cognitive consequences of cOViD-19: results of a cohort study from South America
Background: Neurological and psychiatric manifestations associated with SARS-CoV-2 infection have been reported throughout the scientific literature. However, studies on post-COVID cognitive impairment in people with no previous cognitive complaint are scarce. Objective: We aim to investigate the im...
- Autores:
-
Crivelli, Lucía
Calandri, Ismael Luis
Carello, María Agostina
Keller, Greta
Martínez, Carlos
Arruabarrena, Micaela
Corvalán, Nicolás
Crivelli, Lucía
Allegri, Ricardo Francisco
- Tipo de recurso:
- Article of journal
- Fecha de publicación:
- 2021
- Institución:
- Corporación Universidad de la Costa
- Repositorio:
- REDICUC - Repositorio CUC
- Idioma:
- eng
- OAI Identifier:
- oai:repositorio.cuc.edu.co:11323/9357
- Acceso en línea:
- https://hdl.handle.net/11323/9357
https://doi.org/10.1590/0004-282X-ANP-2021-0320
https://repositorio.cuc.edu.co/
- Palabra clave:
- Cognitive dysfunction
COVID-19
Executive function
Memory
Neuropsychology
COVID-19
Neuropsicología
Disfunción cognitiva
Función ejecutiva
Memoria
- Rights
- openAccess
- License
- Atribución-NoComercial-CompartirIgual 4.0 Internacional (CC BY-NC-SA 4.0)
id |
RCUC2_02dce51cc95cda7c7d64fe0367fc9e9c |
---|---|
oai_identifier_str |
oai:repositorio.cuc.edu.co:11323/9357 |
network_acronym_str |
RCUC2 |
network_name_str |
REDICUC - Repositorio CUC |
repository_id_str |
|
dc.title.eng.fl_str_mv |
cognitive consequences of cOViD-19: results of a cohort study from South America |
dc.title.spa.fl_str_mv |
Consecuencias cognitivas del COVID-19: Resultados de un estudio de cohorte sudamericano |
title |
cognitive consequences of cOViD-19: results of a cohort study from South America |
spellingShingle |
cognitive consequences of cOViD-19: results of a cohort study from South America Cognitive dysfunction COVID-19 Executive function Memory Neuropsychology COVID-19 Neuropsicología Disfunción cognitiva Función ejecutiva Memoria |
title_short |
cognitive consequences of cOViD-19: results of a cohort study from South America |
title_full |
cognitive consequences of cOViD-19: results of a cohort study from South America |
title_fullStr |
cognitive consequences of cOViD-19: results of a cohort study from South America |
title_full_unstemmed |
cognitive consequences of cOViD-19: results of a cohort study from South America |
title_sort |
cognitive consequences of cOViD-19: results of a cohort study from South America |
dc.creator.fl_str_mv |
Crivelli, Lucía Calandri, Ismael Luis Carello, María Agostina Keller, Greta Martínez, Carlos Arruabarrena, Micaela Corvalán, Nicolás Crivelli, Lucía Allegri, Ricardo Francisco |
dc.contributor.author.spa.fl_str_mv |
Crivelli, Lucía Calandri, Ismael Luis Carello, María Agostina Keller, Greta Martínez, Carlos Arruabarrena, Micaela Corvalán, Nicolás |
dc.contributor.author.none.fl_str_mv |
Crivelli, Lucía Allegri, Ricardo Francisco |
dc.subject.proposal.eng.fl_str_mv |
Cognitive dysfunction COVID-19 Executive function Memory Neuropsychology |
topic |
Cognitive dysfunction COVID-19 Executive function Memory Neuropsychology COVID-19 Neuropsicología Disfunción cognitiva Función ejecutiva Memoria |
dc.subject.proposal.spa.fl_str_mv |
COVID-19 Neuropsicología Disfunción cognitiva Función ejecutiva Memoria |
description |
Background: Neurological and psychiatric manifestations associated with SARS-CoV-2 infection have been reported throughout the scientific literature. However, studies on post-COVID cognitive impairment in people with no previous cognitive complaint are scarce. Objective: We aim to investigate the impact of COVID-19 on cognitive functions in adults without cognitive complaints before infection and to study cognitive dysfunction according to disease severity and cognitive risk factors. Methods: Forty-five post-COVID-19 patients and forty-five controls underwent extensive neuropsychological evaluation, which assessed cognitive domains such as memory, language, attention, executive functions, and visuospatial skills, including psychiatric symptomatology scales. Data were collected on the severity of infection, premorbid medical conditions, and functionality for activities of daily living before and after COVID-19. Results: Significant differences between groups were found in cognitive composites of memory (p=0.016, Cohen’s d= 0.73), attention (p<0.001, Cohen’s d=1.2), executive functions (p<0.001, Cohen’s d=1.4), and language (p=0.002, Cohen’s d=0.87). The change from premorbid to post-infection functioning was significantly different between severity groups (WHODAS, p=0.037). Self-reported anxiety was associated with the presence of cognitive dysfunction in COVID-19 subjects (p=0.043). Conclusion: Our results suggest that the presence of cognitive symptoms in post-COVID-19 patients may persist for months after disease remission and argue for the inclusion of cognitive assessment as a protocolized stage of the post-COVID examination. Screening measures may not be sufficient to detect cognitive dysfunction in post-COVID-19 patients. |
publishDate |
2021 |
dc.date.issued.none.fl_str_mv |
2021-10-11 |
dc.date.accessioned.none.fl_str_mv |
2022-07-11T15:03:03Z |
dc.date.available.none.fl_str_mv |
2022-07-11T15:03:03Z |
dc.type.spa.fl_str_mv |
Artículo de revista |
dc.type.coar.fl_str_mv |
http://purl.org/coar/resource_type/c_2df8fbb1 |
dc.type.coarversion.fl_str_mv |
http://purl.org/coar/version/c_970fb48d4fbd8a85 |
dc.type.coar.spa.fl_str_mv |
http://purl.org/coar/resource_type/c_6501 |
dc.type.content.spa.fl_str_mv |
Text |
dc.type.driver.spa.fl_str_mv |
info:eu-repo/semantics/article |
dc.type.redcol.spa.fl_str_mv |
http://purl.org/redcol/resource_type/ART |
format |
http://purl.org/coar/resource_type/c_6501 |
dc.identifier.issn.spa.fl_str_mv |
16784227 |
dc.identifier.uri.spa.fl_str_mv |
https://hdl.handle.net/11323/9357 |
dc.identifier.url.spa.fl_str_mv |
https://doi.org/10.1590/0004-282X-ANP-2021-0320 |
dc.identifier.doi.spa.fl_str_mv |
10.1590/0004-282X-ANP-2021-0320 |
dc.identifier.instname.spa.fl_str_mv |
Corporación Universidad de la Costa |
dc.identifier.reponame.spa.fl_str_mv |
REDICUC - Repositorio CUC |
dc.identifier.repourl.spa.fl_str_mv |
https://repositorio.cuc.edu.co/ |
identifier_str_mv |
16784227 10.1590/0004-282X-ANP-2021-0320 Corporación Universidad de la Costa REDICUC - Repositorio CUC |
url |
https://hdl.handle.net/11323/9357 https://doi.org/10.1590/0004-282X-ANP-2021-0320 https://repositorio.cuc.edu.co/ |
dc.language.iso.none.fl_str_mv |
eng |
language |
eng |
dc.relation.ispartofjournal.spa.fl_str_mv |
Arquivos de Neuro-Psiquiatria |
dc.relation.references.spa.fl_str_mv |
Khan S, Siddique R, Shereen MA, Ali A, Liu J, Bai Q, et al. Correction for Khan et al., “Emergence of a Novel Coronavirus, Severe Acute Respiratory Syndrome Coronavirus 2: Biology and Therapeutic Options”. J Clin Microbiol. 2020 Jul 23;58(8):e01297-20. https://doi. org/10.1128/JCM.01297-20 Helms J, Kremer S, Merdji H, Clere-Jehl R, Schenck M, Kummerlen C, et al. Neurologic features in severe SARS-CoV-2 infection. N Engl J Med. 2020 Jun 4;382(23):2268-70. https://doi.org/10.1056/ NEJMc2008597 Mao L, Jin H, Wang M, Hu Y, Chen S, He Q, et al. Neurologic manifestations of hospitalized patients with Coronavirus disease 2019 in Wuhan, China. JAMA Neurol. 2020 Jun 1;77(6):683-90. https:// doi.org/10.1001/jamaneurol.2020.1127 Ellul MA, Benjamin L, Singh B, Lant S, Michael BD, Easton A, et al. Neurological associations of COVID-19. Lancet Neurol. 2020 Sep 1;19(9):P767-83. https://doi.org/10.1016/S1474-4422(20)30221-0 Troyer EA, Kohn JN, Hong S. Are we facing a crashing wave of neuropsychiatric sequelae of COVID-19? Neuropsychiatric symptoms and potential immunologic mechanisms. Brain Behav Immun. 2020 Jul;87:34-9. https://doi.org/10.1016/j.bbi.2020.04.027 Heneka MT, Golenbock D, Latz E, Morgan D, Brown R. Immediate and long-term consequences of COVID-19 infections for the development of neurological disease. Alz Res Therapy. 2020 Jun 4;12(1):69. https:// doi.org/10.1186/s13195-020-00640-3 Mazza C, Ricci E, Biondi S, Colasanti M, Ferracuti S, Napoli C, et al. A nationwide survey of psychological distress among italian people during the COVID-19 pandemic: immediate psychological responses and associated factors. Int J Environ Res Public Health. 2020 May 2;17(9):3165. https://doi.org/10.3390/ijerph17093165 Hampshire A, Trender W, Chamberlain SR, Jolly AE, Grant JE, Patrick F, et al. Cognitive deficits in people who have recovered from COVID-19. EClinicalMedicine. 2021 Sep 1;39:101044. https://doi. org/10.1016/j.eclinm.2021.101044 Triana RM, Martínez CC, Almeida TM, González MÁÁ, Vaillant TZ, Barreto YR. Cognitive performance in convalescent covid-19 patients. Rev Cuba Hematol Immunol Hemoter. 2020;36(special issue):1-17. Hosp JA, Dressing A, Blazhenets G, Bormann T, Rau A, Schwabenland M, et al. Cognitive impairment and altered cerebral glucose metabolism in the subacute stage of COVID-19. Brain. 2021 May 7;144(4):1263-76. https://doi.org/10.1093/brain/awab009 Ortelli P, Ferrazzoli D, Sebastianelli L, Engl M, Romanello R, Nardone R, et al. Neuropsychological and neurophysiological correlates of fatigue in post-acute patients with neurological manifestations of COVID-19: Insights into a challenging symptom. J Neurol Sci. 2021 Jan 15;420:117271. https://doi.org/10.1016/j.jns.2020.117271 Alemanno F, Houdayer E, Parma A, Spina A, Del Forno A, Scatolini A, et al. COVID-19 cognitive deficits after respiratory assistance in the subacute phase: a COVID-rehabilitation unit experience. PLoS One. 2021 Feb 8;16(2):e0246590. https://doi.org/10.1371/journal. pone.0246590 Brutto OHD, Wu S, Mera RM, Costa AF, Recalde BY, Issa NP. Cognitive decline among individuals with history of mild symptomatic SARS-CoV-2 infection: a longitudinal prospective study nested to a population cohort. Eur J Neurol. 2021 Oct;28(10):3245-53. https://doi. org/10.1111/ene.14775 Zhou J, Liu C, Sun Y, Huang W, Ye K. Cognitive disorders associated with hospitalization of COVID-19: results from an observational cohort study. Brain Behav Immun. 2021 Jan;91:383-92. https://doi. org/10.1016/j.bbi.2020.10.019 Miskowiak KW, Johnsen S, Sattler SM, Nielsen S, Kunalan K, Rungby J, et al. Cognitive impairments four months after COVID-19 hospital discharge: pattern, severity and association with illness variables. Eur Neuropsychopharmacol. 2021 May;46:39-48. https://doi. org/10.1016/j.euroneuro.2021.03.019 Pan American Health Organization / World Health Organization. Epidemiological Update: Coronavirus disease (COVID-19) Washington (DC): PAHO/WHO; 2021. Brucki SMD, Corazza LA, de Queiroz AP, Barros MP, Tatsch JFS, Riso IL, et al. Neurological complications in COVID-19 patients from Latin America. Brain. 2021 Apr 12;144(3):e29. https://doi.org/10.1093/ brain/awaa440 Amalakanti S, Arepalli KVR, Jillella JP. Cognitive assessment in asymptomatic COVID-19 subjects. Virusdisease. 2021 Feb 15;32(1):1- 4. https://doi.org/10.1007/s13337-021-00663-w Raman B, Cassar MP, Tunnicliffe EM, Filippini N, Griffanti L, Alfaro Almagro F, et al. Medium-term effects of SARS-CoV-2 infection on multiple vital organs, exercise capacity, cognition, quality of life and mental health, post-hospital discharge. EClinicalMedicine. 2021 Jan 7;31:100683. https://doi.org/10.1016/j.eclinm.2020.100683 Woo MS, Malsy J, Pöttgen J, Zai SS, Ufer F, Hadjilaou A, et al. Frequent neurocognitive deficits after recovery from mild COVID-19. Brain Commun. 2020 Nov 23;2(2):fcaa205. https://doi.org/10.1093/ braincomms/fcaa205 WHO Working Group on the Clinical Characterisation and Management of COVID-19 infection. A minimal common outcome measure set for COVID-19 clinical research. Lancet Infect Dis. 2020 Aug 1;20(8):e192-97. https://doi.org/10.1016/S1473-3099(20)30483- 7 Serrano CM, Sorbara M, Minond A, Finlay JB, Arizaga RL, Iturry M, et al. Validation of the Argentine version of the Montreal cognitive assessment test (MOCA): a screening tool for mild cognitive impairment and mild dementia in elderly. Dement Neuropsychol. 2020 Jun-Apr;14(2):145-52. https://doi.org/10.1590/1980- 57642020dn14-020007 Reitan RM. Validity of the trail making test as an indicator of organic brain damage. Percept Motor Skill. 1958 Dec 1;8(3):271–6. https://doi. org/10.2W466/pms.1958.8.3.271 Richardson JTE. MMeasures of short-term memory: a historical review. Cortex. 2007 Jul;43(5):635–50. https://doi.org/10.1016/s0010- 9452(08)70493-3 Wechsler D. Wechsler memory scale-revised manual. San Antonio (TX): The Psychological Corporation; 1987. 150 p. Craft S, Newcomer J, Kanne S, Dagogo-Jack S, Cryer P, Sheline Y, et al. Memory improvement following induced hyperinsulinemia in Alzheimer’s disease. Neurobiol Aging. 1996 Jan-Feb;17(1):123-30. https://doi.org/10.1016/0197-4580(95)02002-0 Rey A. L’examen Clinique En Psychologie. 2nd ed. Paris: Presse Universitaires de France; 1964 Possin KL, Laluz VR, Alcantar OZ, Miller BL, Kramer JH. Distinct neuroanatomical substrates and cognitive mechanisms of figure copy performance in Alzheimer’s disease and behavioral variant frontotemporal dementia. Neuropsychologia. 2011 Jan;49(1):43-8. https://doi.org/10.1016/j.neuropsychologia.2010.10.026 Berg EA. A simple objective technique for measuring flexibility in thinking. J Gen Psychol. 1948 Jul;39:15-22. https://doi.org/10.1080/0 0221309.1948.9918159 Stroop JR. Studies of interference in serial verbal reaction. J Exp Psychol. 1935;18(6):643-62. https://doi.org/10.1037/h0054651 Butman J, Allegri RF, Harris P, Drake M. Spanish verbal fluency. Normative data in Argentina. Medicina (B Aires). 2000;60(5):561-4 Head H. Aphasia and Kindred Disorders of Speech (2 Volumes). New York (NY): Hafner Publishing Company; 1963 Ivanova I, Salmon DP, Gollan TH. The multilingual naming test in Alzheimer’s disease: clues to the origin of naming impairments. J Int Neuropsychol Soc. 2013 Mar;19(3):272–83. https://doi.org/10.1017/ S1355617712001282 Morris JC, Heyman A, Mohs RC, Hughes JP, van Belle G, Fillenbaum G, et al. The Consortium to Establish a Registry for Alzheimer’s Disease (CERAD). Part I. Clinical and neuropsychological assessment of Alzheimer’s disease. Neurology. 1989 Sep 1;39(9):1159-65. https:// doi.org/10.1212/WNL.39.9.1159 Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983 Jun;67(6):361-70. https://doi. org/10.1111/j.1600-0447.1983.tb09716.x Kivipelto M, Ngandu T, Laatikainen T, Winblad B, Soininen H, Tuomilehto J. Risk score for the prediction of dementia risk in 20 years among middle aged people: a longitudinal, population-based study. Lancet Neurol. 2006 Sep 1;5(9):P735-41. https://doi. org/10.1016/S1474-4422(06)70537-3 WHO Working Group on the Clinical Characterisation and Management of COVID-19 infection. A minimal common outcome measure set for COVID-19 clinical research. Lancet Infect Dis. 2020 Aug 1;20(8):e192-7. https://doi.org/10.1016/S1473-3099(20)30483-7 Whiteside DM, Oleynick V, Holker E, Waldron EJ, Porter J, Kasprzak M. Neurocognitive deficits in severe COVID-19 infection: case series and proposed model. Clin Neuropsychol. 2021 May;35(4):799-818. https:// doi.org/10.1080/13854046.2021.1874056 Ermis U, Rust MI, Bungenberg J, Costa A, Dreher M, Balfanz P, et al. Neurological symptoms in COVID-19: a cross-sectional monocentric study of hospitalized patients. Neurol Res Pract. 2021 Mar 12;3(1):17. https://doi.org/10.1186/s42466-021-00116-1 Tolentino JC, Gjorup ALT, Schmidt GJ, Schmidt SL. Early attention impairment in a patient with COVID-19. Psychiatry Clin Neurosci. 2021 Feb;75(2):66-7. https://doi.org/10.1111/pcn.13178 Robinson OJ, Vytal K, Cornwell BR, Grillom C. The impact of anxiety upon cognition: perspectives from human threat of shock studies. Front Hum Neurosci. 2013 May 17;7:203. https://doi.org/10.3389/ fnhum.2013.00203 Rogers JP, Chesney E, Oliver D, Pollak TA, McGuire P, Fusar-Poli P, et al. Psychiatric and neuropsychiatric presentations associated with severe coronavirus infections: a systematic review and meta-analysis with comparison to the COVID-19 pandemic. Lancet Psychiatry. 2020 Jul 1;7(7):P611-27. https://doi.org/10.1016/S2215-0366(20)30203-0 Kanmogne GD, Fonsah JY, Umlauf A, Moul J, Doh RF, Kengne AM, et al. Effects of HIV infection, antiretroviral therapy, and immune status on the speed of information processing and complex motor functions in adult Cameroonians. Sci Rep. 2020 Aug 20;10(1):14016. https://doi. org/10.1038/s41598-020-70981-4 Raper J, Kovacs-Balint Z, Mavigner M, Gumber S, Burke MW, Habib J, et al. Long-term alterations in brain and behavior after postnatal Zika virus infection in infant macaques. Nat Commun. 2020 May 21;11(1):2534. https://doi.org/10.1038/s41467-020-16320-7 |
dc.relation.citationendpage.spa.fl_str_mv |
247 |
dc.relation.citationstartpage.spa.fl_str_mv |
240 |
dc.relation.citationissue.spa.fl_str_mv |
3 |
dc.relation.citationvolume.spa.fl_str_mv |
80 |
dc.rights.spa.fl_str_mv |
Atribución-NoComercial-CompartirIgual 4.0 Internacional (CC BY-NC-SA 4.0) |
dc.rights.uri.spa.fl_str_mv |
https://creativecommons.org/licenses/by-nc-sa/4.0/ |
dc.rights.accessrights.spa.fl_str_mv |
info:eu-repo/semantics/openAccess |
dc.rights.coar.spa.fl_str_mv |
http://purl.org/coar/access_right/c_abf2 |
rights_invalid_str_mv |
Atribución-NoComercial-CompartirIgual 4.0 Internacional (CC BY-NC-SA 4.0) https://creativecommons.org/licenses/by-nc-sa/4.0/ http://purl.org/coar/access_right/c_abf2 |
eu_rights_str_mv |
openAccess |
dc.format.extent.spa.fl_str_mv |
8 páginas |
dc.format.mimetype.spa.fl_str_mv |
application/pdf |
dc.publisher.spa.fl_str_mv |
Arquivos de Neuro-Psiquiatria |
dc.publisher.place.spa.fl_str_mv |
Brazil |
institution |
Corporación Universidad de la Costa |
dc.source.url.spa.fl_str_mv |
https://www.scielo.br/j/anp/a/yZytFJkkqqDJpQBQxPB9Pbw/?lang=en&format=pdf |
bitstream.url.fl_str_mv |
https://repositorio.cuc.edu.co/bitstreams/3247253e-de31-4661-b8c9-1439b8e58775/download https://repositorio.cuc.edu.co/bitstreams/959b9dbf-fb33-4ddb-9161-b44bf525795c/download https://repositorio.cuc.edu.co/bitstreams/d80cfd53-a02d-4004-a8f8-e08aa2423686/download https://repositorio.cuc.edu.co/bitstreams/6bc2dd9f-56dc-450a-a6ef-4ed41d687aeb/download |
bitstream.checksum.fl_str_mv |
ce4a0356c33b10cb81c104f78aa5164e e30e9215131d99561d40d6b0abbe9bad 5689a3a8c489ebdb7dd56f91af4077f3 6dcd80d18048153664a77b8e41a1b79b |
bitstream.checksumAlgorithm.fl_str_mv |
MD5 MD5 MD5 MD5 |
repository.name.fl_str_mv |
Repositorio de la Universidad de la Costa CUC |
repository.mail.fl_str_mv |
repdigital@cuc.edu.co |
_version_ |
1828166824411267072 |
spelling |
Crivelli, LucíaCalandri, Ismael LuisCarello, María AgostinaKeller, GretaMartínez, CarlosArruabarrena, MicaelaCorvalán, NicolásCrivelli, LucíaAllegri, Ricardo Franciscovirtual::816-12022-07-11T15:03:03Z2022-07-11T15:03:03Z2021-10-1116784227https://hdl.handle.net/11323/9357https://doi.org/10.1590/0004-282X-ANP-2021-032010.1590/0004-282X-ANP-2021-0320Corporación Universidad de la CostaREDICUC - Repositorio CUChttps://repositorio.cuc.edu.co/Background: Neurological and psychiatric manifestations associated with SARS-CoV-2 infection have been reported throughout the scientific literature. However, studies on post-COVID cognitive impairment in people with no previous cognitive complaint are scarce. Objective: We aim to investigate the impact of COVID-19 on cognitive functions in adults without cognitive complaints before infection and to study cognitive dysfunction according to disease severity and cognitive risk factors. Methods: Forty-five post-COVID-19 patients and forty-five controls underwent extensive neuropsychological evaluation, which assessed cognitive domains such as memory, language, attention, executive functions, and visuospatial skills, including psychiatric symptomatology scales. Data were collected on the severity of infection, premorbid medical conditions, and functionality for activities of daily living before and after COVID-19. Results: Significant differences between groups were found in cognitive composites of memory (p=0.016, Cohen’s d= 0.73), attention (p<0.001, Cohen’s d=1.2), executive functions (p<0.001, Cohen’s d=1.4), and language (p=0.002, Cohen’s d=0.87). The change from premorbid to post-infection functioning was significantly different between severity groups (WHODAS, p=0.037). Self-reported anxiety was associated with the presence of cognitive dysfunction in COVID-19 subjects (p=0.043). Conclusion: Our results suggest that the presence of cognitive symptoms in post-COVID-19 patients may persist for months after disease remission and argue for the inclusion of cognitive assessment as a protocolized stage of the post-COVID examination. Screening measures may not be sufficient to detect cognitive dysfunction in post-COVID-19 patients.Antecedentes: Las manifestaciones neurológicas de la infección por SARS-CoV-2 han sido reportadas en la literatura científica. Sin embargo, los estudios cognitivos post COVID-19 en personas sin queja cognitiva previa son escasos. Objetivo: Nuestro objetivo es investigar el impacto cognitivo del COVID-19 en adultos sin quejas cognitivas previas a la infección y estudiar el desempeño cognitivo de acuerdo a la severidad de la enfermedad y a los factores de riesgo cognitivo. Métodos: Cuarenta y cinco pacientes post COVID-19 y cuarenta y cinco controles sanos apareados por edad, género y educación realizaron una evaluación neuropsicológica, que evalúa memoria, lenguaje, atención, funciones ejecutivas, habilidades visuoespaciales, incluyendo además escalas de sintomatología psiquiátrica, y la recopilación de datos sobre la severidad de la infección, la salud premórbida y la funcionalidad. Resultados: Se encontraron diferencias significativas entre los grupos en los compuestos cognitivos de memoria (p=0,016, d de Cohen= 0,73), atención (p<0,001, d de Cohen= 1,2), funciones ejecutivas (p<0,001, d de Cohen=1,4) y lenguaje (p=0,002, d de Cohen=0,87). El cambio del funcionamiento premórbido al funcionamiento posterior a la infección, fue significativamente diferente entre los grupos de gravedad (WHODAS; p=0,037). La ansiedad autoinformada se asoció con la presencia de disfunción cognitiva en los sujetos de COVID-19 (p=0,043). Conclusión: Nuestros resultados sugieren que los síntomas cognitivos en pacientes post COVID-19 pueden permanecer hasta tres meses después de la remisión de la enfermedad. Este estudio aboga a favor de incluir la evaluación cognitiva como una etapa protocolizada del examen post COVID-19. Es posible que las medidas de cribado no sean suficientes para detectar la disfunción cognitiva en los pacientes post COVID-19.8 páginasapplication/pdfengArquivos de Neuro-PsiquiatriaBrazilAtribución-NoComercial-CompartirIgual 4.0 Internacional (CC BY-NC-SA 4.0)https://creativecommons.org/licenses/by-nc-sa/4.0/info:eu-repo/semantics/openAccesshttp://purl.org/coar/access_right/c_abf2cognitive consequences of cOViD-19: results of a cohort study from South AmericaConsecuencias cognitivas del COVID-19: Resultados de un estudio de cohorte sudamericanoArtículo de revistahttp://purl.org/coar/resource_type/c_6501http://purl.org/coar/resource_type/c_2df8fbb1Textinfo:eu-repo/semantics/articlehttp://purl.org/redcol/resource_type/ARThttp://purl.org/coar/version/c_970fb48d4fbd8a85https://www.scielo.br/j/anp/a/yZytFJkkqqDJpQBQxPB9Pbw/?lang=en&format=pdfArquivos de Neuro-PsiquiatriaKhan S, Siddique R, Shereen MA, Ali A, Liu J, Bai Q, et al. Correction for Khan et al., “Emergence of a Novel Coronavirus, Severe Acute Respiratory Syndrome Coronavirus 2: Biology and Therapeutic Options”. J Clin Microbiol. 2020 Jul 23;58(8):e01297-20. https://doi. org/10.1128/JCM.01297-20Helms J, Kremer S, Merdji H, Clere-Jehl R, Schenck M, Kummerlen C, et al. Neurologic features in severe SARS-CoV-2 infection. N Engl J Med. 2020 Jun 4;382(23):2268-70. https://doi.org/10.1056/ NEJMc2008597Mao L, Jin H, Wang M, Hu Y, Chen S, He Q, et al. Neurologic manifestations of hospitalized patients with Coronavirus disease 2019 in Wuhan, China. JAMA Neurol. 2020 Jun 1;77(6):683-90. https:// doi.org/10.1001/jamaneurol.2020.1127Ellul MA, Benjamin L, Singh B, Lant S, Michael BD, Easton A, et al. Neurological associations of COVID-19. Lancet Neurol. 2020 Sep 1;19(9):P767-83. https://doi.org/10.1016/S1474-4422(20)30221-0Troyer EA, Kohn JN, Hong S. Are we facing a crashing wave of neuropsychiatric sequelae of COVID-19? Neuropsychiatric symptoms and potential immunologic mechanisms. Brain Behav Immun. 2020 Jul;87:34-9. https://doi.org/10.1016/j.bbi.2020.04.027Heneka MT, Golenbock D, Latz E, Morgan D, Brown R. Immediate and long-term consequences of COVID-19 infections for the development of neurological disease. Alz Res Therapy. 2020 Jun 4;12(1):69. https:// doi.org/10.1186/s13195-020-00640-3Mazza C, Ricci E, Biondi S, Colasanti M, Ferracuti S, Napoli C, et al. A nationwide survey of psychological distress among italian people during the COVID-19 pandemic: immediate psychological responses and associated factors. Int J Environ Res Public Health. 2020 May 2;17(9):3165. https://doi.org/10.3390/ijerph17093165Hampshire A, Trender W, Chamberlain SR, Jolly AE, Grant JE, Patrick F, et al. Cognitive deficits in people who have recovered from COVID-19. EClinicalMedicine. 2021 Sep 1;39:101044. https://doi. org/10.1016/j.eclinm.2021.101044Triana RM, Martínez CC, Almeida TM, González MÁÁ, Vaillant TZ, Barreto YR. Cognitive performance in convalescent covid-19 patients. Rev Cuba Hematol Immunol Hemoter. 2020;36(special issue):1-17.Hosp JA, Dressing A, Blazhenets G, Bormann T, Rau A, Schwabenland M, et al. Cognitive impairment and altered cerebral glucose metabolism in the subacute stage of COVID-19. Brain. 2021 May 7;144(4):1263-76. https://doi.org/10.1093/brain/awab009Ortelli P, Ferrazzoli D, Sebastianelli L, Engl M, Romanello R, Nardone R, et al. Neuropsychological and neurophysiological correlates of fatigue in post-acute patients with neurological manifestations of COVID-19: Insights into a challenging symptom. J Neurol Sci. 2021 Jan 15;420:117271. https://doi.org/10.1016/j.jns.2020.117271Alemanno F, Houdayer E, Parma A, Spina A, Del Forno A, Scatolini A, et al. COVID-19 cognitive deficits after respiratory assistance in the subacute phase: a COVID-rehabilitation unit experience. PLoS One. 2021 Feb 8;16(2):e0246590. https://doi.org/10.1371/journal. pone.0246590Brutto OHD, Wu S, Mera RM, Costa AF, Recalde BY, Issa NP. Cognitive decline among individuals with history of mild symptomatic SARS-CoV-2 infection: a longitudinal prospective study nested to a population cohort. Eur J Neurol. 2021 Oct;28(10):3245-53. https://doi. org/10.1111/ene.14775Zhou J, Liu C, Sun Y, Huang W, Ye K. Cognitive disorders associated with hospitalization of COVID-19: results from an observational cohort study. Brain Behav Immun. 2021 Jan;91:383-92. https://doi. org/10.1016/j.bbi.2020.10.019Miskowiak KW, Johnsen S, Sattler SM, Nielsen S, Kunalan K, Rungby J, et al. Cognitive impairments four months after COVID-19 hospital discharge: pattern, severity and association with illness variables. Eur Neuropsychopharmacol. 2021 May;46:39-48. https://doi. org/10.1016/j.euroneuro.2021.03.019Pan American Health Organization / World Health Organization. Epidemiological Update: Coronavirus disease (COVID-19) Washington (DC): PAHO/WHO; 2021.Brucki SMD, Corazza LA, de Queiroz AP, Barros MP, Tatsch JFS, Riso IL, et al. Neurological complications in COVID-19 patients from Latin America. Brain. 2021 Apr 12;144(3):e29. https://doi.org/10.1093/ brain/awaa440Amalakanti S, Arepalli KVR, Jillella JP. Cognitive assessment in asymptomatic COVID-19 subjects. Virusdisease. 2021 Feb 15;32(1):1- 4. https://doi.org/10.1007/s13337-021-00663-wRaman B, Cassar MP, Tunnicliffe EM, Filippini N, Griffanti L, Alfaro Almagro F, et al. Medium-term effects of SARS-CoV-2 infection on multiple vital organs, exercise capacity, cognition, quality of life and mental health, post-hospital discharge. EClinicalMedicine. 2021 Jan 7;31:100683. https://doi.org/10.1016/j.eclinm.2020.100683Woo MS, Malsy J, Pöttgen J, Zai SS, Ufer F, Hadjilaou A, et al. Frequent neurocognitive deficits after recovery from mild COVID-19. Brain Commun. 2020 Nov 23;2(2):fcaa205. https://doi.org/10.1093/ braincomms/fcaa205WHO Working Group on the Clinical Characterisation and Management of COVID-19 infection. A minimal common outcome measure set for COVID-19 clinical research. Lancet Infect Dis. 2020 Aug 1;20(8):e192-97. https://doi.org/10.1016/S1473-3099(20)30483- 7Serrano CM, Sorbara M, Minond A, Finlay JB, Arizaga RL, Iturry M, et al. Validation of the Argentine version of the Montreal cognitive assessment test (MOCA): a screening tool for mild cognitive impairment and mild dementia in elderly. Dement Neuropsychol. 2020 Jun-Apr;14(2):145-52. https://doi.org/10.1590/1980- 57642020dn14-020007Reitan RM. Validity of the trail making test as an indicator of organic brain damage. Percept Motor Skill. 1958 Dec 1;8(3):271–6. https://doi. org/10.2W466/pms.1958.8.3.271Richardson JTE. MMeasures of short-term memory: a historical review. Cortex. 2007 Jul;43(5):635–50. https://doi.org/10.1016/s0010- 9452(08)70493-3Wechsler D. Wechsler memory scale-revised manual. San Antonio (TX): The Psychological Corporation; 1987. 150 p.Craft S, Newcomer J, Kanne S, Dagogo-Jack S, Cryer P, Sheline Y, et al. Memory improvement following induced hyperinsulinemia in Alzheimer’s disease. Neurobiol Aging. 1996 Jan-Feb;17(1):123-30. https://doi.org/10.1016/0197-4580(95)02002-0Rey A. L’examen Clinique En Psychologie. 2nd ed. Paris: Presse Universitaires de France; 1964Possin KL, Laluz VR, Alcantar OZ, Miller BL, Kramer JH. Distinct neuroanatomical substrates and cognitive mechanisms of figure copy performance in Alzheimer’s disease and behavioral variant frontotemporal dementia. Neuropsychologia. 2011 Jan;49(1):43-8. https://doi.org/10.1016/j.neuropsychologia.2010.10.026Berg EA. A simple objective technique for measuring flexibility in thinking. J Gen Psychol. 1948 Jul;39:15-22. https://doi.org/10.1080/0 0221309.1948.9918159Stroop JR. Studies of interference in serial verbal reaction. J Exp Psychol. 1935;18(6):643-62. https://doi.org/10.1037/h0054651Butman J, Allegri RF, Harris P, Drake M. Spanish verbal fluency. Normative data in Argentina. Medicina (B Aires). 2000;60(5):561-4Head H. Aphasia and Kindred Disorders of Speech (2 Volumes). New York (NY): Hafner Publishing Company; 1963Ivanova I, Salmon DP, Gollan TH. The multilingual naming test in Alzheimer’s disease: clues to the origin of naming impairments. J Int Neuropsychol Soc. 2013 Mar;19(3):272–83. https://doi.org/10.1017/ S1355617712001282Morris JC, Heyman A, Mohs RC, Hughes JP, van Belle G, Fillenbaum G, et al. The Consortium to Establish a Registry for Alzheimer’s Disease (CERAD). Part I. Clinical and neuropsychological assessment of Alzheimer’s disease. Neurology. 1989 Sep 1;39(9):1159-65. https:// doi.org/10.1212/WNL.39.9.1159Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983 Jun;67(6):361-70. https://doi. org/10.1111/j.1600-0447.1983.tb09716.xKivipelto M, Ngandu T, Laatikainen T, Winblad B, Soininen H, Tuomilehto J. Risk score for the prediction of dementia risk in 20 years among middle aged people: a longitudinal, population-based study. Lancet Neurol. 2006 Sep 1;5(9):P735-41. https://doi. org/10.1016/S1474-4422(06)70537-3WHO Working Group on the Clinical Characterisation and Management of COVID-19 infection. A minimal common outcome measure set for COVID-19 clinical research. Lancet Infect Dis. 2020 Aug 1;20(8):e192-7. https://doi.org/10.1016/S1473-3099(20)30483-7Whiteside DM, Oleynick V, Holker E, Waldron EJ, Porter J, Kasprzak M. Neurocognitive deficits in severe COVID-19 infection: case series and proposed model. Clin Neuropsychol. 2021 May;35(4):799-818. https:// doi.org/10.1080/13854046.2021.1874056Ermis U, Rust MI, Bungenberg J, Costa A, Dreher M, Balfanz P, et al. Neurological symptoms in COVID-19: a cross-sectional monocentric study of hospitalized patients. Neurol Res Pract. 2021 Mar 12;3(1):17. https://doi.org/10.1186/s42466-021-00116-1Tolentino JC, Gjorup ALT, Schmidt GJ, Schmidt SL. Early attention impairment in a patient with COVID-19. Psychiatry Clin Neurosci. 2021 Feb;75(2):66-7. https://doi.org/10.1111/pcn.13178Robinson OJ, Vytal K, Cornwell BR, Grillom C. The impact of anxiety upon cognition: perspectives from human threat of shock studies. Front Hum Neurosci. 2013 May 17;7:203. https://doi.org/10.3389/ fnhum.2013.00203Rogers JP, Chesney E, Oliver D, Pollak TA, McGuire P, Fusar-Poli P, et al. Psychiatric and neuropsychiatric presentations associated with severe coronavirus infections: a systematic review and meta-analysis with comparison to the COVID-19 pandemic. Lancet Psychiatry. 2020 Jul 1;7(7):P611-27. https://doi.org/10.1016/S2215-0366(20)30203-0Kanmogne GD, Fonsah JY, Umlauf A, Moul J, Doh RF, Kengne AM, et al. Effects of HIV infection, antiretroviral therapy, and immune status on the speed of information processing and complex motor functions in adult Cameroonians. Sci Rep. 2020 Aug 20;10(1):14016. https://doi. org/10.1038/s41598-020-70981-4Raper J, Kovacs-Balint Z, Mavigner M, Gumber S, Burke MW, Habib J, et al. Long-term alterations in brain and behavior after postnatal Zika virus infection in infant macaques. Nat Commun. 2020 May 21;11(1):2534. https://doi.org/10.1038/s41467-020-16320-7247240380Cognitive dysfunctionCOVID-19Executive functionMemoryNeuropsychologyCOVID-19NeuropsicologíaDisfunción cognitivaFunción ejecutivaMemoriaPublication8b45be0f-580e-49a3-ac96-9e6a6914626b3a5e2fdd-48ee-4d8e-acc4-3119bbdc1a17virtual::816-13a5e2fdd-48ee-4d8e-acc4-3119bbdc1a17virtual::816-1https://scholar.google.com/citations?user=qOf7MgUAAAAJhttps://scholar.google.com/citations?user=-SIKk2UAAAAJ&hl=esvirtual::816-10000-0002-0083-93890000-0001-7166-1234virtual::816-1ORIGINALCognitive consequences of COVID-19. results.pdfCognitive consequences of COVID-19. results.pdfapplication/pdf376451https://repositorio.cuc.edu.co/bitstreams/3247253e-de31-4661-b8c9-1439b8e58775/downloadce4a0356c33b10cb81c104f78aa5164eMD51LICENSElicense.txtlicense.txttext/plain; charset=utf-83196https://repositorio.cuc.edu.co/bitstreams/959b9dbf-fb33-4ddb-9161-b44bf525795c/downloade30e9215131d99561d40d6b0abbe9badMD52TEXTCognitive consequences of COVID-19. results.pdf.txtCognitive consequences of COVID-19. results.pdf.txttext/plain38420https://repositorio.cuc.edu.co/bitstreams/d80cfd53-a02d-4004-a8f8-e08aa2423686/download5689a3a8c489ebdb7dd56f91af4077f3MD53THUMBNAILCognitive consequences of COVID-19. results.pdf.jpgCognitive consequences of COVID-19. results.pdf.jpgimage/jpeg14877https://repositorio.cuc.edu.co/bitstreams/6bc2dd9f-56dc-450a-a6ef-4ed41d687aeb/download6dcd80d18048153664a77b8e41a1b79bMD5411323/9357oai:repositorio.cuc.edu.co:11323/93572025-02-25 19:51:52.439https://creativecommons.org/licenses/by-nc-sa/4.0/Atribución-NoComercial-CompartirIgual 4.0 Internacional (CC BY-NC-SA 4.0)open.accesshttps://repositorio.cuc.edu.coRepositorio de la Universidad de la Costa CUCrepdigital@cuc.edu.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 |