Greater executive dysfunction in patients post-COVID-19 compared to those not infected

Jacqueline H Becker; Jenny J Lin; Akosua Twumasi; Ruchir Goswami; Fernando Carnavali; Kimberly Stone; Monica Rivera-Mindt; Minal S Kale; Georges Naasan; Joanne R Festa; Juan P Wisnivesky

doi:10.1016/j.bbi.2023.08.014

Greater executive dysfunction in patients post-COVID-19 compared to those not infected

Brain Behav Immun. 2023 Nov:114:111-117. doi: 10.1016/j.bbi.2023.08.014. Epub 2023 Aug 14.

Affiliations

¹ Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA. Electronic address: jacqueline.becker@mountsinai.org.
² Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA.
³ Department of Neurology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA.
⁴ Department of Neurology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA; The Barbara and Maurice Deane Center for Wellness and Cognitive Health, Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA.
⁵ Division of Pulmonary and Critical Care Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA.

PMID: 37586567
DOI: 10.1016/j.bbi.2023.08.014

Abstract

Background: A number of patients post-coronavirus disease-19 (COVID-19) report cognitive impairment (CI), even months after acute infection. We aimed to assess if COVID-19 is associated with increased incidence of CI in comparison to controls.

Methods: We analyzed data from the Mount Sinai Health System Post-COVID-19 Registry in New York City, a prospective cohort of patients post-COVID-19 ≥18 years of age and non-infected controls. CI was defined by scores ≥ 1.0 standard deviation below population norms, and was assessed using well-validated measures of attention, working memory, processing speed, executive functioning/cognitive flexibility, language, learning, and memory. Logistic regression models assessed odds for CI in each domain in patients post-COVID-19 vs. controls after adjusting for potential confounders. In exploratory analyses, we assessed odds for CI by site of acute COVID-19 care as a proxy for disease severity.

Findings: 417 patients post-COVID-19 and 151 controls (mean age 49 years, 63% female, 21% Black, 17% Latinx) were included. In adjusted analyses, patients were significantly more likely than controls to have CI in executive functioning (odds ratio [OR]: 2.19; 95% confidence interval [CI]: 1.03 to 4.67), particularly those treated in outpatient (OR: 2.22; 95% CI: 1.02 to 4.82) and inpatient hospital (OR: 3.59; 95% CI: 1.27 to 10.16) settings. There were no significant associations between CI in other domains and history of COVID-19 or site of acute care.

Interpretation: Patients post-COVID-19 have greater odds of executive dysfunction, suggesting that focused cognitive screening may be prudent, even in those with mild to moderate disease. Studies should explore the pathophysiology and potential treatments for CI in this population.

Funding: This work was funded by the Icahn School of Medicine at Mount Sinai.

Keywords: COVID-19; Cognitive impairment; post-acute sequelae of COVID-19.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

COVID-19* / complications
Cognitive Dysfunction* / etiology
Executive Function / physiology
Female
Humans
Learning
Male
Middle Aged
Prospective Studies