Prevalence and co-occurrence of cognitive impairment in children and young people up to 12-months post infection with SARS-CoV-2 (Omicron variant)

Paul Foret-Bruno; Roz Shafran; Terence Stephenson; Manjula D Nugawela; Dennis Chan; Shamez Ladhani; Kelsey McOwat; Anna Mensah; Ruth Simmons; Lana Fox Smith; Anaïs D'oelsnitz; Laila Xu; Emma Dalrymple; Isobel Heyman; Tamsin Ford; Terry Segal; Trudie Chalder; Natalia Rojas; Snehal M Pinto Pereira; CLoCk Consortium

doi:10.1016/j.bbi.2024.05.001

Prevalence and co-occurrence of cognitive impairment in children and young people up to 12-months post infection with SARS-CoV-2 (Omicron variant)

Brain Behav Immun. 2024 May 10:119:989-994. doi: 10.1016/j.bbi.2024.05.001. Online ahead of print.

Authors

Paul Foret-Bruno¹, Roz Shafran², Terence Stephenson², Manjula D Nugawela², Dennis Chan³, Shamez Ladhani⁴, Kelsey McOwat⁴, Anna Mensah⁴, Ruth Simmons⁴, Lana Fox Smith², Anaïs D'oelsnitz², Laila Xu², Emma Dalrymple², Isobel Heyman², Tamsin Ford⁵, Terry Segal⁶, Trudie Chalder⁷, Natalia Rojas⁸, Snehal M Pinto Pereira⁹; CLoCk Consortium

Affiliations

¹ Institut de Psychologie, Université Lumière Lyon 2, 18 Quai Claude Bernard 69365 LYON Cedex 07, France.
² UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, The United Kingdom of Great Britain and Northern Ireland.
³ UCL Institute of Cognitive Neuroscience, Alexandra House, London, WC1N 3AZ, The United Kingdom of Great Britain and Northern Ireland.
⁴ Immunisations and Vaccine Preventable Diseases, UK Health Security Agency, 61 Colindale Avenue, London NW9 5EQ, The United Kingdom of Great Britain and Northern Ireland.
⁵ Department of Psychiatry, University of Cambridge, Hershel Smith Building Cambridge Biomedical Campus, CB2 0SZ, The United Kingdom of Great Britain and Northern Ireland.
⁶ University College London Hospitals NHS Foundation Trust, London, NW1 2PG, The United Kingdom of Great Britain and Northern Ireland.
⁷ Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De'Crespigny Park, London, SE5 8AF, The United Kingdom of Great Britain and Northern Ireland.
⁸ Division of Surgery & Interventional Science, Faculty of Medical Sciences, University College London, WC1E 6BT, The United Kingdom of Great Britain and Northern Ireland.
⁹ Division of Surgery & Interventional Science, Faculty of Medical Sciences, University College London, WC1E 6BT, The United Kingdom of Great Britain and Northern Ireland. Electronic address: snehal.pereira@ucl.ac.uk.

PMID: 38735404
DOI: 10.1016/j.bbi.2024.05.001

Abstract

Background: Cognitive impairment is often reported after SARS-CoV-2 infection, yet evidence gaps remain. We aimed to (i) report the prevalence and characteristics of children and young people (CYP) reporting "brain fog" (i.e., cognitive impairment) 12-months post PCR-proven SARS-CoV-2 infection and determine whether differences by infection status exist and (ii) explore the prevalence of CYP experiencing cognitive impairment over a 12-month period post-infection and investigate the relationship between cognitive impairment and poor mental health and well-being, mental fatigue and sleep problems.

Methods: The Omicron CLoCk sub-study, set up in January 2022, collected data on first-time PCR-test-positive and PCR-proven reinfected CYP at time of testing and at 3-, 6- and 12-months post-testing. We describe the prevalence of cognitive impairment at 12-months, indicating when it was first reported. We characterise CYP experiencing cognitive impairment and use chi-squared tests to determine whether cognitive impairment prevalence varied by infection status. We explore the relationship between cognitive impairment and poor mental health and well-being, mental fatigue and trouble sleeping using validated scales. We examine associations at 3-, 6- and 12-months post-testing by infection status using Mann-Whitney U and chi-square tests.

Results: At 12-months post-testing, 7.0 % (24/345) of first-positives and 7.5 % (27/360) of reinfected CYP experienced cognitive impairment with no difference between infection-status groups (p = 0.78). The majority of these CYP experienced cognitive impairment for the first time at either time of testing or 3-months post-test (no difference between the infection-status groups; p = 0.60). 70.8 % of first-positives experiencing cognitive impairment at 12-months, were 15-to-17-years-old as were 33.3 % of reinfected CYP experiencing cognitive impairment (p < 0.01). Consistently at all time points post-testing, CYP experiencing cognitive impairment were more likely to score higher on all Strengths and Difficulties Questionnaire subscales, higher on the Chalder Fatigue sub-scale for mental fatigue, lower on the Short Warwick-Edinburgh Mental Wellbeing Scale and report more trouble sleeping.

Conclusions: CYP have a fluctuating experience of cognitive impairment by 12-months post SARS-CoV-2-infection. Cognitive impairment is consistently correlated with poorer sleep, behavioural and emotional functioning over a 12-month period. Clinicians should be aware of cognitive impairment post-infection and its co-occurring nature with poorer sleep, behavioural and mental health symptoms.

Keywords: Brain fog; Children; Cognitive impairment; Omicron; Post Covid-19 condition; Prospective; Young people; long Covid.