神经新冠后急性后遗症患者的认知功能:疲劳、情绪和住院状态的作用
Cognitive functioning in patients with neuro-PASC: the role of fatigue, mood, and hospitalization status.
作者信息
Cahan Joshua, Finley John-Christopher A, Cotton Erica, Orban Zachary S, Jimenez Millenia, Weintraub Sandra, Sorets Tali, Koralnik Igor J
机构信息
Northwestern Medicine, Davee Department of Neurology, Chicago, IL, United States.
Feinberg School of Medicine, Northwestern University, Chicago, IL, United States.
出版信息
Front Neurol. 2024 Jun 27;15:1401796. doi: 10.3389/fneur.2024.1401796. eCollection 2024.
This study sought to characterize cognitive functioning in patients with neurological post-acute sequelae of SARS-CoV-2 infection (Neuro-PASC) and investigate the association of subjective and objective functioning along with other relevant factors with prior hospitalization for COVID-19. Participants were 106 adult outpatients with Neuro-PASC referred for abbreviated neuropsychological assessment after scoring worse than one standard deviation below the mean on cognitive screening. Of these patients, 23 had been hospitalized and 83 had not been hospitalized for COVID-19. Subjective cognitive impairment was evaluated with the self-report cognition subscale from the Patient-Reported Outcome Measurement Information System. Objective cognitive performance was assessed using a composite score derived from multiple standardized cognitive measures. Other relevant factors, including fatigue and depression/mood symptoms, were assessed via the Patient-Reported Outcome Measurement Information System. Subjective cognitive impairment measures exceeded the minimal difficulties noted on objective tests and were associated with depression/mood symptoms as well as fatigue. However, fatigue independently explained the most variance (17.51%) in patients' subjective cognitive ratings. When adjusting for fatigue and time since onset of COVID-19 symptoms, neither objective nor subjective impairment were associated with prior hospitalization for COVID-19. Findings suggest that abbreviated neuropsychological assessment may not reveal objective difficulties beyond initial cognitive screening in patients with Neuro-PASC. However, subjective cognitive concerns may persist irrespective of hospitalization status, and are likely influenced by fatigue and depression/mood symptoms. The impact of concomitant management of fatigue and mood in patients with Neuro-PASC who report cognitive concerns deserve further study.
本研究旨在描述感染严重急性呼吸综合征冠状病毒2(SARS-CoV-2)后神经后遗症(Neuro-PASC)患者的认知功能,并调查主观和客观功能以及其他相关因素与既往因新型冠状病毒肺炎(COVID-19)住院之间的关联。研究参与者为106名患有Neuro-PASC的成年门诊患者,他们在认知筛查中得分低于平均值一个标准差以上,因此被转介进行简短神经心理学评估。在这些患者中,23人曾因COVID-19住院,83人未曾因COVID-19住院。主观认知障碍通过患者报告结局测量信息系统的自我报告认知子量表进行评估。客观认知表现通过从多个标准化认知测量得出的综合分数进行评估。其他相关因素,包括疲劳和抑郁/情绪症状,通过患者报告结局测量信息系统进行评估。主观认知障碍测量结果超过了客观测试中记录的最小困难,并且与抑郁/情绪症状以及疲劳相关。然而,疲劳独立解释了患者主观认知评分中最大的方差(17.51%)。在调整疲劳和COVID-19症状出现后的时间后,客观和主观障碍均与既往因COVID-19住院无关。研究结果表明,简短神经心理学评估可能无法揭示Neuro-PASC患者在初始认知筛查之外的客观困难。然而,无论住院状态如何,主观认知问题可能持续存在,并且可能受到疲劳和抑郁/情绪症状的影响。对于报告有认知问题的Neuro-PASC患者,同时管理疲劳和情绪的影响值得进一步研究。