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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...
Autores principales: | , , , , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Public Library of Science
2022
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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. |
format | Online Article Text |
id | pubmed-9187094 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | Public Library of Science |
record_format | MEDLINE/PubMed |
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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