Persistent cognitive complaints following SARS-CoV-2 infection, clinical profiles, predictors, and voxel-based morphometry analysis of structural neuroimaging data

Introduction

The SARS-CoV-2-associated pandemic showed that symptoms following viral infections might not be specific and tend to affect vulnerable patients beyond their respiratory system, causing long-lasting neurocognitive disabilities. The predictors of individual vulnerability and underlying mechanisms are still not well understood.

Aims

Understand the predictors of post-SARS-CoV-2 syndrome and evaluate structural particularities associated with different cognitive profiles.

Methods

Patients aged 50 years and older were recruited at the University of North Texas (HABS-HD). Only cognitively unimpaired participants at baseline were eligible. They underwent neurocognitive screenings and 3-Tesla structural magnetic resonance imaging (MRI). The comparative analysis was based on the Wilcoxon rank sum test, Pearson’s Chi-squared test, and Fisher’s exact test. Multivariable logistic regression was used to assess predictive associations. Voxel-based Morphometry (VBM) was performed to assess structural differences between different cognitive profiles.

Results

The preliminary data showed that 200 participants reported persistent symptoms following SARS-CoV-2 infection, while 358 did not. Affected participants were predominantly females (76% vs. 68%, p= 0.037) and Hispanic (35% vs. 25%, p= 0.036). They also reported higher prevalence of depression (45% vs. 25%, p<0.001), anxiety (29% vs. 19%, p= 0.005), and cardiovascular diseases (10% vs. 5.1%, p=0.027). The cognitive complaints were objectified by worse cognitive performance in the mini-mental state examination (MMSE, 29.00 (28.00, 29.00) vs. 29.00 (28.00, 30.00), p=0.025) and impaired executive function in the trail making test-B (TMT-B, 79 (62, 104) vs. 70 (57, 97), p= 0.009).

Participants with memory complaints (n= 65) were predominantly females (86% vs. 71%, p= 0.020) and had higher depression prevalence (55% vs. 40%, p= 0.045).

Participants with attention complaints (n= 54) were significantly younger (60 (55, 67) vs. 67 (59, 73), p= 0.002), predominantly females (87% vs. 72%, p= 0.026), had a higher prevalence of depression (67% vs. 37%, p<0.001) and anxiety (42% vs. 24%, p= 0.018).

Participants with brain fog (n= 50) had lower educational levels (14.0 (12.0, 16.0) vs. 15.0 (12.0, 17.0), p= 0.040), more depression (63% vs. 39%, p=0.003) and anxiety (41% vs. 25%, p= 0.034), as well as lower blood basophile levels (0.60 (0.33, 0.80) vs. 0.70 (0.50, 0.98), p= 0.045).

Participants with sleep disorders (n= 68) were predominantly females (88% vs. 70%, p= 0.004), had lower educational levels (14.0 (12.0, 16.0) vs. 16.0 (12.8, 18.0), p= 0.002) and blood eosinophil levels (2.30 (1.50, 2.93) vs. 2.70 (1.80, 4.00), p= 0.008), and higher depression (64% vs. 36%, p <0.001) and anxiety (38% vs. 24%, p= 0.049) prevalence.

Results of the VBM analysis are visualized in following figures.

Conclusions

Post SARS-CoV-2 syndrome is associated with different cognitive profiles, and each presented particular clinical, biological, and structural characteristics. Females, ethnic minorities, participants with lower educational levels, depression, and anxiety are at higher risk of cognitive adversities following SARS-CoV-2 infection. The underlying pathophysiology needs to be better understood to mitigate the risks.

References

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