Change in Neuropsychological Test Performance Seen in a Longitudinal Study of Patients With Post-acute Sequelae of COVID-19: A 6-Month Follow-up Study

Sean T Lynch; Rhea Dornbush; Sivan Shahar; Rayah Mansour; Lidia Klepacz; Louis H Primavera; Stephen J Ferrando

doi:10.1016/j.jaclp.2023.12.005

Change in Neuropsychological Test Performance Seen in a Longitudinal Study of Patients With Post-acute Sequelae of COVID-19: A 6-Month Follow-up Study

J Acad Consult Liaison Psychiatry. 2024 Jan 1:S2667-2960(23)00856-X. doi: 10.1016/j.jaclp.2023.12.005. Online ahead of print.

Authors

Sean T Lynch¹, Rhea Dornbush², Sivan Shahar³, Rayah Mansour⁴, Lidia Klepacz², Louis H Primavera⁵, Stephen J Ferrando⁶

Affiliations

¹ Department of Psychiatry and Behavioral Sciences, School of Medicine, New York Medical College, Valhalla, NY; Department of Psychiatry, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, New York, NY.
² Department of Psychiatry and Behavioral Sciences, School of Medicine, New York Medical College, Valhalla, NY; Department of Psychiatry, Westchester Medical Center Health System, Valhalla, NY.
³ Department of Psychiatry and Behavioral Sciences, School of Medicine, New York Medical College, Valhalla, NY; Department of Psychiatry, Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, New York, NY.
⁴ School of Public Health, New York Medical College, Valhalla, NY.
⁵ School of Health Sciences, Touro College and University System, Valhalla, NY.
⁶ Department of Psychiatry and Behavioral Sciences, School of Medicine, New York Medical College, Valhalla, NY; Department of Psychiatry, Westchester Medical Center Health System, Valhalla, NY. Electronic address: Stephen.Ferrando@wmchealth.org.

PMID: 38171454
DOI: 10.1016/j.jaclp.2023.12.005

Abstract

Background: Post-acute sequelae of COVID-19 may include physical, psychiatric, and neurocognitive symptoms. Few studies of cognitive symptoms have been longitudinal, with many following participants briefly after infection and relying on subjective complaints, screening instruments, or computerized testing. This group previously reported diminished neuropsychological (NP) test performance in over half of 60 individuals tested in-person 7 months post-COVID-19, particularly those seeking care for cognitive complaints. The current study describes the initial and 6-month follow-up results of an expanded cohort of 75 participants.

Objective: To measure longitudinal changes in neuropsychological test performance, as well as medical and psychiatric changes, post-COVID-19.

Methods: Participants underwent NP, psychiatric, and medical assessments approximately 7 months after acute COVID-19 infection. Sixty-three (84%) returned approximately 6 months later for repeat evaluation.

Results: At the initial visit, 29 (38.7%) met criteria for low NP performance, and 16 (21.3%) met criteria for extremely low NP performance. At 6-month follow-up, several NP domains that were significantly below normative values at the initial visit were no longer abnormal, with the exception of language. Only measures of delayed memory and fatigue showed significant improvements between the 2 time points.

Conclusions: A substantial proportion of individuals recovered from acute COVID-19 infection have persistent neuropsychiatric symptoms over 1 year after infection. While the overall sample in this study showed some improvement in NP test performance relative to norms, only fatigue and delayed memory improved significantly between times 1 and 2. No individual declined in NP test performance, though relatively few individuals made significant clinical improvement, indicating the need for serial neuropsychiatric assessment and treatment supports. Longitudinal follow-up of this cohort is in progress.

Keywords: COVID-19; cognitive complaints; neuropsychiatry; neuropsychological testing; post-acute sequelae of COVID-19 (PASC).