = 8.6-62.5%), thirteen with severe symptoms only (CI = 6.4-81%), one with critical symptoms (CI = 5%), and one without Covid severity description (CI=0%). Consideration of and controls for variables known to impact cognitive performance (e.g., age, education, mood, time since infection) were varied and limited. Only one study included performance validity tests. Conclusions: Estimates for the prevalence of CI following Covid-19 infection are remarkably inconsistent, undoubtedly due to variability in approach and interpretation of cognitive testing. Even when accounting for time since infection and severity of symptoms, reported prevalence of CI ranged widely from 0-100%. These findings signal a clear need for careful consideration of cognitive testing outcomes when completed in haste and/or without the consultation of a neuropsychologist. Future studies examining CI due to Covid-19 should include robust samples and examine factors known to impact performance on cognitive testing with careful consideration of the psychometrics of cognitive tests and utilization of sound methodology.

Poster

02/16/2024
03:30 pm - 04:45 pm
Room: Majestic Complex (Posters 61-120)

Poster Session 09: Epilepsy | Oncology | MS | Infectious Disease

Final Abstract #103

0%-100% Prevalence of Cognitive Impairment Post-Covid-19 Infection: A Cautionary Tale

Victoria Sanborn, Brown University/Rhode Island Hospital - Lifespan, Providence, United States
Mary Simons, Marquette University, Milwaukee, United States
James Hoelzle, Marquette University, Milwaukee, United States
David Marra, Veterans Affairs Boston Healthcare System, Boston, United States

Category: Infectious Disease (HIV/COVID/Hepatitis/Viruses)

Keyword 1: infectious disease
Keyword 2: cognitive screening

Objective:

According to the World Health Organization, over 769 million people globally have been infected by the SARS-CoV-2 virus, resulting in Covid-19. There is widespread interest in the impact of Covid-19 on the brain and cognitive functions. However, a thorough literature review raises important questions about how post-Covid-19 cognitive impairment (CI) has been evaluated and interpreted. We aim to provide a qualitative overview of the research on CI following Covid-19 infection.

Participants and Methods:

We conducted a systematic review using search terms such as “Covid-19” and “neuropsychological assessment” through PubMed in March 2022. We included peer-reviewed articles written or translated to English that examined adult samples (age 18+) with PCR-confirmed Covid-19 infection who were administered well-established neuropsychological measures. We extracted data regarding prevalence of CI, how CI was defined by the authors, as well as types of cognitive measures. We also extracted variables that may influence cognitive performance (e.g., age, disease severity, time since infection, prevalence of mood symptoms, utilization of performance validity tests).

Results:

146 articles were screened for relevance and 48 met inclusion criteria. Five studies examined outcomes based on Covid-19 severity subgroups and, as such, 58 total samples were included in the qualitative review. Sample sizes ranged from 8-740 (M=93.94, SD=115.19). Mean age of patients ranged from 35-72 years (M=58.49, SD_means=7.96). Twenty-nine studies reported mood/psychological symptoms which ranged from 2-97% prevalence, though assessments and interpretations varied. Time since infection ranged from 0 to 393 days (M=123.51, SD=93.20). There was striking variability in how CI was evaluated across studies, ranging from the use of 1 brief cognitive screener to 11 neuropsychological tests. Interpretation of CI also varied, even when using common assessments with established cutoff scores (e.g., MoCA cutoff scores of <15.5 to <26). Rates of CI evidenced by impaired performance in ≥1 cognitive domain ranged from 0-100% (M = 41.49%, SD = 24.21%). There was also a wide range of reported CI prevalence across Covid-19 severity subgroups. One of the fifty-eight samples included patients who were asymptomatic (CI = 7.7%), six samples with mild symptoms only (CI = 3-85.7%), three with mild-to-moderate symptoms (CI = 15-100%), twelve with mixed severity of symptoms (CI = 15-73.2%), five with moderate symptoms only (CI = 18-62.5%), sixteen with moderate-to-severe symptoms (CI = 8.6-62.5%), thirteen with severe symptoms only (CI = 6.4-81%), one with critical symptoms (CI = 5%), and one without Covid severity description (CI=0%). Consideration of and controls for variables known to impact cognitive performance (e.g., age, education, mood, time since infection) were varied and limited. Only one study included performance validity tests.

Conclusions:

Estimates for the prevalence of CI following Covid-19 infection are remarkably inconsistent, undoubtedly due to variability in approach and interpretation of cognitive testing. Even when accounting for time since infection and severity of symptoms, reported prevalence of CI ranged widely from 0-100%. These findings signal a clear need for careful consideration of cognitive testing outcomes when completed in haste and/or without the consultation of a neuropsychologist. Future studies examining CI due to Covid-19 should include robust samples and examine factors known to impact performance on cognitive testing with careful consideration of the psychometrics of cognitive tests and utilization of sound methodology.