Akut COVID-19 Hastalarında Bilişsel Değerlendirme: Kesitsel Bir Çalışma

Yıl 2023, Cilt: 7 Sayı: 3, 364 - 370, 20.12.2023

Yusuf Koçak , Asuman Çelikbilek , Burc Esra Sahin , Duygu Zorlu , Gökmen Zararsız

https://doi.org/10.46332/aemj.1264653

Öz

Amaç: COVID-19’a bağlı kognitif bozukluk daha önce yapılan çalışmalarda yüksek oranda bildirilmiştir. Enfeksiyonun ilk solunum semptomlarından sonraki 5 gün içinde, hafif COVID-19 hastalarında, COVID-19 olmayan hastalara kıyasla, Montreal Bilişsel Değerlendirmesini (MoCA) kullanarak bilişsel işlevleri araştırıldı.

Araçlar ve Yöntem: Bu prospektif kesitsel çalışmaya hafif COVID-19'lu 113 hasta ve yaş ve cinsiyet olarak eşleştirilmiş 109 kontrol alındı. Bilişsel işlevler, MoCA kullanılarak değerlendirildi.

Bulgular: MoCA skorlarının COVID-19 hastalarında kontrollere göre anlamlı derecede düşük olduğunu bulduk (P<0.001). Kontrollerle karşılaştırıldığında, görsel uzamsal (P<0.001), bellek (P=0.017) ve dikkat (P<0.048) alanları gibi bazı MoCA öğelerinde puan kayıpları bulduk. Çok değişkenli modelde kadın cinsiyet (2.06 [1.02–4.16], P=0.044), düşük eğitim düzeyi (15.05 [5.16–43.90], P<0.001), yüksek açlık kan şekeri düzeyi (0.98 [0.96–1.00]), P=0.043) ve COVID-19 (24.24 [9.52–61.72], P<0.001) varlığı bağımsız olarak kognitif bozuklukla ilişkiliyidi (OR, %95 CI).

Sonuç: Hafif COVID-19'lu hastalarda akut faz sırasında görsel uzamsal, bellek ve dikkat alanlarında bilişsel işlev bozukluğu tespit edildi.

Anahtar Kelimeler

COVID-19, biliş, bilişsel değerlendirme, montreal bilişsel değerlendirme, salgın

Cognitive Assessment in Patients with Acute COVID-19: A Cross-Sectional Study

Öz

Purpose: Many reports have revealed a high percentage of patients suffering from cognitive impairment due to COVID-19. We investigated cognitive functions using the Montreal Cognitive Assessment (MoCA) in mild COVID-19 patients compared with non-COVID-19 patients within 5 days after the initial respiratory symptoms of infection.

Materials and Methods: 113 patients with mild COVID-19 and 109 age- and sex-matched controls were enrolled in this prospective cross-sectional study. Cognitive functions were evaluated using the MoCA.

Results: We found that the MoCA scores were significantly lower in the COVID-19 patients than in the controls (P<0.001). Compared to the controls, we found point deficits within some MoCA items such as visuospatial (P<0.001), memory (P=0.017), and attention (P<0.048) domains. In the multivariate model, female sex (2.06 [1.02–4.16], P=0.044), low education level (150.05 [5.16–43.90], P<0.001), high fasting blood glucose level (0.98 [0.96–1.00], P=0.043), and the presence of COVID-19 (24.24 [9.52–61.72], P<0.001) were independently associated with cognitive impairment (OR, 95% CI).

Conclusion: We detected cognitive dysfunction, involving the visuospatial domain, memory, and attention, during the acute phase in patients with mild COVID-19.

Anahtar Kelimeler

COVID-19, cognition, cognitive assessment, montreal cognitive assessment, pandemic

Teşekkür

Dear Editor, We are submitting our manuscript entitled ‘Cognitive assessment in patients with acute COVID-19: A cross-sectional study’ to Ahi Evran Medical Journal for publication after all the authors (Yusuf Kocak, Asuman Celikbilek, Burc Esra Sahin, Duygu Zorlu, Gokmen Zararsiz) have seen and approved the final form of it. We confirm that this manuscript has been submitted solely to this journal and is not published, in press, or submitted elsewhere. The following address can be used for any kind of negotiations. We appreciate if you could consider our manuscript for publication in Ahi Evran Medical Journal. Best wishes, Dr. Asuman Celikbilek Corresponding Author: Asuman Celikbilek, Prof, MD Kirsehir Ahi Evran University, Faculty of Medicine, Department of Neurology 40100, Kirsehir, Turkey ORCID: 0000-0002-2367-1128 Telephone: [phone] Fax: [phone] E-mail: [e-mail] Dear Editor, We are submitting our manuscript entitled ‘Cognitive assessment in patients with acute COVID-19: A cross-sectional study’ to Ahi Evran Medical Journal for publication after all the authors (Yusuf Kocak, Asuman Celikbilek, Burc Esra Sahin, Duygu Zorlu, Gokmen Zararsiz) have seen and approved the final form of it. We confirm that this manuscript has been submitted solely to this journal and is not published, in press, or submitted elsewhere. The following address can be used for any kind of negotiations. We appreciate if you could consider our manuscript for publication in Ahi Evran Medical Journal. Best wishes, Dr. Asuman Celikbilek Corresponding Author: Asuman Celikbilek, Prof, MD Kirsehir Ahi Evran University, Faculty of Medicine, Department of Neurology 40100, Kirsehir, Turkey ORCID: 0000-0002-2367-1128 Telephone: [phone] Fax: [phone] E-mail: [e-mail]

Kaynakça

• 1. Mukherjee R, Bhattacharyya B, Mukherjee A, Das G, Das S, Biswas A. Exploring Caregiver Burden and Health Condition of Dementia Patients during Lockdown due to COVID-19 Pandemic. Ann Indian Acad Neurol. 2022;25(2):235-238.
• 2. Yildrim S, Kirakli C. Accuracy of conventional disease severity scores in predicting COVID-19 ICU mortality: retrospective single-center study in Turkey. Ann Saudi Med. 2022;42(6):408-414.
• 3. Mao L, Jin H, Wang M, et al. Neurologic Manifestations of Hospitalized Patients With Coronavirus Disease 2019 in Wuhan, China. JAMA Neurol. 2020;77(6):683-690.
• 4. Nejad JH, Allahyari F, Hosseinzadeh R, Heiat M, Ranjbar R. Neurological symptoms of COVID-19 infection; a cross-sectional study on hospitalized COVID-19 patients in Iran. Clin Neurol Neurosurg. 2021;210:106985.
• 5. Amalakanti S, Arepalli KVR, Jillella JP. Cognitive assessment in asymptomatic COVID-19 subjects. Virusdisease. 2021;32(1):1-4.
• 6. Solaro C, Gamberini G, Masuccio FG. Cognitive impairment in young COVID-19 patients: the tip of the iceberg? Neurol Sci. 2021;42(12):4865-4866.
• 7. Daroische R, Hemminghyth MS, Eilertsen TH, Breitve MH, Chwiszczuk LJ. Cognitive Impairment After COVID-19-A Review on Objective Test Data. Front Neurol. 2021;12:699582.
• 8. Almeria M, Cejudo JC, Sotoca J, Deus J, Krupinski J. Cognitive profile following COVID-19 infection: Clinical predictors leading to neuropsychological impairment. Brain Behav Immun Health. 2020;9:100163.
• 9. Pirker-Kees A, Platho-Elwischger K, Hafner S, Redlich K, Baumgartner C. Hyposmia Is Associated with Reduced Cognitive Function in COVID-19: First Preliminary Results. Dement Geriatr Cogn Disord. 2021;50(1):68-73.
• 10. Matos AMB, Dahy FE, de Moura JVL, et al. Subacute Cognitive Impairment in Individuals With Mild and Moderate COVID-19: A Case Series. Front Neurol. 2021;12:678924.
• 11. Pistarini C, Fiabane E, Houdayer E, Vassallo C, Manera MR, Alemanno F. Cognitive and Emotional Disturbances Due to COVID-19: An Exploratory Study in the Rehabilitation Setting. Front Neurol. 2021;12:643646.
• 12. Boldrini M, Canoll PD, Klein RS. How COVID-19 Affects the Brain. JAMA Psychiatry. 2021;78(6):682-683.
• 13. Yavarpour-Bali H, Ghasemi-Kasman M. Update on neurological manifestations of COVID-19. Life Sci. 2020;257:118063.
• 14. Alemanno F, Houdayer E, Parma A, et al. COVID-19 cognitive deficits after respiratory assistance in the subacute phase: A COVID-rehabilitation unit experience. PLoS One. 2021;16(2):e0246590.
• 15. Aiello EN, Fiabane E, Manera MR, et al. Screening for cognitive sequelae of SARS-CoV-2 infection: a comparison between the Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA). Neurol Sci. 2022;43(1):81-84.
• 16. Hugon J, Msika EF, Queneau M, Farid K, Paquet C. Long COVID: cognitive complaints (brain fog) and dysfunction of the cingulate cortex. J Neurol. 2022;269(1):44-46.
• 17. Helms J, Kremer S, Merdji H, et al. Neurologic Features in Severe SARS-CoV-2 Infection. N Engl J Med. 2020;382(23):2268-2270.
• 18. Negrini F, Ferrario I, Mazziotti D, et al. Neuropsychological Features of Severe Hospitalized Coronavirus Disease 2019 Patients at Clinical Stability and Clues for Postacute Rehabilitation. Arch Phys Med Rehabil. 2021;102(1):155-158.
• 19. Zhou H, Lu S, Chen J, et al. The landscape of cognitive function in recovered COVID-19 patients. J Psychiatr Res. 2020;129:98-102.
• 20. De Lorenzo R, Conte C, Lanzani C, et al. Residual clinical damage after COVID-19: A retrospective and prospective observational cohort study. PLoS One. 2020;15(10):e0239570.
• 21. Beaud V, Crottaz-Herbette S, Dunet V, et al. Pattern of cognitive deficits in severe COVID-19. J Neurol Neurosurg Psychiatry. 2021;92(5):567-568.
• 22. Rogers JP, Chesney E, Oliver D, et al. Psychiatric and neuropsychiatric presentations associated with severe coronavirus infections: a systematic review and meta-analysis with comparison to the COVID-19 pandemic. Lancet Psychiatry. 2020;7(7):611-627.
• 23. Smith NA, Yeow YY. Use of the Montreal Cognitive Assessment test to investigate the prevalence of mild cognitive impairment in the elderly elective surgical population. Anaesth Intensive Care. 2016;44(5):581-586.
• 24. Nasreddine ZS, Phillips NA, Bédirian V, et al. The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc. 2005;53(4):695-699.
• 25. Yilmaz A, Marklund E, Andersson M, et al. Upper Respiratory Tract Levels of Severe Acute Respiratory Syndrome Coronavirus 2 RNA and Duration of Viral RNA Shedding Do Not Differ Between Patients With Mild and Severe/Critical Coronavirus Disease 2019. J Infect Dis. 2021;223(1):15-18.
• 26. A minimal common outcome measure set for COVID-19 clinical research. Lancet Infect Dis. 2020;20(8):e192-e197.
• 27. Selekler K, Cangoz B, Uluc S. Power Of Discrimination Of Montreal Cognitive Assessment (Moca) Scale In Turkish Patients With Mild Cognitive Impairement And Alzheimer's Disease. Turk Geriatri Derg. 2010;13(3):166-171.
• 28. Ozdilek B, Kenangil G. Validation of the Turkish Version of the Montreal Cognitive Assessment Scale (MoCA-TR) in patients with Parkinson's disease. Clin Neuropsychol. 2014;28(2):333-343.
• 29. Hosmer Jr DW, Lemeshow S, Sturdivant RX. Applied logistic regression. John Wiley & Sons; 2013.
• 30. Shipp S. The functional logic of cortico-pulvinar connections. Philos Trans R Soc Lond B Biol Sci. 2003;358(1438):1605-1624.
• 31. Ritchie K, Chan D, Watermeyer T. The cognitive consequences of the COVID-19 epidemic: collateral damage? Brain Commun. 2020;2(2):fcaa069.
• 32. Lindlau A, Widmann CN, Putensen C, Jessen F, Semmler A, Heneka MT. Predictors of hippocampal atrophy in critically ill patients. Eur J Neurol. 2015;22(2):410-415.
• 33. Lichenstein SD, Verstynen T, Forbes EE. Adolescent brain development and depression: A case for the importance of connectivity of the anterior cingulate cortex. Neurosci Biobehav Rev. 2016;70:271-287.
• 34. Chang JG, Ha EH, Lee W, Lee SY. Cognitive impairments in patients with subacute coronavirus disease: Initial experiences in a post-coronavirus disease clinic. Front Aging Neurosci. 2022;14:994331.
• 35. Woo MS, Malsy J, Pöttgen J, et al. Frequent neurocognitive deficits after recovery from mild COVID-19. Brain Commun. 2020;2(2):fcaa205.
• 36. Celikbilek A, Celikbilek M, Bozkurt G. Cognitive assessment of patients with nonalcoholic fatty liver disease. Eur J Gastroenterol Hepatol. 2018;30(8):944-950.