Title : Cognitive Inhibition Deficit in Post COVID-19 Syndrome
Abstract:
Background and Objectives: As the COVID-19 pandemic progresses, an increasing amount of research points towards the importance and prevalence of long-term neurocognitive symptoms following infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).
Design: A PCR test confirmed SARS-CoV-2 infection in our 134 participants at least 12 weeks prior to the interview. Questions focusing on sociodemographic information, past medical history and COVID-19 infection were administered over the phone, followed by standardized neuropsychological tests and health questionnaires screening anxiety, depression, fatigue and autonomy,
Results: This study is the first to observe prefrontal inhibition deficits with the Hayling test. An impairment of cognitive flexibility and inhibition was revealed in 38.8% of participants (n=52), as assessed by an abnormal score on the neuropsychological test. Severity of depression, hospital or intensive care unit (ICU) admission and the duration of hospital or ICU stay predicted an abnormal Hayling score. An abnormal TICS evaluation in 19.4% of participants (n=25) showcased a global impairment of cognition and cognitive efficiency, while 13.4% of participants (n=18) had an abnormal Oral Trail Making Test (TMT) result. Executive dysfunction was screened in 56.0% of patients (n=76) as evidenced by an abnormal TMT test or Hayling test. Furthermore, 56.7% of participants (n=77) showed signs of cognitive impairment, receiving an abnormal score on at least one neuropsychological assessment. Regarding general health questionnaires, 55.2% of patients (n=74) had symptoms of psychiatric illness, while 21.6% (n=29) of patients had moderate to severe anxiety or depression. Specifically, GAD-7 questionnaire screened anxiety of mild severity in 20.9% of patients, of moderate severity in 7.5% of participants and severe anxiety in 5.2%. Regarding depression, the PHQ-9 questionnaire revealed mild symptoms of depression in 20.9%, moderate depression in 11.9%, moderately severe depression in 3.7% and severe depression in 3.0% of study participants. Fatigue was screened in 70.9% of patients. (n=95)
Discussion: This study supports the extensive literature on the cognitive and neuropsychiatric sequelae of COVID-19. Hayling’s test results suggests long-lasting inhibition deficits, validating and expanding on past Stroop test data. Devoid of correlation between the duration elapsed since the initial infection and the interview, this study suggests that persistent cognitive impairments may not improve with time. Furthermore, statistically significant correlations between the severity of depression and inhibition deficits after COVID-19 infection shed light on similar pathophysiological mechanism, and the interesting interplay between depression and cognition in post COVID-19 syndrome. The orbitofrontal cortex plays a crucial role in inhibition functions, in addition to social and emotional regulation. Thus, these frontal inhibition deficits lend support to the hypothesis that SARS-CoV-2 can invade the CNS from the olfactory tract, due to the anatomical contiguity of the cribriform plate and the orbitofrontal cortex.
Conclusion: It is becoming evident that there is an ever-increasing need for physical and cognitive rehabilitation in patients who have had COVID-19. Future research should assess inhibition deficits in a longitudinal matter to assess the progression of these impairments.
What will audience learn from your presentation?
• Due to the significant prevalence and social burden of post COVID-19 syndrome cognitive sequelae, it is important for clinicians to be aware of newly discovered deficits. The audience will learn about the prevalence of inhibition deficits in post COVID-19 syndrome patients, how to recognize such deficits and their consequences.
• The audience will learn about mechanisms underlying inhibition deficits in COVID-19 and its close relation with depression. An intriguing interplay between these two prevalent COVID-19 sequelae leads to a vicious cycle, emphasizing the need for longitudinal care and therapy in post COVID-19 syndrome patients.
• By illustrating the important relation between the severity of COVID-19 infection and subsequent cognitive impairment, the audience will gain insights on the how greater infection severity can translate to neuronal injury, leading to a significantly higher frequency and severity of cognitive impairment. In the clinical setting, this will allow clinicians to anticipate persistent cognitive deficits in a population, allowing them to address their longitudinal need for care and rehabilitation.
