Department of Neurology and Centre for Clinical Neuroscience, Daping Hospital, Third Military Medical University, Chongqing, China.
Department of Anaesthesiology, Daping Hospital, Third Military Medical University, Chongqing, China.
JAMA Neurol. 2022 May 1;79(5):509-517. doi: 10.1001/jamaneurol.2022.0461.
Determining the long-term impact of COVID-19 on cognition is important to inform immediate steps in COVID-19 research and health policy.
To investigate the 1-year trajectory of cognitive changes in older COVID-19 survivors.
DESIGN, SETTING, AND PARTICIPANTS: This cohort study recruited 3233 COVID-19 survivors 60 years and older who were discharged from 3 COVID-19-designated hospitals in Wuhan, China, from February 10 to April 10, 2020. Their uninfected spouses (N = 466) were recruited as a control population. Participants with preinfection cognitive impairment, a concomitant neurological disorder, or a family history of dementia were excluded, as well as those with severe cardiac, hepatic, or kidney disease or any kind of tumor. Follow-up monitoring cognitive functioning and decline took place at 6 and 12 months. A total of 1438 COVID-19 survivors and 438 control individuals were included in the final follow-up. COVID-19 was categorized as severe or nonsevere following the American Thoracic Society guidelines.
The main outcome was change in cognition 1 year after patient discharge. Cognitive changes during the first and second 6-month follow-up periods were assessed using the Informant Questionnaire on Cognitive Decline in the Elderly and the Telephone Interview of Cognitive Status-40, respectively. Based on the cognitive changes observed during the 2 periods, cognitive trajectories were classified into 4 categories: stable cognition, early-onset cognitive decline, late-onset cognitive decline, and progressive cognitive decline. Multinomial and conditional logistical regression models were used to identify factors associated with risk of cognitive decline.
Among the 3233 COVID-19 survivors and 1317 uninfected spouses screened, 1438 participants who were treated for COVID-19 (691 male [48.05%] and 747 female [51.95%]; median [IQR] age, 69 [66-74] years) and 438 uninfected control individuals (222 male [50.68%] and 216 female [49.32%]; median [IQR] age, 67 [66-74] years) completed the 12-month follow-up. The incidence of cognitive impairment in survivors 12 months after discharge was 12.45%. Individuals with severe cases had lower Telephone Interview of Cognitive Status-40 scores than those with nonsevere cases and control individuals at 12 months (median [IQR]: severe, 22.50 [16.00-28.00]; nonsevere, 30.00 [26.00-33.00]; control, 31.00 [26.00-33.00]). Severe COVID-19 was associated with a higher risk of early-onset cognitive decline (odds ratio [OR], 4.87; 95% CI, 3.30-7.20), late-onset cognitive decline (OR, 7.58; 95% CI, 3.58-16.03), and progressive cognitive decline (OR, 19.00; 95% CI, 9.14-39.51), while nonsevere COVID-19 was associated with a higher risk of early-onset cognitive decline (OR, 1.71; 95% CI, 1.30-2.27) when adjusting for age, sex, education level, body mass index, and comorbidities.
In this cohort study, COVID-19 survival was associated with an increase in risk of longitudinal cognitive decline, highlighting the importance of immediate measures to deal with this challenge.
重要性：确定 COVID-19 对认知的长期影响对于告知 COVID-19 研究和卫生政策的当前步骤非常重要。
目的：调查老年 COVID-19 幸存者认知变化的 1 年轨迹。
设计、地点和参与者：这项队列研究招募了 3233 名年龄在 60 岁及以上的 COVID-19 幸存者，他们于 2020 年 2 月 10 日至 4 月 10 日从武汉的 3 家 COVID-19 指定医院出院。他们未感染的配偶（N=466）被招募为对照组。排除了有感染前认知障碍、同时存在神经障碍或痴呆家族史、或有严重心脏、肝脏或肾脏疾病或任何类型肿瘤的患者，以及有严重心脏、肝脏或肾脏疾病或任何类型肿瘤的患者。在 6 个月和 12 个月时进行了后续监测认知功能和下降情况。共有 1438 名 COVID-19 幸存者和 438 名对照个体被纳入最终随访。根据美国胸科学会指南，将 COVID-19 分为严重或非严重。
主要结果和措施：主要结果是患者出院后 1 年的认知变化。使用认知障碍老年知情者问卷和电话访谈认知状态-40 分别评估第一和第二 6 个月随访期间的认知变化。根据这两个时期观察到的认知变化，将认知轨迹分为 4 类：稳定认知、早期认知下降、晚期认知下降和进行性认知下降。使用多项和条件逻辑回归模型来确定与认知下降风险相关的因素。
结果：在筛查的 3233 名 COVID-19 幸存者和 1317 名未感染配偶中，有 1438 名接受 COVID-19 治疗的参与者（691 名男性[48.05%]和 747 名女性[51.95%]；中位[IQR]年龄，69[66-74]岁）和 438 名未感染的对照个体（222 名男性[50.68%]和 216 名女性[49.32%]；中位[IQR]年龄，67[66-74]岁）完成了 12 个月的随访。幸存者出院后 12 个月的认知障碍发生率为 12.45%。严重病例的电话访谈认知状态-40 评分低于非严重病例和对照组个体在 12 个月时（中位数[IQR]：严重，22.50[16.00-28.00]；非严重，30.00[26.00-33.00]；对照组，31.00[26.00-33.00]）。严重的 COVID-19 与早期认知下降（比值比[OR]，4.87；95%CI，3.30-7.20）、晚期认知下降（OR，7.58；95%CI，3.58-16.03）和进行性认知下降（OR，19.00；95%CI，9.14-39.51）的风险增加相关，而非严重的 COVID-19 与早期认知下降（OR，1.71；95%CI，1.30-2.27）的风险增加相关，同时调整了年龄、性别、教育水平、体重指数和合并症。
结论和相关性：在这项队列研究中，COVID-19 存活与纵向认知下降风险增加相关，这突出表明需要立即采取措施应对这一挑战。
