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Título

Cognitive and behavioral changes related to COVID-19 in patients evaluated at a reference center in São Paulo, Brazil

Resumo

Background: Central nervous system involvement associated with Coronavirus Disease 2019 (COVID-19) has been reported, including cognitive impairment, even in patients with mild COVID-19. Objectives: To assess cognitive decline related to the SARS-CoV-2 infection in patients with neurological disease after COVID-19. Methods: Longitudinal prospective study developed to compare the cognitive performance of patients after COVID-19 based on cognitive complaints. Patients aged between 18 and 65 years without previous neurological disease were included in the study and illiterate people were excluded. Beck's anxiety and depression questionnaires were applied, also the Addenbrooke´s Cognitive Examination-Revised (ACE-R) and the Trail Making Test (TMT), parts A and B. Results: Sixty one patients were evaluated, 41 women (67.21%) and 20 men. The mean age of all patients was 46.36 years (standard deviation – SD 9.92) and median of 46 years. In relation to schooling, mean of 13.93 years (SD 4.06) and median of 16 years. Forty-four patients had cognitive complaint (72.13%), 21 (47.72%) of them the only complaint. Regarding the time between the first symptom of COVID-19 and the onset of the neurological symptom, mean of 39.52 days (SD 40.7) and median of 29 days. Among all patients, the mean score of Beck's anxiety and depression questionnaires was, respectively, 16.72 (SD 10.05) and 13.31 (SD 6.97), and median of 15 and 12, which indicates mild to moderate degrees of anxiety and depression. The results of ACE-R were altered in 41 patients (67.21%) - 30/44 (68.18%) patients with a cognitive complaint and 11/17 (61.11%) patients without this complaint (p = 0.07798). The score on the mini-mental state examination (MMSE) was also altered in 41 patients. In the TMT part A, score altered in 39 patients (63.93%) - 10 had lower average performance, 8 borderline and 21 severe performance. In the TMT part B, score altered in 43 patients (70.49%) - 4 had lower average, 3 borderline and 36 severe performance. No patient had superior performance on any part of the test. Two patients could not take the TMT’s due to motor limitation because of motor sequelae of COVID-19. Conclusions: Cognitive complaint was not a predictor of cognitive decline, and the cognitive decline was observed in most patients, in the MMSE, ACE-R and TMT assessments cognitive decline.

Palavras Chave

COVID-19; encephalopathy; cognitive impairment; cognitive decline