Becker Jacqueline H, Li Jia, Lin Jenny J, Federman Alex, Bagiella Emilia, Kale Minal S, Fierer Daniel, Bartram Logan, Wisnivesky Juan P
Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY, 10029, USA.
Graduate School of Biomedical Sciences, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY, 10029, USA.
Brain Behav Immun Health. 2025 Aug 19;48:101093. doi: 10.1016/j.bbih.2025.101093. eCollection 2025 Oct.
Patients frequently report symptoms of cognitive impairment or "brain fog" after acute COVID-19 infection, but the trajectory of these symptoms over time has yet to be determined. We assessed cognitive function over a 42-month period after acute SARS-CoV-2 infection and identified factors associated with the trajectory of cognitive function over this period.
We analyzed data from participants in the Mount Sinai Health System Post-COVID-19 Registry in New York City, a prospective cohort study of adults followed after acute SARS-CoV-2 infection of any severity. Participants were identified from a list of all patients with COVID-19 who received care at an MSHS facility in New York, recruited beginning April 2020 and followed through January 2024. Cognition was assessed using well-validated in-person measures of attention, working memory, processing speed, executive functioning, language, and memory. We used linear mixed models to investigate the relationships between cognitive scores and time. We also assessed factors (including race, ethnicity, site of acute COVID-19 care, fatigue, depression, anxiety, body mass index, medical comorbidities, and COVID-19 vaccination) that may influence changes in cognitive scores over time.
We analyzed data from 1553 participants (median age 53 years, 63 % female, 17 % Black, 21 % Hispanic). In adjusted analyses, scores from cognitive measures of attention, working memory, processing speed, executive functions, and verbal learning and memory improved progressively through 42 months post-COVID. However, despite the improvements, on average, measures of processing speed and executive functioning remained ≥1 standard deviation below the normative mean. Having a body mass index of <25 kg/m was predictive of a greater improvement in cognitive scores.
While cognitive impairment occurring after COVID-19 improved over time in most domains, processing speed and executive functioning remained below the normal range. The cognitive health burden of Long COVID is therefore significant and lasting. Future studies should examine interventions to support rapid recovery, as well as dynamic risk prediction models to determine factors that may impact cognitive recovery longer term.
患者在急性新冠病毒感染后经常报告认知障碍或“脑雾”症状，但这些症状随时间的变化轨迹尚未确定。我们评估了急性严重急性呼吸综合征冠状病毒2（SARS-CoV-2）感染后42个月内的认知功能，并确定了与这一时期认知功能变化轨迹相关的因素。
我们分析了纽约市西奈山医疗系统新冠后登记处参与者的数据，这是一项对任何严重程度的急性SARS-CoV-2感染后的成年人进行随访的前瞻性队列研究。参与者从在纽约MSHS机构接受治疗的所有新冠患者名单中确定，于2020年4月开始招募，并随访至2024年1月。使用经过充分验证的面对面注意力、工作记忆、处理速度、执行功能、语言和记忆测量方法评估认知。我们使用线性混合模型来研究认知分数与时间之间的关系。我们还评估了可能影响认知分数随时间变化的因素（包括种族、族裔、急性新冠治疗地点、疲劳、抑郁、焦虑、体重指数、合并症和新冠疫苗接种）。
我们分析了1553名参与者的数据（中位年龄53岁，63%为女性，17%为黑人，21%为西班牙裔）。在调整分析中，注意力认知测量、工作记忆、处理速度、执行功能以及言语学习和记忆的分数在新冠后42个月内逐渐改善。然而，尽管有所改善，但平均而言，处理速度和执行功能测量仍比正常均值低≥1个标准差。体重指数<25kg/m²可预测认知分数有更大改善。
虽然新冠后出现的认知障碍在大多数领域随时间有所改善，但处理速度和执行功能仍低于正常范围。因此，长期新冠的认知健康负担是重大且持久的。未来的研究应检查支持快速康复的干预措施，以及确定可能长期影响认知恢复因素的动态风险预测模型。
