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Cognitive and Psychiatric Burden Substantial Up to 3 Years After Acute COVID-19
Cognitive and psychiatric symptom trajectories increased over 2 to 3 years after hospitalization for acute COVID-19, according to a study published in Lancet Psychiatry.
“Prompt interventions to treat symptoms present in the months after hospital discharge might prevent the emergence of additional symptoms and the development of a more complex syndrome,” researchers wrote. “Interventions promoting cognitive recovery or preventing cognitive decline might limit the occupational impact of SARS-CoV-2 infections, thereby improving functional and economic outcomes of COVID-19 for the individual and society as a whole.”
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The study included 475 adults hospitalized with COVID-19 across 83 hospitals. Two to 3 years after admission, participants completed cognitive assessments and a slate of psychiatric questionnaires. Researchers looked at how symptoms evolved between 6-month and 12-month follow-ups and the 2- to 3-year assessments.
Across all cognitive domains examined, participants had worse cognitive scores than expected based on their sociodemographic characteristics, according to the study. Most participants reported at least mild depression (74.5%), anxiety (53.5%), fatigue (62.3%), or subjective cognitive decline (52.1%). Symptoms were severe in more than a fifth: 22.4% reported severe depression, 24.6% reported severe fatigue, and 24.9% reported severe subjective cognitive decline.
Regarding symptom trajectories, depression, anxiety, and fatigue were worse at 2 to 3 years after COVID-19 hospitalization compared with at 6 months or 12 months afterward because of symptom worsening as well as new symptoms.
“We found that the burden of symptoms increased compared with 6 months and 12 months post-COVID-19 due to both worsening of existing symptoms and emergence of new ones,” wrote corresponding author Maxime Taquet, PhD, of the University of Oxford Department of Psychiatry, Oxford, England, and study coauthors. “We also found that emergence of new symptoms occurred mostly in people with other symptoms present at 6 months and 12 months, rather than in people who were completely well at those earlier timepoints.”
The severity of acute COVID-19 illness did not predict subjective cognitive or psychiatric outcomes at 2 to 3 years. Factors that strongly did, however, were degree of recovery at 6 months; a biocognitive profile linking acutely raised D-dimer relative to C-reactive protein with subjective cognitive deficits at 6 months; and anxiety, depression, fatigue, and subjective cognitive deficits at 6 months. Objective cognitive deficits at 2 to 3 years were solely predicted by cognitive deficits at 6 months.
The study also revealed that 26.9% of participants reported changing occupations after their COVID-19 hospitalization, mostly because of poor health. Occupation change was strongly linked with objective cognitive deficits and subjective cognitive decline.
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