Demographic and social determinants of cognitive dysfunction following hospitalization for COVID-19

• Published in: Journal of the neurological sciences Vol. 438; p. 120146
• Main Authors: Valdes, Eduard, Fuchs, Benjamin, Morrison, Chris, Charvet, Leigh, Lewis, Ariane, Thawani, Sujata, Balcer, Laura, Galetta, Steven L., Wisniewski, Thomas, Frontera, Jennifer A.
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 15.07.2022
• Subjects: Brain fog; Cognition; Cognitive; Cognitive Dysfunction - diagnosis; Cognitive Dysfunction - epidemiology; Cognitive Dysfunction - etiology; COVID-19; COVID-19 - complications; COVID-19 - epidemiology; Dementia - complications; Hospitalization; Humans; Long-COVID; Long-hauler; Memory; MOCA; Post-acute sequelae of COVID; Prospective Studies; SARS-CoV-2; Social Determinants of Health; COVID-19; Long-hauler; SARS-CoV-2; MOCA; Memory; Brain fog; Long-COVID; Cognitive; Cognition; Post-acute sequelae of COVID
• ISSN: 0022-510X; 1878-5883
• DOI: 10.1016/j.jns.2022.120146

Persistent cognitive symptoms have been reported following COVID-19 hospitalization. We investigated the relationship between demographics, social determinants of health (SDOH) and cognitive outcomes 6-months after hospitalization for COVID-19. We analyzed 6-month follow-up data collected from a multi-center, prospective study of hospitalized COVID-19 patients. Demographic and SDOH variables (age, race/ethnicity, education, employment, health insurance status, median income, primary language, living arrangements, and pre-COVID disability) were compared between patients with normal versus abnormal telephone Montreal Cognitive Assessments (t-MOCA; scores<18/22). Multivariable logistic regression models were constructed to evaluate predictors of t-MoCA. Of 382 patients available for 6-month follow-up, 215 (56%) completed the t-MoCA (n = 109/215 [51%] had normal and n = 106/215 [49%] abnormal results). 14/215 (7%) patients had a prior history of dementia/cognitive impairment. Significant univariate predictors of abnormal t-MoCA included older age, ≤12 years of education, unemployment pre-COVID, Black race, and a pre-COVID history of cognitive impairment (all p < 0.05). In multivariable analyses, education ≤12 years (adjusted OR 5.21, 95%CI 2.25–12.09), Black race (aOR 5.54, 95%CI 2.25–13.66), and the interaction of baseline functional status and unemployment prior to hospitalization (aOR 3.98, 95%CI 1.23–12.92) were significantly associated with abnormal t-MoCA scores after adjusting for age, history of dementia, language, neurological complications, income and discharge disposition. Fewer years of education, Black race and unemployment with baseline disability were associated with abnormal t-MoCA scores 6-months post-hospitalization for COVID-19. These associations may be due to undiagnosed baseline cognitive dysfunction, implicit biases of the t-MoCA, other unmeasured SDOH or biological effects of SARS-CoV-2. •Abnormal telephone MoCA scores occurred in 49% of patients 6-months after hospitalization for COVID-19.•Cognitive impairment was independent of any hospital metric or measure of COVID-19 illness severity.•Black race, ≤12 years of education, and pre-hospitalization unemployment with disability predicted impaired cognition.•These associations may be due to undiagnosed baseline cognitive deficits, implicit testing biases, or other SDOH.