The effects of COVID-19 on cognitive performance in a community-based cohort: a COVID symptom study biobank prospective cohort study.

Publication date: Aug 01, 2023

Cognitive impairment has been reported after many types of infection, including SARS-CoV-2. Whether deficits following SARS-CoV-2 improve over time is unclear. Studies to date have focused on hospitalised individuals with up to a year follow-up. The presence, magnitude, persistence and correlations of effects in community-based cases remain relatively unexplored. Cognitive performance (working memory, attention, reasoning, motor control) was assessed in a prospective cohort study of participants from the United Kingdom COVID Symptom Study Biobank between July 12, 2021 and August 27, 2021 (Round 1), and between April 28, 2022 and June 21, 2022 (Round 2). Participants, recruited from the COVID Symptom Study smartphone app, comprised individuals with and without SARS-CoV-2 infection and varying symptom duration. Effects of COVID-19 exposures on cognitive accuracy and reaction time scores were estimated using multivariable ordinary least squares linear regression models weighted for inverse probability of participation, adjusting for potential confounders and mediators. The role of ongoing symptoms after COVID-19 infection was examined stratifying for self-perceived recovery. Longitudinal analysis assessed change in cognitive performance between rounds. 3335 individuals completed Round 1, of whom 1768 also completed Round 2. At Round 1, individuals with previous positive SARS-CoV-2 tests had lower cognitive accuracy (N = 1737, β = -0. 14 standard deviations, SDs, 95% confidence intervals, CI: -0. 21, -0. 07) than negative controls. Deficits were largest for positive individuals with ≥12 weeks of symptoms (N = 495, β = -0. 22 SDs, 95% CI: -0. 35, -0. 09). Effects were comparable to hospital presentation during illness (N = 281, β = -0. 31 SDs, 95% CI: -0. 44, -0. 18), and 10 years age difference (60-70 years vs. 50-60 years, β = -0. 21 SDs, 95% CI: -0. 30, -0. 13) in the whole study population. Stratification by self-reported recovery revealed that deficits were only detectable in SARS-CoV-2 positive individuals who did not feel recovered from COVID-19, whereas individuals who reported full recovery showed no deficits. Longitudinal analysis showed no evidence of cognitive change over time, suggesting that cognitive deficits for affected individuals persisted at almost 2 years since initial infection. Cognitive deficits following SARS-CoV-2 infection were detectable nearly two years post infection, and largest for individuals with longer symptom durations, ongoing symptoms, and/or more severe infection. However, no such deficits were detected in individuals who reported full recovery from COVID-19. Further work is needed to monitor and develop understanding of recovery mechanisms for those with ongoing symptoms. Chronic Disease Research Foundation, Wellcome Trust, National Institute for Health and Care Research, Medical Research Council, British Heart Foundation, Alzheimer’s Society, European Union, COVID-19 Driver Relief Fund, French National Research Agency.

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Concepts Keywords
Alzheimer Cognition
Biobank Cognitive impairment
July COVID-19
Smartphone COVID-19 recovery


Type Source Name
disease MESH COVID-19
disease IDO symptom
disease MESH Cognitive impairment
disease MESH infection
disease VO time
pathway REACTOME SARS-CoV-2 Infection
drug DRUGBANK Sodium lauryl sulfate
disease VO population
disease MESH Chronic Disease
drug DRUGBANK Etodolac
disease MESH Delirium
disease MESH Infectious Diseases
drug DRUGBANK Potassium Chloride
drug DRUGBANK Coenzyme M
disease MESH Long COVID
disease VO report
disease VO vaccination
drug DRUGBANK Methionine
disease IDO quality
disease MESH dementia
disease MESH respiratory infections
drug DRUGBANK Trestolone
disease IDO blood
disease MESH Alzheimer’s disease
disease MESH Anxiety Disorder
disease MESH psychological distress
disease MESH educational attainment
disease VO biological sex
disease MESH asthma
pathway KEGG Asthma
disease MESH cancer
disease MESH heart disease
disease MESH kidney disease
disease MESH lung disease
disease VO age
disease MESH syndrome
drug DRUGBANK Methyl isocyanate
drug DRUGBANK Pidolic Acid
drug DRUGBANK Imidacloprid
disease IDO history
drug DRUGBANK Saquinavir
disease MESH underweight
disease MESH overweight
disease MESH sequelae
disease IDO replication
drug DRUGBANK Etoperidone
drug DRUGBANK Ademetionine
disease IDO facility
disease IDO infectious disease
disease MESH pneumonia
disease MESH inflammation
disease MESH Autism
disease MESH stroke
disease MESH gait
drug DRUGBANK Guanosine

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