Ilić Aleksandra Đ, Galić Vladimir, Ignjatović Vojislava Bugarski, Nikolašević Željka, Vlahović Dmitar, Knezović Goran, Boban Jasmina, Kozić Duško, Živanović Željko
Medical Faculty Novi Sad, University of Novi Sad, Hajduk Veljkova Street 1-9, Novi Sad, 21000, Serbia.
Department of Neurology, University Clinical Center of Vojvodina, Novi Sad, Serbia.
J Neurovirol. 2025 Sep 15. doi: 10.1007/s13365-025-01276-5.
COVID-19 is a systemic infection that causes endothelial dysfunction, contributing to severe cases. While vascular complications are well-documented, their impact on vascular structure, function, and cognition remains unclear. This cross-sectional study explored vascular and cognitive differences across patients with mild, moderate, and severe COVID-19, examining correlations between global cognitive performance and vascular parameters. This study included 83 working-age patients (30-65 years, both sexes) who recovered from COVID-19 within 6-12 months. They were grouped by severity: mild (outpatients, no oxygen support), moderate (hospitalized, conventional oxygen therapy), and severe (hospitalized, advanced oxygen therapy). Exclusions included pre-existing cognitive or neurological conditions, significant atherosclerosis, malignancies, and prior COVID-19 vaccination. Global cognitive function was assessed using the Montreal Cognitive Assessment (MoCA) test, while vascular parameters - carotid intima-media thickness (IMT), beta stiffness index (β index), mean flow velocity (MVs), maximum velocity after breath-holding (MV-BH), and breath-holding index (BHI) - were evaluated using duplex ultrasound and transcranial Doppler. Patients with severe COVID-19 had the highest carotid stiffness and poorest cerebrovascular reactivity. While MoCA scores showed no significant group differences, 23-40% had mild cognitive impairment. MoCA scores negatively correlated with β index in mild group (ρ=--0.453; p = 0.034), while MVs positively correlated with MoCA in severe cases (ρ = 0.414; p = 0.028). The association between arterial stiffness and cognitive impairment in mild cases, suggests lasting effects of SARS-CoV-2 rather than pre-existing conditions. These findings highlight carotid stiffness as a key factor in post-COVID-19 cognitive impairment, emphasizing early risk identification for timely intervention.
新冠病毒病（COVID-19）是一种全身性感染，可导致内皮功能障碍，进而引发重症病例。虽然血管并发症已有充分记录，但其对血管结构、功能和认知的影响仍不清楚。这项横断面研究探讨了轻度、中度和重度COVID-19患者的血管和认知差异，研究了整体认知表现与血管参数之间的相关性。本研究纳入了83名年龄在30至65岁之间、在6至12个月内从COVID-19中康复的工作年龄患者（男女不限）。他们按病情严重程度分组：轻度（门诊患者，无需吸氧支持）、中度（住院患者，常规吸氧治疗）和重度（住院患者，高级吸氧治疗）。排除标准包括既往存在的认知或神经疾病、严重动脉粥样硬化、恶性肿瘤以及既往接种过COVID-19疫苗。使用蒙特利尔认知评估量表（MoCA）测试评估整体认知功能，而血管参数——颈动脉内膜中层厚度（IMT）、β硬度指数（β指数）、平均流速（MVs）、屏气后最大流速（MV-BH）和屏气指数（BHI）——则使用双功超声和经颅多普勒进行评估。重度COVID-19患者的颈动脉僵硬度最高，脑血管反应性最差。虽然MoCA评分在各组之间没有显著差异，但23%至40%的患者存在轻度认知障碍。轻度组中MoCA评分与β指数呈负相关（ρ = -0.453；p = 0.034），而在重度病例中MVs与MoCA呈正相关（ρ = 0.414；p = 0.028）。轻度病例中动脉僵硬度与认知障碍之间的关联表明严重急性呼吸综合征冠状病毒2（SARS-CoV-2）的长期影响而非既往存在的疾病。这些发现突出了颈动脉僵硬度是COVID-19后认知障碍的关键因素，强调早期风险识别以便及时干预。
