Biagianti Bruno, Di Liberto Asia, Nicolò Edoardo Aiello, Lisi Ilaria, Nobilia Letizia, de Ferrabonc Giulia Delor, Zanier Elisa R, Stocchetti Nino, Brambilla Paolo
Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy.
Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.
Front Aging Neurosci. 2022 Jul 1;14:909661. doi: 10.3389/fnagi.2022.909661. eCollection 2022.
Patients with post-infective severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) often show both short- and long-term cognitive deficits within the dysexecutive/inattentive spectrum. However, little is known about which cognitive alterations are commonly found in patients recovered from SARS-CoV-2, and which psychometric tools clinicians should consider when assessing cognition in this population. The present work reviewed published studies to provide a critical narrative of neuropsychological (NPs) deficits commonly observed after SARS-CoV-2 infection and the tests most suited for detecting such cognitive sequelae depending on illness severity.
This review followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines and was pre-registered on Prospective Register of Systematic Reviews (PROSPERO) (CRD42021253079). Observational studies quantitatively assessing cognition in patients with post-infective SARS-CoV-2 were considered. From 711 retrieved articles, 19 studies conducted on patients with SARS-CoV-2 without medical comorbidities were included and stratified by disease severity.
The majority of studies ( = 13) adopted first-level tests. The most frequently administered screeners were the Montreal Cognitive Assessment (MoCA) and the Mini-Mental State Examination (MMSE)-with the former more likely to detect mild, and the latter moderate/severe deficits. Among second-level tests, those assessing attention and executive functions (EFs) were highly represented. Remotely-delivered tests yielded lower percentages of cognitive impairment. Overall, cognitive domains often found to be impaired were EFs, attention, and memory.
Cognitive sequelae in patients with post-infective SARS-CoV-2 can be detected with NPs testing. Depending on the psychometric test features, the likelihood of observing cognitive deficits can vary. Further studies on larger sample sizes are needed to investigate the clinical usefulness of second-level tools. The primary goal of preventative health services should be the early detection and intervention of emerging cognitive deficits.
感染严重急性呼吸综合征冠状病毒2（SARS-CoV-2）后的患者通常在执行功能障碍/注意力不集中范围内表现出短期和长期认知缺陷。然而，对于从SARS-CoV-2中康复的患者中常见哪些认知改变，以及临床医生在评估该人群的认知时应考虑哪些心理测量工具，人们知之甚少。本研究回顾了已发表的研究，以对SARS-CoV-2感染后常见的神经心理学（NP）缺陷以及根据疾病严重程度最适合检测此类认知后遗症的测试进行批判性叙述。
本综述遵循系统评价和Meta分析的首选报告项目（PRISMA）指南，并在系统评价前瞻性注册库（PROSPERO）（CRD42021253079）上进行了预注册。纳入了定量评估感染后SARS-CoV-2患者认知的观察性研究。从检索到的711篇文章中，纳入了19项针对无合并症的SARS-CoV-2患者进行的研究，并按疾病严重程度进行分层。
大多数研究（n = 13）采用一级测试。最常用的筛查工具是蒙特利尔认知评估量表（MoCA）和简易精神状态检查表（MMSE），前者更有可能检测到轻度缺陷，后者更有可能检测到中度/重度缺陷。在二级测试中，评估注意力和执行功能（EF）的测试占比很高。远程测试得出的认知障碍百分比更低。总体而言，经常发现受损的认知领域是EF、注意力和记忆。
感染后SARS-CoV-2患者的认知后遗症可以通过NP测试来检测。根据心理测量测试的特点，观察到认知缺陷的可能性可能会有所不同。需要对更大样本量进行进一步研究，以调查二级工具的临床实用性。预防性健康服务的主要目标应该是早期发现和干预新出现的认知缺陷。
