A significant number of individuals with acute COVID-19 illness do not fully recover and experience a constellation of lingering symptoms after the acute symptoms of the viral infection have resolved. These persistent symptoms have been called post- COVID condition, or more commonly, long COVID. While we still do not understand exactly what causes or contributes to these symptoms, it is clear that many individuals with long COVID have not been able to return to their previous level of functioning.
At the outset of the pandemic, Roy Perlis, MD MSc, Director of the Center for Quantitative Health at MGH, and colleagues launched the COVID States Project. This is a joint project conducted by researchers from Mass General, Harvard University, Northeastern University, Rutgers University, and Northwestern University that has used periodic internet-based surveys to assess the impact on COVID-19 on the American public. (A complete archive of their reports can be found at covidstates.org.)
Focusing on the cognitive symptoms associated with long COVID, Perlis and colleagues analyzed data from two waves of this large-scale internet survey (between December 22, 2022 and May 5, 2023) of individuals aged 18 years or older across 50 States and the District of Columbia.
The cohort included 14,767 survey respondents reporting test-confirmed COVID-19 illness at least two months prior to completing the survey. The mean (SD) age was 44.6 (16.3) years; 568 (3.8%) were Asian, 1484 (10.0%) were Black, 1408 (9.5%) were Hispanic, and 10 811 (73.2%) were White. A total of 10,037 respondents (68.0%) were women and 4730 (32.0%) were men.
Responses to seven items from the Neuro-QoL cognition battery were used to assess the frequency of cognitive symptoms, including slowed thinking, trouble concentrating, having to work hard to pay attention to avoid making mistakes, trouble getting started, trouble remembering to do things, difficulty multitasking, and trouble making decisions. The Patient Health Questionnaire (9 items) was used to assess for depressive symptoms.
- 1683 individuals (11.1%) reported post-COVID-19 conditions.
- 56.7% of adults with post-COVID conditions reported experiencing at least one cognitive symptom daily, compared to 27.1% of those without post-COVID-19 conditions.
- Daily cognitive symptoms were associated with a greater likelihood of moderate interference with functioning (adjusted odds ratio [AOR] 1.30), lower likelihood of full-time employment (AOR, 0.92) and greater severity of depressive symptoms (adjusted coefficient 1.27).
Sociodemographic factors associated with a higher number of daily symptoms included younger age and lower income. The relationship between age and cognitive symptoms was nonlinear, with the greatest symptom burden in the 18- to 24-year and 45- to 54-year groups, and the least among the 65 years and older group.
Clinical Implications
The findings of the current study indicate that cognitive symptoms are common among individuals with post-COVID conditions and are associated with greater functional impairment, lower likelihood of full-time employment, and greater depressive symptom severity. Given the high prevalence of cognitive symptoms in patients with post-COVID condition, the authors recommend screening for cognitive symptoms in patients with post-COVID condition. Because of their marked association with worse functioning and quality of life, it is imperative that we better understand the mechanisms responsible for cognitive symptoms in post-COVID condition and work to identify effective and scalable interventions to remediate cognitive dysfunction in this population.
Read More
Jaywant A, Gunning FM, Oberlin LE, Santillana M, Ognyanova K, Druckman JN, Baum MA, Lazer D, Perlis RH. Cognitive Symptoms of Post-COVID-19 Condition and Daily Functioning. JAMA Netw Open. 2024 Feb 5;7(2):e2356098.
Perlis RH, Lunz Trujillo K, Safarpour A, Santillana M, Ognyanova K, Druckman J, Lazer D. Association of Post-COVID-19 Condition Symptoms and Employment Status. JAMA Netw Open. 2023 Feb 1; 6(2):e2256152.
Perlis RH, Santillana M, Ognyanova K, Safarpour A, Lunz Trujillo K, Simonson MD, Green J, Quintana A, Druckman J, Baum MA, Lazer D. Prevalence and Correlates of Long COVID Symptoms Among US Adults. JAMA Netw Open. 2022 Oct 3;5(10):e2238804.
In the News
Long COVID Associated With Depressive Symptoms, Functional Impairment (Neurology Advisor)
Studies spotlight cognitive issues, depression, fatigue in those with long COVID (Center of Infectious Disease Research and Policy)
Roy Perlis, MD, MSc is the Director of the Center for Quantitative Health at MGH and Associate Chief for Research in the Department of Psychiatry. He is the Ronald I. Dozoretz, MD Endowed Professor of Psychiatry at Harvard Medical School and Associate Editor (Neuroscience) at JAMA's new open-access journal, JAMA Network - Open.
