Department of Pathology, Faculdade de Medicina da Universidade de São Paulo FMUSP, São Paulo, Brazil.
Division of Geriatrics, LIM-66, Faculdade de Medicina da Universidade de São Paulo FMUSP, São Paulo, Brazil.
Alzheimers Dement. 2023 Sep;19(9):3771-3782. doi: 10.1002/alz.12993. Epub 2023 Mar 2.
Cognitive impairment is common after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. However, associations between post-hospital discharge risk factors and cognitive trajectories have not been explored.
A total of 1105 adults (mean age ± SD 64.9 ± 9.9 years, 44% women, 63% White) with severe coronavirus disease 2019 (COVID-19) were evaluated for cognitive function 1 year after hospital discharge. Scores from cognitive tests were harmonized, and clusters of cognitive impairment were defined using sequential analysis.
Three groups of cognitive trajectories were observed during the follow-up: no cognitive impairment, initial short-term cognitive impairment, and long-term cognitive impairment. Predictors of cognitive decline after COVID-19 were older age (β = -0.013, 95% CI = -0.023;-0.003), female sex (β = -0.230, 95% CI = -0.413;-0.047), previous dementia diagnosis or substantial memory complaints (β = -0.606, 95% CI = -0.877;-0.335), frailty before hospitalization (β = -0.191, 95% CI = -0.264;-0.119), higher platelet count (β = -0.101, 95% CI = -0.185;-0.018), and delirium (β = -0.483, 95% CI = -0.724;-0.244). Post-discharge predictors included hospital readmissions and frailty.
Cognitive impairment was common and the patterns of cognitive trajectories depended on sociodemographic, in-hospital, and post-hospitalization predictors.
Cognitive impairment after coronavirus disease 2019 (COVID-19) hospital discharge was associated with higher age, less education, delirium during hospitalization, a higher number of hospitalizations post discharge, and frailty before and after hospitalization. Frequent cognitive evaluations for 12-month post-COVID-19 hospitalization showed three possible cognitive trajectories: no cognitive impairment, initial short-term impairment, and long-term impairment. This study highlights the importance of frequent cognitive testing to determine patterns of COVID-19 cognitive impairment, given the high frequency of incident cognitive impairment 1 year after hospitalization.
严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）感染后常发生认知障碍。然而，出院后风险因素与认知轨迹之间的关联尚未得到探讨。
共对 1105 名患有严重 2019 年冠状病毒病（COVID-19）的成年人（平均年龄±标准差 64.9±9.9 岁，44%为女性，63%为白人）进行认知功能评估，评估时间为出院后 1 年。对认知测试的分数进行了协调，并使用序贯分析定义了认知障碍的聚类。
在随访期间观察到三种认知轨迹组：无认知障碍、短期初始认知障碍和长期认知障碍。COVID-19 后认知下降的预测因素包括年龄较大（β=-0.013，95%置信区间=-0.023；-0.003）、女性（β=-0.230，95%置信区间=-0.413；-0.047）、住院前存在痴呆诊断或明显记忆障碍（β=-0.606，95%置信区间=-0.877；-0.335）、住院前虚弱（β=-0.191，95%置信区间=-0.264；-0.119）、血小板计数较高（β=-0.101，95%置信区间=-0.185；-0.018）和谵妄（β=-0.483，95%置信区间=-0.724；-0.244）。出院后的预测因素包括住院再入院和虚弱。
认知障碍很常见，认知轨迹模式取决于社会人口统计学、住院期间和出院后的预测因素。
COVID-19 出院后认知障碍与较高的年龄、较低的教育程度、住院期间的谵妄、出院后的多次住院以及住院前后的虚弱有关。对 COVID-19 住院后 12 个月的频繁认知评估显示了三种可能的认知轨迹：无认知障碍、短期初始障碍和长期障碍。这项研究强调了频繁进行认知测试的重要性，以确定 COVID-19 认知障碍的模式，因为在住院后 1 年，认知障碍的发生率很高。
