Clark Phoebe, Rosenberg Paul, Oh Esther S, Parker Ann, Vannorsdall Tracy, Azola Alba, Nickles Elizabeth, Galiatsatos Panagis, Malik Mansoor
Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
J Med Cases. 2024 Aug;15(8):195-200. doi: 10.14740/jmc4254. Epub 2024 Jul 25.
A substantial number of patients develop cognitive dysfunction after contracting severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), significantly contributing to long-coronavirus disease (COVID) morbidity. Despite the urgent and overwhelming clinical need, there are currently no proven interventions to treat post-COVID cognitive dysfunction (PCCD). Psychostimulants like methylphenidate may enhance both noradrenergic and dopaminergic pathways in mesolimbic and pre-frontal areas, thus improving memory and cognition. We present a case series of six patients who were treated at the Johns Hopkins Post-Acute COVID-19 Team (PACT) clinic for PCCD with methylphenidate 5 - 20 mg in the context of routine clinical care and followed for 4 to 8 weeks. Baseline and post-treatment outcomes included subjective cognitive dysfunction and objective performance on a battery devised to measure cognitive dysfunction in long-COVID patients. Three out of the six patients reported subjective improvement with methylphenidate, one patient described it as "notable" and another as "marked" improvement in memory and concentration. We also found significant pre-treatment subjective complaints of cognitive dysfunction; however, formal cognitive assessment scores were not severely impaired. A statistically significant difference in pre and post scores, favoring intervention, was found for the following cognitive assessments: Hopkins verbal learning test (HVLT) immediate recall, HVLT delayed recall and category-cued verbal fluency. The current series demonstrates promising neurocognitive effects of methylphenidate for long-COVID cognitive impairment, particularly in recall and verbal fluency domains.
相当数量的患者在感染严重急性呼吸综合征冠状病毒2（SARS-CoV-2）后出现认知功能障碍，这对长期新冠病毒病（COVID）的发病率有显著影响。尽管临床需求迫切且巨大，但目前尚无经证实的干预措施来治疗新冠后认知功能障碍（PCCD）。像哌甲酯这样的精神兴奋药可能会增强中脑边缘和前额叶区域的去甲肾上腺素能和多巴胺能通路，从而改善记忆和认知。我们报告了一个病例系列，六名患者在约翰·霍普金斯急性新冠后团队（PACT）诊所接受治疗，在常规临床护理中使用5 - 20毫克哌甲酯治疗PCCD，并随访4至8周。基线和治疗后的结果包括主观认知功能障碍以及在为测量长期新冠患者认知功能障碍而设计的一组测试中的客观表现。六名患者中有三名报告使用哌甲酯后主观症状有所改善，一名患者称记忆和注意力有“显著”改善，另一名患者称有“明显”改善。我们还发现治疗前存在明显的认知功能障碍主观主诉；然而，正式的认知评估分数并未严重受损。在以下认知评估中发现治疗前后分数存在统计学上的显著差异，且干预组更具优势：霍普金斯言语学习测试（HVLT）即时回忆、HVLT延迟回忆和类别线索言语流畅性。本病例系列证明了哌甲酯对长期新冠认知障碍具有有前景的神经认知作用，特别是在回忆和言语流畅性方面。
