
Neurocognitive and Neuropsychiatric Consequences of COVID-19
Many individuals infected with COVID-19 continue to experience symptoms after recovering from the initial viral infection. Persistent symptoms include neurocognitive and neuropsychiatric symptoms that can interfere with meaningful daily activities and roles. Given the symptom overlap, best practices and evidenced-based techniques for the treatment of concussion/mTBI can inform treatment approaches to manage symptoms and reduce the negative impact of long COVID.
Although recognized as primarily a respiratory virus injuring the respiratory tract and causing cough, shortness of breath, decreased oxygen saturations, and pneumonia, COVID-19 also affects other organs and systems in the body, including the nervous system.1 The mechanisms of injury to the brain and nervous system include chronic inflammation, changes in the integrity of the blood-brain barrier, hypoxia, and coagulopathies resulting in the formation of blood clots.2,3 Long COVID, and other terms, such as “long haulers,” or “post-COVID syndrome,” have been used to describe symptoms persisting beyond 12 weeks that cannot be explained by another condition.4 Some individuals with long COVID report ongoing or continuous symptoms experienced during initial infection, while others report the onset of new symptoms not experienced during initial infection, or continuous remitting and relapsing of symptoms.5 Commonly reported neurocognitive and neuropsychiatric symptoms of long COVID include fatigue, sleep problems,
Since the World Health Organization declared COVID-19 a pandemic in early March 2020, approximately 107 million cases have been reported in the United States, resulting in over 6 million COVID-related hospitalizations.8 According to data from the Household Pulse Survey, launched by the Census Bureau at the beginning of the pandemic, approximately 30% of individuals diagnosed with COVID-19 go on to develop long-COVID.9 As is now evident, individuals with long-COVID frequently report neurocognitive and neuropsychiatric symptoms.
Research
Mazza et al screened 402 adults diagnosed with COVID-19 at approximately 1 month post discharge from the hospital.10 They screened for psychiatric symptoms using a clinical interview and a battery of self-report questionnaires. Their analysis found that a significant percentage of participants self-reported at the psychopathological range for PTSD (28%), depression (31%), anxiety (42%), and
Hampshire and colleagues examined the association between COVID-19 infection and cognitive performance in a large cross sectional sample of 81,337 participants using a self-report questionnaire about COVID infection and a web-based version of the Great British Intelligence Test.12 Their analysis showed that individuals who had recovered from COVID-19 exhibited significant deficits as compared to controls in a number of cognitive domains, including attention, working memory, problem-solving, and emotional processing. Significant cognitive deficits were seen in both hospitalized and nonhospitalized cases of COVID-19.
Research indicates that neurocognitive and neuropsychiatric symptoms of long COVID not only affect mental, emotional, and cognitive well-being, but may also interfere with a person’s ability to engage in self-care (dressing, bathing, etc), driving, and the ability to return to work.9,13
Similarities to Concussion/mTBI
With the similarities observed in neurocognitive and neuropsychiatric symptoms of long COVID and concussion/
For individuals with physical, cognitive and psychiatric symptoms, a multidisciplinary team approach with coordination provided by a case manager may be necessary. The core multidisciplinary team may include physician specialties (physiatry, psychiatry, neurology, etc), occupational therapy (to improve activities of daily living and monitor timing for return to work and driving), physical therapy (to managing pain, balance problems, vestibular issues), speech/language pathology (for treatment of cognitive-linguistic deficits), and counseling (for mood disturbance,
Concluding Thoughts
In conclusion, a large number of individuals infected with COVID-19 continue to experience symptoms after recovering from the initial viral infection, and may seek treatment from mental health and rehabilitation providers. Persistent symptoms include neurocognitive and neuropsychiatric symptoms that can interfere with meaningful daily activities and roles. Given the symptom overlap between concussion/mTBI and long COVID, best practices and evidenced-based techniques for the treatment of concussion/mTBI can inform treatment approaches to manage symptoms and reduce the negative impact of long COVID.
Dr Seale is the regional director of clinical services at the Centre for Neuro Skills, which operates post-acute brain injury rehabilitation programs in California and Texas. He is licensed in Texas as a chemical dependency counselor and psychological associate with independent practice. He also holds a clinical appointment at the University of Texas Medical Branch (UTMB) in Galveston in the Department of Rehabilitation Sciences.
References
1. Azizi SA, Azizi S-A.
2. Lahiri D, Ardila A.
3. Aghagoli G, Marin BG, Katchur NJ, et al.
4. Mahase E.
5. Nabavi N.
6. Crook H, Raza S, Nowell J, et al.
7. Sykes DL, Holdsworth L, Jawad N, et al.
8. Long COVID or post-COVID conditions. Centers for Disease Control and Prevention. December 16, 2022. Accessed June 9, 2023.
9. Long COVID. Household Pulse Survey, 2022-2023. National Center for Health Statistics.
10. Mazza MG, Lorenzo RD, Conte C, et al.
11. Rass V, Beer R, Schiefecker AJ, et al.
12. Hampshire A, Trender W, Chamberlain SR, et al.
13. Kumar S, Veldhuis A, Malhortra T.
14. Junn C, Bell KR, Shenouda C, Hoffman JM.
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