Cognitive and Emotional Disturbances Due to COVID-19: An Exploratory Study in the Rehabilitation Setting

Caterina Pistarini; Elena Fiabane; Elise Houdayer; Claudio Vassallo; Marina Rita Manera; Federica Alemanno

doi:10.3389/fneur.2021.643646

Cognitive and Emotional Disturbances Due to COVID-19: An Exploratory Study in the Rehabilitation Setting

Front Neurol. 2021 May 17:12:643646. doi: 10.3389/fneur.2021.643646. eCollection 2021.

Authors

Caterina Pistarini¹, Elena Fiabane², Elise Houdayer³, Claudio Vassallo², Marina Rita Manera⁴, Federica Alemanno³

Affiliations

¹ Department of Neurorehabilitation, Istituti Clinici Scientifici Maugeri, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Pavia, Italy.
² Department of Physical and Rehabilitation Medicine, Istituti Clinici Scientifici Maugeri, Genoa, Italy.
³ Department of Rehabilitation and Functional Recovery, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) San Raffaele Scientific Institute, Milan, Italy.
⁴ Psychology Unit, Istituti Clinici Scientifici Maugeri, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Pavia, Italy.

Abstract

The coronavirus disease 19 (COVID-19) can cause neurological, psychiatric, psychological, and psychosocial impairments. Literature regarding cognitive impact of COVID-19 is still limited. The aim of this study was to evaluate cognitive deficits and emotional distress among COVID-19 and post-COVID-19 patients who required functional rehabilitation. Specifically, this study explored and compared cognitive and psychological status of patients in the subacute phase of the disease (COVID-19 group) and patients in the postillness period (post-COVID-19 group). Forty patients admitted to rehabilitation units were enrolled in the study and divided into two groups according to the phase of the disease: (a) COVID-19 group (n = 20) and (b) post-COVID-19 group (n = 20). All patients underwent a neuropsychological assessment including Mini-Mental State Evaluation (MMSE), Montreal Cognitive Assessment (MoCA), Hamilton Rating Scale for Depression, and Impact of Event Scale-Revised (IES-R). A larger part of the COVID group showed neuropsychological deficits in the total MMSE (35%) compared to the post-COVID group (5%), whereas the majority of both groups (75-70%) reported cognitive impairments in the total MoCA. The post-COVID group reported significantly higher score in MMSE subtests of language (p = 0.02) and in MoCA subtests of executive functions (p = 0.05), language (p = 0.01), and abstraction (p = 0.02) compared to the COVID group. Regarding emotional disturbances, ~40% of patients presented with mild to moderate depression (57.9-60%). The post-COVID-19 group reported significantly higher levels of distress at the IES-R compared to the COVID group (p = 0.02). These findings highlight the gravity of neuropsychological and psychological symptoms that can be induced by COVID-19 infection and the need for tailored rehabilitation, including cognitive training and psychological support.

Keywords: COVID-19; cognitive function; depression; pandemic; rehabilitation; stress.