In a new Neurological Sciences study, researchers examined the prevalence of cognitive complaints (CC) in COVID-19 patients and factors associated with brain fog after one year.

Cognitive symptoms, weariness, anxiety, chest tightness, and myalgia have been observed in long-COVID patients after 1 year of SARS-CoV-2 infection. CC, also called “brain fog,” makes it hard to pay attention, think clearly, and understand things.

Recent imaging investigations have also identified functional changes in the brains of people with long-term SARS-CoV-2 infection-related cognitive deficits. Even after around a year of SARS-CoV-2 infection, persistent brain fog has been noted; however, more research is needed to determine the mechanisms driving brain fog as well as its relationship to the severity of COVID-19, long-term COVID-19 symptoms, and premorbid disorders.

In the current study, researchers assessed the prevalence of and risk factors for CC among patients with SARS-CoV-2 infection one year after COVID-19 diagnosis.

Patients who were hospitalized between 1 March and 31 May as a result of respiratory problems related to COVID-19 were included in the study. After one year from hospital discharge, the patients underwent complete neurological, psychological, and clinical tests. The Montreal Cognitive Assessment (MoCA), the Impact of Event Scale-Revised (IES-R), the Zung Self-Rating Anxiety Scale (SAS), the Fatigue Severity Scale (FSS), and the Zung Self-Rating Depression Scale (SDS) were all used in the evaluations.

The modified ranking scale (mRS), the fast sequential organ failure assessment (qSOFA), the requirements for low-flow oxygen and non-invasive ventilation, and the overall length of oxygen therapy are among the other analyses. People who had cognitive problems, depressive anamnestic syndrome, or premorbid conditions like dementia were left out of the analysis.

After correcting for a number of covariates, including sex, age, CIRS scores for premorbid conditions, level of education, and Brescia-COVID respiratory severity scale (BCRSS) scores, logistic regression modeling was used to assess potential characteristics associated with brain fog.

Only 132 of the 246 patients were taken into account for the final study. Three individuals with depressed anamnestic syndrome and two patients with premorbid dementia or cognitive impairment were eliminated from the analysis. After a year of SARS-CoV-2 infection, only 22% (n=25) of individuals reported having trouble thinking. Participants with CC were generally male (72%, n=18), with an average age of 68.5 years.

Comparing participants with and without cognitive disorders, those with cognitive disorders had lower MoCA scores (23 against 26) and higher IES-R scores (34 versus 26), SDS scores (41 versus 36), and FSS scores (34 versus 24). Notably, after data adjustments for confounders and MoCA scores, the SDS scores showed a strong correlation with brain fog, demonstrating that depression was the strongest predictor of the development of cognitive deficits among long COVID patients, regardless of their MoCA scores. The findings are particularly intriguing given that participants with psychological illnesses and premorbid cognitive decay were not included in the study.

The researchers found no link between CC/brain fogging and the severity of SARS-CoV-2 infections, suggesting that a variety of factors may have an effect on the long-term effects of COVID-19. To better understand the parameters related to cognitive impairment or improvement post-acute COVID-19, additional research with prospective study designs and assessments of glial and neuronal markers among post-COVID patients is needed.

Overall, the study’s findings demonstrated that COVID-19-related persistent brain fog was most strongly predicted by depression; however, longitudinal observational studies with larger sample sizes must be carried out to gain a more comprehensive understanding of the cognitive impairments experienced by COVID patients over the long term.

Despite the severity of SARS-CoV-2 infections and the presence of concomitant diseases, the authors of the present study think it is the first of its kind to reveal the positive link between brain fog or cognitive symptoms and depression year after COVID-19 recovery.

To lessen the long-term neurological burden of COVID-19, further study is needed to elucidate underlying pathways that contribute to the disease.

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