Psychiatry & Clinical Psychobiology, Division of Neuroscience, IRCCS Scientific Institute Ospedale San Raffaele, Milano, Italy; Vita-Salute San Raffaele University, Milano, Italy.
Psychiatry & Clinical Psychobiology, Division of Neuroscience, IRCCS Scientific Institute Ospedale San Raffaele, Milano, Italy.
Brain Behav Immun. 2021 May;94:138-147. doi: 10.1016/j.bbi.2021.02.021. Epub 2021 Feb 24.
COVID-19 outbreak is associated with mental health implications during viral infection and at short-term follow-up. Data on psychiatric and cognitive sequelae at medium-term follow-up are still lacking. During an ongoing prospective cohort study, the psychopathological and cognitive status of 226 COVID-19 pneumonia survivors (149 male, mean age 58) were prospectively evaluated one and three months after hospital discharge. Psychiatric clinical interview, self-report questionnaires, and neuropsychological profiling of verbal memory, working memory, psychomotor coordination, executive functions, attention and information processing, and verbal fluency were performed. Three months after discharge from the hospital, 35.8% still self-rated symptoms in the clinical range in at least one psychopathological dimension. We observed persistent depressive symptomatology, while PTSD, anxiety, and insomnia decreased during follow-up. Sex, previous psychiatric history, and the presence of depression at one month affected the depressive symptomatology at three months. Regardless of clinical physical severity, 78% of the sample showed poor performances in at least one cognitive domain, with executive functions and psychomotor coordination being impaired in 50% and 57% of the sample. Baseline systemic immune-inflammation index (SII), which reflects the immune response and systemic inflammation based on peripheral lymphocyte, neutrophil, and platelet counts, predicted self-rated depressive symptomatology and cognitive impairment at three-months follow-up; and changes of SII predicted changes of depression during follow-up. Neurocognitive impairments associated with severity of depressive psychopathology, and processing speed, verbal memory and fluency, and psychomotor coordination were predicted by baseline SII. We hypothesize that COVID-19 could result in prolonged systemic inflammation that predisposes patients to persistent depression and associated neurocognitive dysfunction. The linkage between inflammation, depression, and neurocognition in patients with COVID-19 should be investigated in long-term longitudinal studies, to better personalize treatment options for COVID-19 survivors.
COVID-19 爆发与病毒感染期间和短期随访期间的心理健康问题有关。关于中期随访时的精神和认知后遗症的数据仍然缺乏。在一项正在进行的前瞻性队列研究中，前瞻性评估了 226 名 COVID-19 肺炎幸存者（149 名男性，平均年龄 58 岁）在出院后一个月和三个月的精神病理和认知状况。进行了精神病学临床访谈、自我报告问卷以及言语记忆、工作记忆、精神运动协调、执行功能、注意力和信息处理以及言语流畅性的神经心理学分析。出院三个月后，仍有 35.8%的患者在至少一个精神病理维度上自我评估症状处于临床范围。我们观察到持续性抑郁症状，而 PTSD、焦虑和失眠在随访期间有所下降。性别、既往精神病史和一个月时的抑郁状态影响三个月时的抑郁症状。无论临床身体严重程度如何，78%的样本在至少一个认知领域表现不佳，其中执行功能和精神运动协调在 50%和 57%的样本中受损。反映基于外周淋巴细胞、中性粒细胞和血小板计数的免疫反应和全身炎症的基线全身免疫炎症指数（SII）预测了三个月随访时的自我评估抑郁症状和认知障碍；SII 的变化预测了随访期间抑郁的变化。与抑郁严重程度、处理速度、言语记忆和流畅性以及精神运动协调相关的神经认知障碍，由基线 SII 预测。我们假设 COVID-19 可能导致长期的全身炎症，使患者容易出现持续性抑郁和相关的神经认知功能障碍。在长期纵向研究中，应调查 COVID-19 患者的炎症、抑郁和认知之间的联系，以更好地为 COVID-19 幸存者个性化治疗方案。
