Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD.
Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
J Acad Consult Liaison Psychiatry. 2022 Mar-Apr;63(2):133-143. doi: 10.1016/j.jaclp.2021.10.006. Epub 2021 Nov 15.
BACKGROUND: There is a limited understanding of the cognitive and psychiatric sequelae of COVID-19 during the post-acute phase, particularly among racially and ethnically diverse patients. OBJECTIVE: We sought to prospectively characterize cognition, mental health symptoms, and functioning approximately four months after an initial diagnosis of COVID-19 in a racially and ethnically diverse group of patients. METHODS: Approximately four months after COVID-19 diagnosis, patients in the Johns Hopkins Post-Acute COVID-19 Team Pulmonary Clinic underwent a clinical telephone-based assessment of cognition, depression, anxiety, trauma, and function. RESULTS: Most Johns Hopkins Post-Acute COVID-19 Team patients assessed were women (59%) and members of racial/ethnic minority groups (65%). Of 82 patients, 67% demonstrated ≥1 abnormally low cognitive score. Patients requiring intensive care unit (ICU) stays displayed greater breadth and severity of impairment than those requiring less intensive treatment. Processing speed (35%), verbal fluency (26%-32%), learning (27%), and memory (27%) were most commonly impaired. Among all patients, 35% had moderate symptoms of depression (23%), anxiety (15%), or functional decline (15%); 25% of ICU patients reported trauma-related distress. Neuropsychiatric symptoms and functional decline did not differ by post-ICU versus non-ICU status and were unrelated to global cognitive composite scores. CONCLUSIONS: At approximately 4 months after acute illness, cognitive dysfunction, emotional distress, and functional decline were common among a diverse clinical sample of COVID-19 survivors varying in acute illness severity. Patients requiring ICU stays demonstrated greater breadth and severity of cognitive impairment than those requiring less intensive treatment. Findings help extend our understanding of the nature, severity, and potential duration of neuropsychiatric morbidity after COVID-19 and point to the need for longitudinal assessment of cognitive and mental health outcomes among COVID-19 survivors of different demographic backgrounds and illness characteristics.
背景：对于 COVID-19 急性后期的认知和精神后遗症，特别是在不同种族和民族的患者中，人们的了解有限。
目的：我们旨在前瞻性地描述一组不同种族和民族的患者在 COVID-19 初始诊断后大约四个月时的认知、心理健康症状和功能。
方法：在 COVID-19 诊断后大约四个月，约翰霍普金斯大学急性后期 COVID-19 团队肺病诊所的患者接受了一项基于电话的认知、抑郁、焦虑、创伤和功能的临床评估。
结果：大多数接受评估的约翰霍普金斯大学急性后期 COVID-19 团队患者为女性（59%）和种族/民族少数群体成员（65%）。在 82 名患者中，67%的患者存在≥1 项认知得分异常低的情况。需要重症监护病房（ICU）治疗的患者比需要较少治疗的患者表现出更广泛和更严重的认知障碍。患者的认知功能最常受损的方面包括：处理速度（35%）、语言流畅性（26%-32%）、学习（27%）和记忆（27%）。所有患者中，35%有中度抑郁（23%）、焦虑（15%）或功能下降（15%）；25%的 ICU 患者报告了与创伤相关的困扰。神经精神症状和功能下降在 ICU 后与非 ICU 状态之间没有差异，与整体认知综合评分无关。
结论：在急性疾病后大约 4 个月时，认知功能障碍、情绪困扰和功能下降在不同严重程度急性疾病的 COVID-19 幸存者的多样化临床样本中很常见。需要 ICU 治疗的患者比需要较少治疗的患者表现出更广泛和更严重的认知障碍。这些发现有助于扩展我们对 COVID-19 后神经精神发病率的性质、严重程度和潜在持续时间的理解，并指出需要对不同人口统计学背景和疾病特征的 COVID-19 幸存者的认知和心理健康结果进行纵向评估。
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