背景:SARS-CoV-2感染与包括抑郁症在内的多种短期和长期并发症有关,和认知障碍(CI)。然而,尚未完全记录COVID-19后患有CI的老年人。
目的:评估SARS-CoV-2感染后墨西哥成年人的认知功能。
方法:在这项前瞻性观察队列研究中,我们通过蒙特利尔认知评估(MOCA)测试评估认知功能(CF),截止值小于26分,和通过远程医疗的功能状态。具有中重度COVID-19病史的符合条件的患者,年龄≥60岁,纳入了认知健康(通过日常认知量表评估)和需要入住重症监护病房(ICU).有痴呆病史的患者,中风,排除认知评估期间的谵妄。用Cox回归模型评估CI和COVID-19之间的关联。
结果:在入住ICU的634名患者中,415幸存下来,之后排除308例,分析107例.平均年龄是70岁,58%是女性,53%患有严重的COVID。MoCA平均得分为21±5分,61例患者(57%)存在CI。感染严重程度(RR1.87;95%CI:1.11-3.15,p<0.05),教育程度较低(RR0.92;95%CI:0.87-0.97,p<0.01),和日常生活活动能力障碍(RR1.87;95%CI:1.07-3.26,p<0.05)是与CI(年龄和性别的未调整模型)相关的主要因素。延迟召回,定位,和语言(分别为83.2、77.6和72.9%)领域在CI患者中受到的影响最大。
结论:分析的患者中有57%在ICU出院后6个月发生SARS-CoV-2CI,COVID严重程度是与其预后相关的主要因素。
BACKGROUND: SARS-CoV-2 infection has been associated with multiple short- and long-term complications including depression, and cognitive impairment (CI). However, older adults with CI after COVID-19 have not been fully documented.
OBJECTIVE: To evaluate cognitive function in Mexican adults post-recovery from SARS-CoV-2 infection.
METHODS: In this prospective observational cohort study, we assess cognitive function (CF) by the Montreal Cognitive Assessment (MOCA) test with a cut-off less than 26 points, and functional status via telemedicine. Eligible patients with a history of moderate-severe COVID-19 aged ≥60 years, cognitively healthy (evaluated by Everyday Cognition Scale) and required admission to an intensive care unit (ICU) were included. Patients with history of dementia, stroke, and delirium during the cognitive evaluation were excluded. The association between CI and COVID-19 was assessed with a Cox regression model.
RESULTS: From the 634 patients admitted to the ICU, 415 survived, afterward 308 were excluded and 107 were analyzed. Mean age was 70 years, 58% were female, and 53% had severe COVID. The mean MoCA score was 21±5 points, CI was present in 61 patients (57%). Infection severity (RR 1.87; 95% CI: 1.11-3.15, p<0.05), lower education (RR 0.92; 95% CI: 0.87-0.97, p<0.01), and activity daily living disability (RR 1.87; 95% CI: 1.07-3.26, p<0.05) were the main factors associated with CI (unadjusted model by age and sex). The delayed recall, orientation, and language (83.2, 77.6 and 72.9% respectively) domains were the most affected in patients with CI.
CONCLUSIONS: Fifty-seven percent of patients analyzed developed CI six months post-ICU discharge due to SARS-CoV-2, and COVID severity was the main factor associated to its outcome.