Department of Neurology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
Copenhagen Research Center for Biological and Precision Psychiatry, Mental Health Centre Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark.
JAMA Netw Open. 2023 Dec 1;6(12):e2349659. doi: 10.1001/jamanetworkopen.2023.49659.
Brain health is most likely compromised after hospitalization for COVID-19; however, long-term prospective investigations with matched control cohorts and face-to-face assessments are lacking.
To assess whether long-term cognitive, psychiatric, or neurological complications among patients hospitalized for COVID-19 differ from those among patients hospitalized for other medical conditions of similar severity and from healthy controls.
DESIGN, SETTING, AND PARTICIPANTS: This prospective cohort study with matched controls was conducted at 2 academic hospitals in Copenhagen, Denmark. The case cohort comprised patients with COVID-19 hospitalized between March 1, 2020, and March 31, 2021. Control cohorts consisted of patients hospitalized for pneumonia, myocardial infarction, or non-COVID-19 intensive care-requiring illness between March 1, 2020, and June 30, 2021, and healthy age- and sex-matched individuals. The follow-up period was 18 months; participants were evaluated between November 1, 2021, and February 28, 2023.
Hospitalization for COVID-19.
The primary outcome was overall cognition, assessed by the Screen for Cognitive Impairment in Psychiatry (SCIP) and the Montreal Cognitive Assessment (MoCA). Secondary outcomes were executive function, anxiety, depressive symptoms, and neurological deficits.
The study included 345 participants, including 120 patients with COVID-19 (mean [SD] age, 60.8 [14.4] years; 70 men [58.3%]), 125 hospitalized controls (mean [SD] age, 66.0 [12.0] years; 73 men [58.4%]), and 100 healthy controls (mean [SD] age, 62.9 [15.3] years; 46 men [46.0%]). Patients with COVID-19 had worse cognitive status than healthy controls (estimated mean SCIP score, 59.0 [95% CI, 56.9-61.2] vs 68.8 [95% CI, 66.2-71.5]; estimated mean MoCA score, 26.5 [95% CI, 26.0-27.0] vs 28.2 [95% CI, 27.8-28.6]), but not hospitalized controls (mean SCIP score, 61.6 [95% CI, 59.1-64.1]; mean MoCA score, 27.2 [95% CI, 26.8-27.7]). Patients with COVID-19 also performed worse than healthy controls during all other psychiatric and neurological assessments. However, except for executive dysfunction (Trail Making Test Part B; relative mean difference, 1.15 [95% CI, 1.01-1.31]), the brain health of patients with COVID-19 was not more impaired than among hospitalized control patients. These results remained consistent across various sensitivity analyses.
This prospective cohort study suggests that post-COVID-19 brain health was impaired but, overall, no more than the brain health of patients from 3 non-COVID-19 cohorts of comparable disease severity. Long-term associations with brain health might not be specific to COVID-19 but associated with overall illness severity and hospitalization. This information is important for putting understandable concerns about brain health after COVID-19 into perspective.
因 COVID-19 住院后大脑健康很可能受损；然而，缺乏长期前瞻性研究、匹配对照队列和面对面评估。
评估 COVID-19 住院患者与因其他严重程度相似的医疗条件住院的患者以及健康对照组相比，是否存在长期认知、精神或神经并发症。
设计、地点和参与者：这是一项在丹麦哥本哈根的 2 家学术医院进行的前瞻性队列研究，匹配对照。病例队列包括 2020 年 3 月 1 日至 2021 年 3 月 31 日期间因 COVID-19 住院的患者。对照组包括 2020 年 3 月 1 日至 2021 年 6 月 30 日期间因肺炎、心肌梗死或非 COVID-19 需要重症监护的疾病住院的患者，以及年龄和性别匹配的健康个体。随访期为 18 个月；参与者于 2021 年 11 月 1 日至 2023 年 2 月 28 日接受评估。
COVID-19 住院。
主要结局是整体认知，通过精神科认知障碍筛查（SCIP）和蒙特利尔认知评估（MoCA）进行评估。次要结局是执行功能、焦虑、抑郁症状和神经缺陷。
研究纳入了 345 名参与者，包括 120 名 COVID-19 患者（平均[SD]年龄 60.8[14.4]岁；70 名男性[58.3%]）、125 名住院对照（平均[SD]年龄 66.0[12.0]岁；73 名男性[58.4%]）和 100 名健康对照（平均[SD]年龄 62.9[15.3]岁；46 名男性[46.0%]）。与健康对照组相比，COVID-19 患者的认知状态较差（估计平均 SCIP 评分 59.0[95%CI，56.9-61.2] vs 68.8[95%CI，66.2-71.5]；估计平均 MoCA 评分 26.5[95%CI，26.0-27.0] vs 28.2[95%CI，27.8-28.6]），但与住院对照组无差异（平均 SCIP 评分 61.6[95%CI，59.1-64.1]；平均 MoCA 评分 27.2[95%CI，26.8-27.7]）。COVID-19 患者在所有其他精神和神经评估中也表现不佳。然而，除了执行功能（Trail Making Test 部分 B；相对平均差异 1.15[95%CI，1.01-1.31]）外，COVID-19 患者的大脑健康状况并不比病情严重程度相当的 3 个非 COVID-19 对照组患者更受损。这些结果在各种敏感性分析中仍然一致。
这项前瞻性队列研究表明，COVID-19 后大脑健康受损，但总体而言，与病情严重程度相当的 3 个非 COVID-19 队列患者的大脑健康状况相比并无更严重。与大脑健康的长期关联可能不是 COVID-19 特有的，而是与整体疾病严重程度和住院有关。这些信息对于正确看待 COVID-19 后大脑健康的担忧非常重要。
