Demmer Ryan T, Cornelius Talea, Kraal Zarina, Pike James R, Sun Yifei, Balte Pallavi, Wu Chaoqi, Allen Norrina B, Cushman Mary, Suchy-Dicey Astrid M, Elkind Mitchell S V, Howard Virginia, Kucharska-Newton Anna, Levine Deb, Lutsey Pamela L, Manly Jennifer, Mosley Thomas H, Palta Priya, Power Melinda C, Seshadri Sudha, Tracy Russell P, Walker Keenan, Coresh Josef, Oelsner Elizabeth C
Division of Epidemiology, Department of Quantitative Health Sciences, College of Medicine and Science, Mayo Clinic, Rochester, Minnesota.
Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York.
JAMA Netw Open. 2025 Jun 2;8(6):e2518648. doi: 10.1001/jamanetworkopen.2025.18648.
SARS-CoV-2 infection has been linked to neurotoxic effects and cognitive deficits.
To determine whether decreases in cognitive function were accelerated after SARS-CoV-2 infection compared with individuals not infected.
DESIGN, SETTING, AND PARTICIPANTS: Multicenter, prospective cohort study from 2016 to 2022 among 3525 participants alive on March 1, 2020, and enrolled in The Atherosclerosis Risk in Communities (ARIC) study and the Collaborative Cohort of Cohorts for COVID-19 Research study who completed a prepandemic cognitive assessment and a pandemic-era assessment of SARS-CoV-2 infection. Final analyses performed in November 2024.
SARS-CoV-2 infection determined via self-report of a positive SARS-CoV-2 test or health care professional diagnosis of COVID-19, a positive SARS-CoV-2 antinucleocapsid antibody response, or presence of an administrative code for COVID-19 on medical records.
A neuropsychological battery assessed multiple cognitive domains, and a cocalibrated confirmatory factor analysis generated factor scores for global cognitive function. The primary outcome was the rate of excess change in cognitive function.
The 3525 eligible participants had a mean (SD) age of 80.8 (4.7) years, 2085 (59.1%) were female, 752 (21.4%) were Black, and 2773 (78.6%) were White. SARS-CoV-2 infection was detected among 307 participants (8.7%), 103 of whom (33.6%) were hospitalized. Among uninfected participants, the mean annualized change in cognitive function was -0.09 (95% CI, -0.13 to -0.04). Compared with this rate, change was faster (β = -0.06; 95% CI, -0.09 to -0.02) among participants hospitalized for infection, but not different from participants who were infected but not hospitalized (β = 0.00; 95% CI, -0.02 to 0.03). The association among participants hospitalized for infection was evident in the cognitive domains of memory and executive function, but not language.
This cohort study of older participants found accelerated decreases in cognition among individuals hospitalized for SARS-CoV-2 infection, but not nonhospitalized infection, in comparison with individuals not yet infected.
严重急性呼吸综合征冠状病毒2（SARS-CoV-2）感染与神经毒性作用和认知缺陷有关。
确定与未感染个体相比，SARS-CoV-2感染后认知功能下降是否加速。
设计、设置和参与者：2016年至2022年的多中心前瞻性队列研究，研究对象为2020年3月1日仍在世、参加社区动脉粥样硬化风险（ARIC）研究以及COVID-19研究合作队列研究的3525名参与者，他们完成了疫情前的认知评估和疫情期间的SARS-CoV-2感染评估。最终分析于2024年11月进行。
通过SARS-CoV-2检测呈阳性的自我报告或医护人员对COVID-19的诊断、SARS-CoV-2抗核衣壳抗体反应呈阳性或病历上存在COVID-19的管理代码来确定SARS-CoV-2感染。
一套神经心理测试评估多个认知领域，通过共同校准的验证性因素分析得出整体认知功能的因素得分。主要结局是认知功能的过度变化率。
3525名符合条件的参与者的平均（标准差）年龄为80.8（4.7）岁，2085名（59.1%）为女性，752名（21.4%）为黑人，2773名（78.6%）为白人。307名参与者（8.7%）检测出SARS-CoV-2感染，其中103名（33.6%）住院治疗。在未感染的参与者中，认知功能的平均年化变化为-0.09（95%置信区间，-0.13至-0.04）。与该变化率相比，因感染住院的参与者变化更快（β=-0.06；95%置信区间，-0.09至-0.02），但与感染但未住院的参与者无差异（β=0.00；95%置信区间，-0.02至0.03）。因感染住院的参与者之间的关联在记忆和执行功能的认知领域明显，但在语言领域不明显。
这项针对老年参与者的队列研究发现，与未感染个体相比，因SARS-CoV-2感染住院的个体认知能力下降加速，但未住院感染的个体则不然。
