Long-term Cognitive and Psychiatric Issues in COVID-19 Survivors

A new study published in The Lancet Psychiatry examined whether mental and cognitive symptoms begin or continue after a year of hospitalization due to coronavirus illness 2019 (COVID-19). They looked into early features of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection that are predictive of long-term symptoms and associations between symptoms and functioning at work.

Context
In hospitalized individuals, COVID-19 increases the risk of mental and cognitive consequences, including depression, anxiety, and cognitive impairments. It is uncertain whether neuropsychiatric abnormalities begin or continue after the first year, whether acute COVID-19 characteristics predict subsequent results, and whether symptoms impact occupational functioning due to a lack of long-term longitudinal evidence. Emergent disorders and delayed diagnosis cannot be distinguished by electronic health data. There aren’t many studies tracking the development of new or enduring symptoms or evaluating cognitive impairments.

About the study
In order to find features of acute COVID-19 that predict these outcomes and evaluate symptom connection with occupational changes, researchers evaluated the development and evolution of tiredness, cognitive, and psychiatric symptoms across time in the current prospective cohort, longitudinal study.

Adults admitted to any of the National Health Service (NHS) hospitals in the United Kingdom as a result of a SARS-CoV-2 infection were included in the Post-hospitalization COVID-19 (PHOSP-COVID) trial. Digital cognitive evaluations and clinical assessment scales were completed two to three years after hospitalization by COVID-19 (C-Fog) people who were followed for three years following their hospitalization in a subgroup study.

Eight categories of cognition were covered by the Cognitron battery tests that participants completed. The domains included verbal analogies, spatial planning, spatial working memory, immediate and delayed object memory, two-dimensional mental manipulation, and simple reaction speed. The seven-item Generalized Anxiety Disorder (GAD7) scale for anxiety, the Cognitive Change Index (CCI-20), the Patient Symptom Questionnaire (C-PSQ) to assess subjective cognitive decline, and the Functional Assessment of Chronic Illness Therapy—Fatigue (FACIT-F) Scale were also completed by participants. The Patient Health Questionnaire (PHQ9) was used to assess depression.

At six-month, one-year, and two-to three-year follow-ups after hospitalization, the researchers assessed the risks of symptom progression and whether acute COVID-19 features predicted symptoms at the latter time. After two to three years, participants filled out questionnaires about changes in their work status or occupation to evaluate the causes for the changes as well as any accompanying symptoms.

The examinations were carried out by the researchers from November 23, 2022, to May 1, 2023. After correcting for age, sex, and length of stay in the hospital, they calculated the odds ratios (OR) for analysis using multivariate linear regressions. They examined five variables—acute severity markers, psychiatric or neurological comorbidity history, recovery clusters, clinical scales, and two biocognitive profiles—to predict fatigue, psychiatric, and cognitive outcomes two to three years after COVID-19. Benjamini-Hochberg adjustments were applied to all results.

In summary
The study discovered that growing symptom incidence and deterioration of prominent symptoms at six months led to an increase in cognitive and mental symptoms in the first two to three years after COVID-19 hospitalization. Later symptom onset may be prevented by early symptom detection and treatment. Transitions in occupation are common and linked to cognitive deficits that are both subjective and objective. To reduce COVID-19’s functional and financial limitations, interventions that support cognitive recovery or stop deterioration are needed.

For More Information: Cognitive and psychiatric symptom trajectories 2–3 years after hospital admission for COVID-19: a longitudinal, prospective cohort study in the UK, The Lancet Psychiatry, DOI: https://doi.org/10.1016/ S2215-0366(24)00214-