Cognitive Assessment in SARS-CoV-2 Patients: A Systematic Review

Bruno Biagianti; Asia Di Liberto; Aiello Nicolò Edoardo; Ilaria Lisi; Letizia Nobilia; Giulia Delor de Ferrabonc; Elisa R Zanier; Nino Stocchetti; Paolo Brambilla

doi:10.3389/fnagi.2022.909661

Cognitive Assessment in SARS-CoV-2 Patients: A Systematic Review

Front Aging Neurosci. 2022 Jul 1:14:909661. doi: 10.3389/fnagi.2022.909661. eCollection 2022.

Authors

Bruno Biagianti^{1

2}, Asia Di Liberto¹, Aiello Nicolò Edoardo^{3

4}, Ilaria Lisi⁵, Letizia Nobilia⁶, Giulia Delor de Ferrabonc¹, Elisa R Zanier⁵, Nino Stocchetti^{2

7}, Paolo Brambilla^{1

2}

Affiliations

¹ Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy.
² Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.
³ University of Milano-Bicocca, Milan, Italy.
⁴ School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.
⁵ Laboratory of Acute Brain Injury and Therapeutic Strategies, Department of Neuroscience, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy.
⁶ Department of Psychology, University of Milano-Bicocca, Milan, Italy.
⁷ Department of Anaesthesia and Critical Care, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.

Abstract

Background: Patients with post-infective severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) often show both short- and long-term cognitive deficits within the dysexecutive/inattentive spectrum. However, little is known about which cognitive alterations are commonly found in patients recovered from SARS-CoV-2, and which psychometric tools clinicians should consider when assessing cognition in this population. The present work reviewed published studies to provide a critical narrative of neuropsychological (NPs) deficits commonly observed after SARS-CoV-2 infection and the tests most suited for detecting such cognitive sequelae depending on illness severity.

Methods: This review followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines and was pre-registered on Prospective Register of Systematic Reviews (PROSPERO) (CRD42021253079). Observational studies quantitatively assessing cognition in patients with post-infective SARS-CoV-2 were considered. From 711 retrieved articles, 19 studies conducted on patients with SARS-CoV-2 without medical comorbidities were included and stratified by disease severity.

Results: The majority of studies (N = 13) adopted first-level tests. The most frequently administered screeners were the Montreal Cognitive Assessment (MoCA) and the Mini-Mental State Examination (MMSE)-with the former more likely to detect mild, and the latter moderate/severe deficits. Among second-level tests, those assessing attention and executive functions (EFs) were highly represented. Remotely-delivered tests yielded lower percentages of cognitive impairment. Overall, cognitive domains often found to be impaired were EFs, attention, and memory.

Conclusion: Cognitive sequelae in patients with post-infective SARS-CoV-2 can be detected with NPs testing. Depending on the psychometric test features, the likelihood of observing cognitive deficits can vary. Further studies on larger sample sizes are needed to investigate the clinical usefulness of second-level tools. The primary goal of preventative health services should be the early detection and intervention of emerging cognitive deficits.

Keywords: COVID-19; SARS-CoV-2; cognitive impairment; neuropsychology; psychometrics.

Publication types

Review