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Cognitive Aspects of COVID-19

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Abstract

Purpose of Review

Since the beginning of the coronavirus disease 2019 pandemic, many lasting neurological sequelae including cognitive impairment have been recognized as part of the so-called long COVID syndrome. This narrative review summarizes the cognitive aspects of COVID-19.

Recent Findings

Studies have consistently identified attention, memory, and executive functions as the cognitive domains most often affected by COVID-19 infection. Many studies have also reported neuroimaging, biofluid, and neurophysiological abnormalities that could potentially reflect the pathophysiological aspects of post-COVID cognitive impairment. While patients suffering from dementia have an elevated risk of COVID-19 infection, increasing evidence has also indicated that COVID-19 infection may increase the risks of Alzheimer’s disease, suggesting bidirectional relationships.

Summary

Post-COVID cognitive dysfunction is a pervasive and multifaceted problem and we are surely in our infancy of understanding. Future elucidation into the long-term effects, mechanisms, and therapies will depend on a concerted effort from clinicians, researchers, patients, and policy-makers alike.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. WHO coronavirus (COVID-19) dashboard with vaccination data [Cited 20 May 2023.] Available from URL: https://covid19.who.int/

  2. • Nalbandian A, Sehgal K, Gupta A, Madhavan MV, McGroder C, Stevens JS, et al. Post-acute COVID-19 syndrome. Nat Med. 2021;27:601–15. https://doi.org/10.1038/s41591-021-01283-z. This comprehensive review summarized the epidemiology, organ-specific manifestations, and interdisciplinary comprehensive management considerations for post-acute COVID-19 syndrome.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Long COVID or post-COVID conditions. https://www.cdc.gov/coronavirus/2019-ncov/long-termeffects/index.html?s_cid=11840:long/20covid/20definition:sem.ga:p:RG:GM:gen: PTN:FY23

  4. • Davis HE, McCorkell L, Vogel JM, Topol EJ. Long COVID: major findings, mechanisms, and recommendations. Nat Rev Microbiol. 2023;21:133–46. https://doi.org/10.1038/s41579-022-00846-2. This review article summarized the current knowledge base of long COVID and misconceptions surrounding long COVID.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Liotta EM, Batra A, Clark JR, Shlobin NA, Hoffman SC, Orban ZS, et al. Frequent neurologic manifestations and encephalopathy-associated morbidity in COVID-19 patients. Ann Clin Transl Neurol. 2020;7:2221–30. https://doi.org/10.1002/acn3.51210.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Xu E, Xie Y, Al-Aly Z. Long-term neurologic outcomes of COVID-19. Nat Med. 2022;28:2406–15. https://doi.org/10.1038/s41591-022-02001-z.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Rass V, Beer R, Schiefecker AJ, Lindner A, Kofler M, Andre Ianosi B, et al. Neurological outcomes 1 year after COVID-19 diagnosis: a prospective longitudinal cohort study. Eur J Neurol. 2022;29:1685–96. https://doi.org/10.1111/ene.15307.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Kubota T, Kuroda N, Sone D. Neuropsychiatric aspects of long COVID: a comprehensive review. Psychiatry Clin Neurosci. 2023;77:84–93. https://doi.org/10.1111/pcn.13508.

    Article  PubMed  Google Scholar 

  9. •• Monje M, Iwasaki A. The neurobiology of long COVID. Neuron. 2022;110:3484–96. https://doi.org/10.1016/j.neuron.2022.10.006. This comprehensive review proposed six potential mechanisms of COVID-19-induced neural injury.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Leng A, Shah M, Ahmad SA, Premraj L, Wildi K, Li Bassi G, et al. Pathogenesis underlying neurological manifestations of long COVID syndrome and potential therapeutics. Cells. 2023;12:816. https://doi.org/10.3390/cells12050816.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. García-Grimshaw M, Chirino-Pérez A, Flores-Silva FD, Valdés-Ferrer SI, Vargas-Martínez MLA, Jiménez-Ávila AI, et al. Critical role of acute hypoxemia on the cognitive impairment after severe COVID-19 pneumonia: a multivariate causality model analysis. Neurol Sci. 2022;43:2217–29. https://doi.org/10.1007/s10072-021-05798-8.

    Article  PubMed  PubMed Central  Google Scholar 

  12. •• Fernández-Castañeda A, Lu P, Geraghty AC, Song E, Lee MH, Wood J, et al. Mild respiratory COVID can cause multi-lineage neural cell and myelin dysregulation. Cell. 2022;185:2452-2468.e16. https://doi.org/10.1016/j.cell.2022.06.008. This is a milestone study that reported evidence of impaired hippocampal neurogenesis, decreased oligodendrocytes, myelin loss, and elevated CSF cytokines/chemokines in mice with mild respiratory COVID.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Venkataramani V, Winkler F. Cognitive deficits in long COVID-19. N Engl J Med. 2022;387:1813–5. https://doi.org/10.1056/NEJMcibr2210069.

    Article  CAS  PubMed  Google Scholar 

  14. Soung AL, Vanderheiden A, Nordvig AS, Sissoko CA, Canoll P, Mariani MB, et al. COVID-19 induces CNS cytokine expression and loss of hippocampal neurogenesis. Brain. 2022;145:4193–201. https://doi.org/10.1093/brain/awac270.

    Article  PubMed  PubMed Central  Google Scholar 

  15. •• Crivelli L, Palmer K, Calandri I, Guekht A, Beghi E, Carroll W, et al. Changes in cognitive functioning after COVID-19: a systematic review and meta-analysis. Alzheimers Dement. 2022;18:1047–66. https://doi.org/10.1002/alz.12644. This article provided a comprehensive systematic review and meta-analysis of COVID-19-associated cognitive dysfunction including literature up to the end of 2021.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Velichkovsky BB, Razvaliaeva AY, Khlebnikova AA, Manukyan PA, Kasatkin VN. Attention and memory after COVID-19 as measured by neuropsychological tests: systematic review and meta-analysis. Acta Psychol (Amst). 2023;233:103838. https://doi.org/10.1016/j.actpsy.2023.103838.

    Article  PubMed  Google Scholar 

  17. Tavares-Júnior JWL, de Souza ACC, Borges JWP, Oliveira DN, Siqueira-Neto JI, Sobreira-Neto MA, et al. COVID-19 associated cognitive impairment: a systematic review. Cortex. 2022;152:77–97. https://doi.org/10.1016/j.cortex.2022.04.006.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Bertuccelli M, Ciringione L, Rubega M, Bisiacchi P, Masiero S, Del Felice A. Cognitive impairment in people with previous COVID-19 infection: a scoping review. Cortex. 2022;154:212–30. https://doi.org/10.1016/j.cortex.2022.06.002.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Biagianti B, Di Liberto A, NicolòEdoardo A, Lisi I, Nobilia L, de Ferrabonc GD, et al. Cognitive assessment in SARS-CoV-2 patients: a systematic review. Front Aging Neurosci. 2022;14:909661. https://doi.org/10.3389/fnagi.2022.909661.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Badenoch JB, Rengasamy ER, Watson C, Jansen K, Chakraborty S, Sundaram RD, et al. Persistent neuropsychiatric symptoms after COVID-19: a systematic review and meta-analysis. Brain Commun. 2021;4:fcab297. https://doi.org/10.1093/braincomms/fcab297.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Houben S, Bonnechère B. The impact of COVID-19 infection on cognitive function and the implication for rehabilitation: a systematic review and meta-analysis. Int J Environ Res Public Health. 2022;19:7748. https://doi.org/10.3390/ijerph19137748.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Serena S, Deborah P, Anja F, Gwendolyn G, Puhan MA, Albanese E. Association between serologically confirmed COVID-19 infection and cognitive functioning in community dwelling older adults. Front Neurol. 2023;14:1093852. https://doi.org/10.3389/fneur.2023.1093852.

    Article  PubMed  PubMed Central  Google Scholar 

  23. •• Douaud G, Lee S, Alfaro-Almagro F, Arthofer C, Wang C, McCarthy P, et al. SARS-CoV-2 is associated with changes in brain structure in UK Biobank. Nature. 2022;604(7907):697–707. https://doi.org/10.1038/s41586-022-04569-5. This is a milestone study that demonstrated MRI evidence of structural brain change including reduction of global brain volume, gray matter thickness, and markers of brain damage in selected brain areas in patients with COVID-19 compared to control cases.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Cecchetti G, Agosta F, Canu E, Basaia S, Barbieri A, Cardamone R, et al. Cognitive, EEG, and MRI features of COVID-19 survivors: a 10-month study. J Neurol. 2022;269:3400–12. https://doi.org/10.1007/s00415-022-11047-5.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Petersen M, N€agele FL, Mayer C, Schell, M, Petersen E, K€uhn S, et al. Brain imaging and neuropsychological assessment of individuals recovered from mild to moderate SARS-CoV-2 infection. Proc Natl Acad Sci USA. 2023; 120: e2217232120. https://doi.org/10.1073/pnas.2217232120.

  26. Caroli A, Capelli S, Napolitano A, Cabrini G, Arrigoni A, Pezzetti G, et al. Brain diffusion alterations in patients with COVID-19 pathology and neurological manifestations. Neuroimage Clin. 2023;37:103338. https://doi.org/10.1016/j.nicl.2023.103338.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Ortelli P, Ferrazzoli D, Sebastianelli L, Maestri R, Dezi S, Spampinato D, et al. Altered motor cortex physiology and dysexecutive syndrome in patients with fatigue and cognitive difficulties after mild COVID-19. Eur J Neurol. 2022;29:1652–62. https://doi.org/10.1111/ene.15278.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Ajčević M, Iscra K, Furlanis G, Michelutti M, Miladinović A, Buoite Stella A, et al. Cerebral hypoperfusion in post-COVID-19 cognitively impaired subjects revealed by arterial spin labeling MRI. Sci Rep. 2023;13:5808. https://doi.org/10.1038/s41598-023-32275-3.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. de Paula JJ, Paiva RERP, Souza-Silva NG, Rosa DV, Duran FLS, Coimbra RS, et al. Selective visuoconstructional impairment following mild COVID-19 with inflammatory and neuroimaging correlation findings. Mol Psychiatry. 2023;28:553–63. https://doi.org/10.1038/s41380-022-01632-5.

    Article  CAS  PubMed  Google Scholar 

  30. Franke C, Boesl F, Goereci Y, Gerhard A, Schweitzer F, Schroeder M, et al. Association of cerebrospinal fluid brain-binding autoantibodies with cognitive impairment in post-COVID-19 syndrome. Brain Behav Immun. 2023;109:139–43. https://doi.org/10.1016/j.bbi.2023.01.006.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  31. Apple AC, Oddi A, Peluso MJ, Asken BM, Henrich TJ, Kelly JD, et al. Risk factors and abnormal cerebrospinal fluid associate with cognitive symptoms after mild COVID-19. Ann Clin Transl Neurol. 2022;9:221–6. https://doi.org/10.1002/acn3.51498.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  32. Furlanis G, Buoite Stella A, Biaduzzini F, Bellavita G, Frezza NA, et al. Cognitive deficit in post-acute COVID-19: an opportunity for EEG evaluation? Neurol Sci. 2023;44:1491–8. https://doi.org/10.1007/s10072-023-06615-0.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Hariyanto TI, Putri C, Arisa J, Situmeang RFV, Kurniawan A. Dementia and outcomes from coronavirus disease 2019 (COVID-19) pneumonia: a systematic review and meta-analysis. Arch Gerontol Geriatr. 2021;93:104299. https://doi.org/10.1016/j.archger.2020.104299.

    Article  CAS  PubMed  Google Scholar 

  34. Rolland Y, Baziard M, De Mauleon A, Dubus E, Saidlitz P, Soto ME. Coronavirus disease-2019 in older people with cognitive impairment. Clin Geriatr Med. 2022;38:501–17. https://doi.org/10.1016/j.cger.2022.03.002.

    Article  PubMed  PubMed Central  Google Scholar 

  35. •• Toniolo S, Scarioni M, Di Lorenzo F, Hort J, Georges J, Tomic S, et al. Dementia and COVID-19, a bidirectional liaison: risk factors, biomarkers, and optimal health care. J Alzheimers Dis. 2021;82:883–98. https://doi.org/10.3233/JAD-210335. This article reviewed literature with evidence indicating COVID-19 may be more prevalent in patients with dementia and cognitive impairment and COVID-19 may increase risks of developing Alzheimer’s disease and related dementia and the potential mechanisms.

    Article  CAS  PubMed  Google Scholar 

  36. • Wang Y, Li M, Kazis LE, Xia W. Clinical outcomes of COVID-19 infection among patients with Alzheimer’s disease or mild cognitive impairment. Alzheimers Dement. 2022;18:911–23. https://doi.org/10.1002/alz.12665. This cohort study of 436,823 veterans demonstrated increased risks of COVID-19 infection and mortality among subjects with Alzheimer’s disease.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  37. Matsui T, Mitsuma S, Nagata A, Matsushita A, Asahi T. Accelerated cognitive decline after the COVID-19 pandemic in a community population of older persons with cognitive impairment: a 4-year time series analysis in the Tokyo Metropolis area. Geriatr Gerontol Int. 2023;23:200–4. https://doi.org/10.1111/ggi.14543.

    Article  PubMed  Google Scholar 

  38. Merla L, Montesi MC, Ticali J, Bais B, Cavarape A, Colussi G. COVID-19 accelerated cognitive decline in elderly patients with pre-existing dementia followed up in an outpatient memory care facility. J Clin Med. 2023;12:1845. https://doi.org/10.3390/jcm12051845.

    Article  PubMed  PubMed Central  Google Scholar 

  39. • Olivera E, Sáez A, Carniglia L, Caruso C, Lasaga M, Durand D. Alzheimer’s disease risk after COVID-19: a view from the perspective of the infectious hypothesis of neurodegeneration. Neural Regen Res. 2023;18:1404–10. https://doi.org/10.4103/1673-5374.360273. This review article summarized literature with evidence indicating COVID-19 infection may increase the risks of Alzheimer’s disease and the potential pathophysiological mechanisms.

    Article  PubMed  Google Scholar 

  40. Ciaccio M, Lo Sasso B, Scazzone C, Gambino CM, Ciaccio AM, Bivona G, et al. COVID-19 and Alzheimer’s Disease. Brain Sci. 2021;11:305. https://doi.org/10.3390/brainsci11030305.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  41. Rahman MA, Islam K, Rahman S, Alamin M. Neurobiochemical cross-talk between COVID-19 and Alzheimer’s disease. Mol Neurobiol. 2021;58:1017–23. https://doi.org/10.1007/s12035-020-02177-w.

    Article  CAS  PubMed  Google Scholar 

  42. •• Reiken S, Sittenfeld L, Dridi H, Liu Y, Liu X, Marks AR. Alzheimer’s-like signaling in brains of COVID-19 patients. Alzheimers Dement. 2022;18:955–65. https://doi.org/10.1002/alz.12558. This original study provided evidence linking SARS-CoV-2 infection to neuropathological abnormalities typically associated with AD, including activation of TGF-β signaling and oxidative overload, as well as tau hyperphosphorylation.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  43. Kuo CL, Pilling LC, Atkins JL, Masoli JAH, Delgado J, Kuchel GA, et al. APOE e4 genotype predicts severe COVID-19 in the UK Biobank Community Cohort. J Gerontol A Biol Sci Med Sci. 2020;75:2231–2. https://doi.org/10.1093/gerona/glaa131.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  44. Nouraeinejad A. The functional and structural changes in the hippocampus of COVID-19 patients. Acta Neurol Belg. 2023;25:1–10. https://doi.org/10.1007/s13760-023-02291-1.

    Article  Google Scholar 

  45. Wang L, Davis PB, Volkow ND, Berger NA, Kaelber DC, Xu R. Association of COVID-19 with new-onset Alzheimer’s disease. J Alzheimers Dis. 2022;89:411–4. https://doi.org/10.3233/JAD-220717.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

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Ezekiel Gonzalez-Fernandez and Juebin Huang wrote the main manuscript text. Juebin Huang reviewed and finalized the manuscript.

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Correspondence to Juebin Huang.

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Gonzalez-Fernandez, E., Huang, J. Cognitive Aspects of COVID-19. Curr Neurol Neurosci Rep 23, 531–538 (2023). https://doi.org/10.1007/s11910-023-01286-y

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