Abstract：
BACKGROUND: Persistent cognitive impairment is a serious consequence of the post-COVID condition. However, there have been no established effective treatments for this pathophysiology supported by sufficient evidence.
METHODS: A 32-year-old woman became aware of difficulty in word recalling, reading, and writing as well as difficulty in completing various household multitasks 3 weeks after the COVID-19 infection. Although blood tests, magnetic resonance imaging, electroencephalography, and Kohs block design test were all within normal limits, completion time by trail making test (TMT) A or B was markedly delayed. Finally, she was referred to our hospital 3 months after the infection. At baseline, the THINC integrated tool (THINC-it), a digital battery consisting of the five-item version of the perceived deficit questionnaire (PDQ-5), choice reaction time (CRT), 1-back test, digit symbol substitution test (DSST), and TMT-B, revealed poor capability in attention, working memory, and executive function. Also, near-infrared spectroscopy (NIRS) demonstrated no activation in frontal or temporal regions during verbal fluency task. Extended-release guanfacine (GXR) 2 mg/day was initiated and a month later was elevated up to 4 mg/day as a maintenance dose. The PDQ-5, CRT, 1-back test, DSST, and TMT-B were dramatically improved 1 month after GXR treatment. NIRS finding was also normalized after 2 months of treatment. These effects were successfully maintained throughout the 6-month follow-up period.
CONCLUSIONS: GXR may be helpful in improving subjective/objective cognitive functioning and frontotemporal brain activity in long-COVID patients manifesting apparent cognitive impairment.
METHODS: A 32-year-old woman became aware of difficulty in word recalling, reading, and writing as well as difficulty in completing various household multitasks 3 weeks after the COVID-19 infection. Although blood tests, magnetic resonance imaging, electroencephalography, and Kohs block design test were all within normal limits, completion time by trail making test (TMT) A or B was markedly delayed. Finally, she was referred to our hospital 3 months after the infection. At baseline, the THINC integrated tool (THINC-it), a digital battery consisting of the five-item version of the perceived deficit questionnaire (PDQ-5), choice reaction time (CRT), 1-back test, digit symbol substitution test (DSST), and TMT-B, revealed poor capability in attention, working memory, and executive function. Also, near-infrared spectroscopy (NIRS) demonstrated no activation in frontal or temporal regions during verbal fluency task. Extended-release guanfacine (GXR) 2 mg/day was initiated and a month later was elevated up to 4 mg/day as a maintenance dose. The PDQ-5, CRT, 1-back test, DSST, and TMT-B were dramatically improved 1 month after GXR treatment. NIRS finding was also normalized after 2 months of treatment. These effects were successfully maintained throughout the 6-month follow-up period.
CONCLUSIONS: GXR may be helpful in improving subjective/objective cognitive functioning and frontotemporal brain activity in long-COVID patients manifesting apparent cognitive impairment.
摘要：
背景：持续性认知障碍是COVID后疾病的严重后果。然而,对于这种病理生理学,目前尚无足够证据支持的有效治疗方法.
方法：一名32岁的妇女意识到单词回忆的困难，阅读,COVID-19感染后3周，写作以及难以完成各种家庭多任务。虽然验血,磁共振成像，脑电图,Kohs块设计测试都在正常范围内，试验测试（TMT）A或B的完成时间明显延迟。最后,她在感染3个月后被转诊到我们医院。在基线,THINC集成工具（THINC-it），由五个项目版本的感知赤字问卷（PDQ-5）组成的数字电池，选择反应时间（CRT），1-后退试验,数字符号替换测试(DSST),和TMT-B，显示出注意力能力差，工作记忆,和执行功能。此外，近红外光谱（NIRS）显示在言语流利度任务中额叶或颞区没有激活。开始延长释放胍法辛（GXR）2mg/天，一个月后作为维持剂量升高至4mg/天。PDQ-5，CRT，1-后退试验,DSST,GXR治疗1个月后TMT-B显著改善。NIRS发现在治疗2个月后也恢复正常。这些效果在整个6个月的随访期间成功维持。
结论：GXR可能有助于改善表现出明显认知障碍的长期COVID患者的主观/客观认知功能和额颞脑活动。
方法：一名32岁的妇女意识到单词回忆的困难，阅读,COVID-19感染后3周，写作以及难以完成各种家庭多任务。虽然验血,磁共振成像，脑电图,Kohs块设计测试都在正常范围内，试验测试（TMT）A或B的完成时间明显延迟。最后,她在感染3个月后被转诊到我们医院。在基线,THINC集成工具（THINC-it），由五个项目版本的感知赤字问卷（PDQ-5）组成的数字电池，选择反应时间（CRT），1-后退试验,数字符号替换测试(DSST),和TMT-B，显示出注意力能力差，工作记忆,和执行功能。此外，近红外光谱（NIRS）显示在言语流利度任务中额叶或颞区没有激活。开始延长释放胍法辛（GXR）2mg/天，一个月后作为维持剂量升高至4mg/天。PDQ-5，CRT，1-后退试验,DSST,GXR治疗1个月后TMT-B显著改善。NIRS发现在治疗2个月后也恢复正常。这些效果在整个6个月的随访期间成功维持。
结论：GXR可能有助于改善表现出明显认知障碍的长期COVID患者的主观/客观认知功能和额颞脑活动。
