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Comprehensive clinical assessment identifies specific neurocognitive deficits in working-age patients with long-COVID

INTRODUCTION: There have been more than 425 million COVID-19 infections worldwide. Post-COVID illness has become a common, disabling complication of this infection. Therefore, it presents a significant challenge to global public health and economic activity. METHODS: Comprehensive clinical assessmen...

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Autores principales: Holdsworth, David A., Chamley, Rebecca, Barker-Davies, Rob, O’Sullivan, Oliver, Ladlow, Peter, Mitchell, James L., Dewson, Dominic, Mills, Daniel, May, Samantha L. J., Cranley, Mark, Xie, Cheng, Sellon, Edward, Mulae, Joseph, Naylor, Jon, Raman, Betty, Talbot, Nick P., Rider, Oliver J., Bennett, Alexander N., Nicol, Edward D.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9187094/
https://www.ncbi.nlm.nih.gov/pubmed/35687603
http://dx.doi.org/10.1371/journal.pone.0267392
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author Holdsworth, David A.
Chamley, Rebecca
Barker-Davies, Rob
O’Sullivan, Oliver
Ladlow, Peter
Mitchell, James L.
Dewson, Dominic
Mills, Daniel
May, Samantha L. J.
Cranley, Mark
Xie, Cheng
Sellon, Edward
Mulae, Joseph
Naylor, Jon
Raman, Betty
Talbot, Nick P.
Rider, Oliver J.
Bennett, Alexander N.
Nicol, Edward D.
author_facet Holdsworth, David A.
Chamley, Rebecca
Barker-Davies, Rob
O’Sullivan, Oliver
Ladlow, Peter
Mitchell, James L.
Dewson, Dominic
Mills, Daniel
May, Samantha L. J.
Cranley, Mark
Xie, Cheng
Sellon, Edward
Mulae, Joseph
Naylor, Jon
Raman, Betty
Talbot, Nick P.
Rider, Oliver J.
Bennett, Alexander N.
Nicol, Edward D.
author_sort Holdsworth, David A.
collection PubMed
description INTRODUCTION: There have been more than 425 million COVID-19 infections worldwide. Post-COVID illness has become a common, disabling complication of this infection. Therefore, it presents a significant challenge to global public health and economic activity. METHODS: Comprehensive clinical assessment (symptoms, WHO performance status, cognitive testing, CPET, lung function, high-resolution CT chest, CT pulmonary angiogram and cardiac MRI) of previously well, working-age adults in full-time employment was conducted to identify physical and neurocognitive deficits in those with severe or prolonged COVID-19 illness. RESULTS: 205 consecutive patients, age 39 (IQR30.0–46.7) years, 84% male, were assessed 24 (IQR17.1–34.0) weeks after acute illness. 69% reported ≥3 ongoing symptoms. Shortness of breath (61%), fatigue (54%) and cognitive problems (47%) were the most frequent symptoms, 17% met criteria for anxiety and 24% depression. 67% remained below pre-COVID performance status at 24 weeks. One third of lung function tests were abnormal, (reduced lung volume and transfer factor, and obstructive spirometry). HRCT lung was clinically indicated in <50% of patients, with COVID-associated pathology found in 25% of these. In all but three HRCTs, changes were graded ‘mild’. There was an extremely low incidence of pulmonary thromboembolic disease or significant cardiac pathology. A specific, focal cognitive deficit was identified in those with ongoing symptoms of fatigue, poor concentration, poor memory, low mood, and anxiety. This was notably more common in patients managed in the community during their acute illness. CONCLUSION: Despite low rates of residual cardiopulmonary pathology, in this cohort, with low rates of premorbid illness, there is a high burden of symptoms and failure to regain pre-COVID performance 6-months after acute illness. Cognitive assessment identified a specific deficit of the same magnitude as intoxication at the UK drink driving limit or the deterioration expected with 10 years ageing, which appears to contribute significantly to the symptomatology of long-COVID.
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spelling pubmed-91870942022-06-11 Comprehensive clinical assessment identifies specific neurocognitive deficits in working-age patients with long-COVID Holdsworth, David A. Chamley, Rebecca Barker-Davies, Rob O’Sullivan, Oliver Ladlow, Peter Mitchell, James L. Dewson, Dominic Mills, Daniel May, Samantha L. J. Cranley, Mark Xie, Cheng Sellon, Edward Mulae, Joseph Naylor, Jon Raman, Betty Talbot, Nick P. Rider, Oliver J. Bennett, Alexander N. Nicol, Edward D. PLoS One Research Article INTRODUCTION: There have been more than 425 million COVID-19 infections worldwide. Post-COVID illness has become a common, disabling complication of this infection. Therefore, it presents a significant challenge to global public health and economic activity. METHODS: Comprehensive clinical assessment (symptoms, WHO performance status, cognitive testing, CPET, lung function, high-resolution CT chest, CT pulmonary angiogram and cardiac MRI) of previously well, working-age adults in full-time employment was conducted to identify physical and neurocognitive deficits in those with severe or prolonged COVID-19 illness. RESULTS: 205 consecutive patients, age 39 (IQR30.0–46.7) years, 84% male, were assessed 24 (IQR17.1–34.0) weeks after acute illness. 69% reported ≥3 ongoing symptoms. Shortness of breath (61%), fatigue (54%) and cognitive problems (47%) were the most frequent symptoms, 17% met criteria for anxiety and 24% depression. 67% remained below pre-COVID performance status at 24 weeks. One third of lung function tests were abnormal, (reduced lung volume and transfer factor, and obstructive spirometry). HRCT lung was clinically indicated in <50% of patients, with COVID-associated pathology found in 25% of these. In all but three HRCTs, changes were graded ‘mild’. There was an extremely low incidence of pulmonary thromboembolic disease or significant cardiac pathology. A specific, focal cognitive deficit was identified in those with ongoing symptoms of fatigue, poor concentration, poor memory, low mood, and anxiety. This was notably more common in patients managed in the community during their acute illness. CONCLUSION: Despite low rates of residual cardiopulmonary pathology, in this cohort, with low rates of premorbid illness, there is a high burden of symptoms and failure to regain pre-COVID performance 6-months after acute illness. Cognitive assessment identified a specific deficit of the same magnitude as intoxication at the UK drink driving limit or the deterioration expected with 10 years ageing, which appears to contribute significantly to the symptomatology of long-COVID. Public Library of Science 2022-06-10 /pmc/articles/PMC9187094/ /pubmed/35687603 http://dx.doi.org/10.1371/journal.pone.0267392 Text en © 2022 Holdsworth et al https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Holdsworth, David A.
Chamley, Rebecca
Barker-Davies, Rob
O’Sullivan, Oliver
Ladlow, Peter
Mitchell, James L.
Dewson, Dominic
Mills, Daniel
May, Samantha L. J.
Cranley, Mark
Xie, Cheng
Sellon, Edward
Mulae, Joseph
Naylor, Jon
Raman, Betty
Talbot, Nick P.
Rider, Oliver J.
Bennett, Alexander N.
Nicol, Edward D.
Comprehensive clinical assessment identifies specific neurocognitive deficits in working-age patients with long-COVID
title Comprehensive clinical assessment identifies specific neurocognitive deficits in working-age patients with long-COVID
title_full Comprehensive clinical assessment identifies specific neurocognitive deficits in working-age patients with long-COVID
title_fullStr Comprehensive clinical assessment identifies specific neurocognitive deficits in working-age patients with long-COVID
title_full_unstemmed Comprehensive clinical assessment identifies specific neurocognitive deficits in working-age patients with long-COVID
title_short Comprehensive clinical assessment identifies specific neurocognitive deficits in working-age patients with long-COVID
title_sort comprehensive clinical assessment identifies specific neurocognitive deficits in working-age patients with long-covid
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9187094/
https://www.ncbi.nlm.nih.gov/pubmed/35687603
http://dx.doi.org/10.1371/journal.pone.0267392
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