Infections West, Hollywood Private Hospital, Suite 37, Monash Avenue, Western Australia, Australia.
The Biosecurity Program, The Kirby Institute, The University of New South Wales, Sydney, Australia.
Ageing Res Rev. 2024 Nov;101:102448. doi: 10.1016/j.arr.2024.102448. Epub 2024 Aug 8.
Cognitive impairment can be caused by infections with various pathogens, including SARS-CoV-2. Research has yet to determine the true incidence and course of cognitive impairment in older adults following COVID-19. Furthermore, research has theorised that COVID-19 is associated with dementia progression and diagnosis but this association has yet to be fully described.
A systematic review was registered in Prospero and conducted on the databases PubMed, Embase, Ovid, CENTRAL and Cochrane Library. Studies reporting cognitive impairment and dementia outcomes in post-acute and post-COVID-19 patients aged ≥65 years, and which included control data, were included in this review.
15,124 articles were identified by the search strategy. After eliminating duplicate titles and completing title, abstracts and full-text review, 18 studies were included comprising of 412,957 patients with COVID-19 (46.63 % male) and 411,929 patients without COVID-19 (46.59 % male). The overall mean Montreal Cognitive Assessment (MoCA) score in COVID-19 patients was 23.34 out of 30 (95 % CI [22.24, 24.43]). indicating cognitive impairment. The overall proportion of patients identified as having new onset cognitive impairment was 65 % (95 % CI [44,81]). Subgroup analyses indicated that time since infection significantly improves overall MoCA score and reduces proportion of patients with cognitive impairment.
This study indicates that cognitive impairment may be an important sequela of COVID-19. Further research with adequate sample sizes is warranted regarding COVID-19's association with new-onset dementia and dementia progression, and the effect of repeat infections. There is a need for development of diagnostic and management protocols for COVID-19 patients with cognitive impairment.
认知障碍可由多种病原体感染引起，包括 SARS-CoV-2。研究尚未确定 COVID-19 后老年人认知障碍的真实发病率和病程。此外，研究提出 COVID-19 与痴呆进展和诊断相关，但这种关联尚未得到充分描述。
系统评价在 Prospero 上进行，并在 PubMed、Embase、Ovid、CENTRAL 和 Cochrane Library 数据库中进行。本综述纳入了报告急性后和 COVID-19 后年龄≥65 岁患者认知障碍和痴呆结局且纳入对照数据的研究。
通过检索策略确定了 15124 篇文章。在消除重复标题并完成标题、摘要和全文审查后，纳入了 18 项研究，共纳入 412957 例 COVID-19 患者（46.63%为男性）和 411929 例非 COVID-19 患者（46.59%为男性）。COVID-19 患者的总体平均蒙特利尔认知评估（MoCA）得分为 23.34 分（30 分的 95%置信区间[22.24，24.43]），表明存在认知障碍。新诊断为认知障碍的患者比例总体为 65%（95%置信区间[44，81]）。亚组分析表明，从感染到评估的时间显著提高了总体 MoCA 评分并降低了认知障碍患者的比例。
本研究表明认知障碍可能是 COVID-19 的重要后遗症。需要进一步开展研究，纳入足够的样本量，以明确 COVID-19 与新发痴呆和痴呆进展的关联，以及重复感染的影响。需要制定针对 COVID-19 合并认知障碍患者的诊断和管理方案。
