TY - JOUR
T1 - Cognitive domains affected post-COVID-19; a systematic review and meta-analysis
AU - Fanshawe, Jack B.
AU - Sargent, Brendan F.
AU - Badenoch, James B.
AU - Saini, Aman
AU - Watson, Cameron J.
AU - Pokrovskaya, Aleksandra
AU - Aniwattanapong, Daruj
AU - Conti, Isabella
AU - Nye, Charles
AU - Burchill, Ella
AU - Hussain, Zain U.
AU - Said, Khanafi
AU - Kuhoga, Elinda
AU - Tharmaratnam, Kukatharmini
AU - Pendered, Sophie
AU - Mbwele, Bernard
AU - Taquet, Maxime
AU - Wood, Greta K.
AU - Rogers, Jonathan P.
AU - Hampshire, Adam
AU - Carson, Alan
AU - David, Anthony S.
AU - Michael, Benedict D.
AU - Nicholson, Timothy R.
AU - Paddick, Stella Maria
AU - Leek, Charles E.
N1 - Publisher Copyright:
© 2024 The Authors. European Journal of Neurology published by John Wiley & Sons Ltd on behalf of European Academy of Neurology.
PY - 2024
Y1 - 2024
N2 - Background and purpose: This review aims to characterize the pattern of post-COVID-19 cognitive impairment, allowing better prediction of impact on daily function to inform clinical management and rehabilitation. Methods: A systematic review and meta-analysis of neurocognitive sequelae following COVID-19 was conducted, following PRISMA-S guidelines. Studies were included if they reported domain-specific cognitive assessment in patients with COVID-19 at >4 weeks post-infection. Studies were deemed high-quality if they had >40 participants, utilized healthy controls, had low attrition rates and mitigated for confounders. Results: Five of the seven primary Diagnostic and Statistical Manual of Mental Disorders (DSM-5) cognitive domains were assessed by enough high-quality studies to facilitate meta-analysis. Medium effect sizes indicating impairment in patients post-COVID-19 versus controls were seen across executive function (standardised mean difference (SMD) −0.45), learning and memory (SMD −0.55), complex attention (SMD −0.54) and language (SMD −0.54), with perceptual motor function appearing to be impacted to a greater degree (SMD −0.70). A narrative synthesis of the 56 low-quality studies also suggested no obvious pattern of impairment. Conclusions: This review found moderate impairments across multiple domains of cognition in patients post-COVID-19, with no specific pattern. The reported literature was significantly heterogeneous, with a wide variety of cognitive tasks, small sample sizes and disparate initial disease severities limiting interpretability. The finding of consistent impairment across a range of cognitive tasks suggests broad, as opposed to domain-specific, brain dysfunction. Future studies should utilize a harmonized test battery to facilitate inter-study comparisons, whilst also accounting for the interactions between COVID-19, neurological sequelae and mental health, the interplay between which might explain cognitive impairment.
AB - Background and purpose: This review aims to characterize the pattern of post-COVID-19 cognitive impairment, allowing better prediction of impact on daily function to inform clinical management and rehabilitation. Methods: A systematic review and meta-analysis of neurocognitive sequelae following COVID-19 was conducted, following PRISMA-S guidelines. Studies were included if they reported domain-specific cognitive assessment in patients with COVID-19 at >4 weeks post-infection. Studies were deemed high-quality if they had >40 participants, utilized healthy controls, had low attrition rates and mitigated for confounders. Results: Five of the seven primary Diagnostic and Statistical Manual of Mental Disorders (DSM-5) cognitive domains were assessed by enough high-quality studies to facilitate meta-analysis. Medium effect sizes indicating impairment in patients post-COVID-19 versus controls were seen across executive function (standardised mean difference (SMD) −0.45), learning and memory (SMD −0.55), complex attention (SMD −0.54) and language (SMD −0.54), with perceptual motor function appearing to be impacted to a greater degree (SMD −0.70). A narrative synthesis of the 56 low-quality studies also suggested no obvious pattern of impairment. Conclusions: This review found moderate impairments across multiple domains of cognition in patients post-COVID-19, with no specific pattern. The reported literature was significantly heterogeneous, with a wide variety of cognitive tasks, small sample sizes and disparate initial disease severities limiting interpretability. The finding of consistent impairment across a range of cognitive tasks suggests broad, as opposed to domain-specific, brain dysfunction. Future studies should utilize a harmonized test battery to facilitate inter-study comparisons, whilst also accounting for the interactions between COVID-19, neurological sequelae and mental health, the interplay between which might explain cognitive impairment.
KW - attention
KW - cognition
KW - cognitive impairment
KW - COVID-19
KW - executive function
KW - language
KW - learning
KW - memory
UR - http://www.scopus.com/inward/record.url?scp=85186236541&partnerID=8YFLogxK
U2 - 10.1111/ene.16181
DO - 10.1111/ene.16181
M3 - Review article
C2 - 38375608
AN - SCOPUS:85186236541
SN - 1351-5101
JO - European Journal of Neurology
JF - European Journal of Neurology
ER -