Persistent Cognitive Symptoms After COVID-19 Linked to Depression, Impaired Daily Function
Key findings
- This nationwide survey aimed to better understand the nature and correlates of cognitive symptoms in post–COVID-19 condition by analyzing data from two waves of the COVID States Project, an internet survey conducted by a consortium of academic sites
- 1,683 respondents (11%) met the study definition of post–COVID-19 condition; 57% of them reported experiencing at least one cognitive symptom daily, compared with 27% of respondents who did not report post–COVID-19 condition
- Younger age and lower income were associated with an increased number of daily cognitive symptoms, although the 45- to 54-year-old age group exhibited a prevalence similar to the 18- to 24-year-old group
- The number of cognitive symptoms reported at least daily was associated with greater severity of depressive symptoms, greater likelihood of reporting at least moderate interference with functioning, and lower likelihood of full-time employment
- Cognitive symptoms in patients with post–COVID-19 condition are important targets for assessment and interventions
Research into post-COVID-19 condition ("long COVID") has established that deficits in attention, speed of information processing, executive functions and memory can persist well after acute illness. However, it's still unclear how these symptoms affect daily functioning.
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Roy Perlis, MD, MSc, a psychiatrist who directs the Center for Quantitative Health at Massachusetts General Hospital, and colleagues examined in a nationwide online survey. In JAMA Network Open, they say people with post-COVID-19 condition and cognitive symptoms have greater functional impairment, reduced likelihood of full-time employment, and more severe depressive symptoms than people who fully recovered from COVID-19.
Methods
The data sources for the study were two waves of the COVID States Project, an internet survey conducted by a consortium of academic sites from December 22, 2022, to January 7, 2023, and again from April 5 to May 5, 2023. To mitigate selection bias, the survey was presented as a general opinion survey, not a survey about COVID-19.
The survey collected data from adults residing in all 50 states and the District of Columbia. They answered questions about:
- Socioeconomic variables
- Any positive COVID-19 test result
- Whether symptoms had resolved; if not, signs and symptoms of current acute or post–COVID-19 condition
- Frequency of cognitive symptoms over the past 7 days: slowed thinking, trouble concentrating, having to work hard to pay attention to avoid making mistakes, trouble getting started, trouble remembering to take a desired action, difficulty multitasking, and trouble making decisions
- Depressive symptom severity using the 9-item Patient Health Questionnaire
- Extent to which post–COVID-19 symptoms interfered in daily life
- Current employment status
Prevalence of Cognitive Symptoms
14,767 individuals reported test-confirmed SARS-CoV-2 infection at least two months before taking the survey. 1,683 of them (11%) reported continued symptoms.
57% of those 1,683 participants reported experiencing at least one cognitive symptom daily, compared with 27% of respondents who did not report post–COVID-19 condition.
Other ways in which the post–COVID-19 group differed from the fully recovered group:
- All individual cognitive symptoms were more often reported as occurring at least daily
- Cognitive symptoms occurred more frequently overall
- On average, significantly more cognitive symptoms were experienced at least daily
Features Associated with Cognitive Symptoms
Younger age and lower income were associated with a greater number of daily cognitive symptoms. However, age reflected a nonlinear pattern, with the number of symptoms equally high in the 18- to 24-year and 45- to 54-year groups.
Mood and Daily Functioning
The number of cognitive symptoms reported at least daily was associated with:
- Greater severity of depressive symptoms (adjusted coefficient, 1.27; 95% CI, 1.17–1.38)
- Greater likelihood of reporting at least moderate interference with daily life (adjusted OR, 1.30; 95% CI, 1.25–1.36)
- Lower likelihood of full-time employment (adjusted OR, 0.92; 95% CI, 0.88–0.96)
"Brain Fog" After COVID-19 Is Real
The cognitive deficits reported in this study encompass what many laypeople term "brain fog." In light of the marked association of the symptoms with poorer functioning and poorer quality of life, they are important targets for assessment and interventions.
Notably, though, the overlap between cognition and depression in post–COVID-19 condition does not in any way suggest a causal relationship.
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