Long-Term Cognitive & Psychiatric Effects of COVID-19

What the data shows 2-3 years post-pandemic.

I’m Paul Ciuryek, MD, and this is MedSpresso: An independent, subscriber-supported newsletter summarizing the most important and impactful news, studies, and research from the fast-changing world of healthcare.

COVID-19, caused by the SARS-CoV-2 virus, is primarily known for its respiratory symptoms, but it can also have significant neurological and psychiatric effects.

With the pandemic behind us, understanding the long-term impacts of COVID-19 on cognitive and mental health is crucial for developing effective care strategies.

The PHOSP-COVID study investigates these long-term outcomes in individuals who were hospitalized with COVID-19, focusing on cognitive deficits, depression, anxiety, and fatigue.

Study Overview

Researchers in the UK performed the PHOSP-COVID study to examine the cognitive and psychiatric outcomes of people hospitalized with COVID-19. The longitudinal cohort study followed 475 participants and assessed their cognitive and psychiatric health 2–3 years after discharge. Participants completed cognitive assessments and questionnaires measuring depression, anxiety, and fatigue. The study aimed to identify factors predicting long-term outcomes and assess these symptoms' impact on occupational functioning.

Key Findings

Persistent Cognitive and Psychiatric Symptoms:  Many participants reported persistent cognitive deficits, depression, anxiety, and fatigue 2–3 years after COVID-19 hospitalization. These symptoms were more severe than those observed at 6 and 12 months post-discharge. The study found that 74.5% of participants experienced at least mild depression, 53.5% had anxiety, and 62.3% reported fatigue. Severe symptoms were also common, with 22.4% experiencing severe depression and 24.6% reporting severe fatigue.

Predictors of Long-Term Outcomes: The severity of acute COVID-19 illness did not predict long-term cognitive or psychiatric outcomes. Instead, the degree of recovery at six months post-discharge was a strong predictor of symptoms at 2–3 years. Participants with poor health status at six months were more likely to experience severe symptoms later.

Impact on Occupational Functioning: Cognitive deficits were strongly associated with changes in occupational status. Approximately 26.9% of participants reported changing their occupation due to poor health, with cognitive deficits being a significant factor.

The Mechanism Behind These Findings?

The exact mechanisms by which COVID-19 affects cognitive and psychiatric health are not fully understood, but several hypotheses have been proposed:

• Immune Response and Inflammation: Triggering systemic inflammation and over-activating the immune response may lead to neuroinflammation and cognitive impairments.

• Vascular Damage: The virus’ effect on the vascular system may precipitate blood clots and reduce cerebral blood flow, contributing to cognitive effects.

• Direct Viral Effects: Direct invasion of SARS-CoV-2 into the central nervous system may cause neuronal damage and psychiatric symptoms.

Healthcare Implications

Long-term monitoring and support for individuals recovering from COVID-19 are often overlooked but important parts of patient care. Healthcare providers should be aware of the potential for persistent cognitive and psychiatric symptoms and consider incorporating cognitive assessments and mental health support into post-COVID care plans. Early intervention and rehabilitation strategies could help improve outcomes and quality of life for affected individuals.

CONCLUSION

The PHOSP-COVID study provides valuable insights into the long-term cognitive and psychiatric impacts of COVID-19. The persistence and worsening of symptoms 2–3 years after hospitalization highlight the need for ongoing research and intervention strategies. By addressing these long-term effects, healthcare systems can better support individuals recovering from COVID-19 and mitigate the broader societal impacts of the pandemic.

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