Posthospitalization COVID-19 cognitive deficits at 1 year are global and associated with elevated brain injury markers and gray matter volume reduction

• Published in: Nature medicine
• Main Authors: Wood, Greta K, Sargent, Brendan F, Ahmad, Zain-Ul-Abideen, Tharmaratnam, Kukatharmini, Dunai, Cordelia, Egbe, Franklyn N, Martin, Naomi H, Facer, Bethany, Pendered, Sophie L, Rogers, Henry C, Hübel, Christopher, van Wamelen, Daniel J, Bethlehem, Richard A I, Giunchiglia, Valentina, Hellyer, Peter J, Trender, William, Kalsi, Gursharan, Needham, Edward, Easton, Ava, Jackson, Thomas A, Cunningham, Colm, Upthegrove, Rachel, Pollak, Thomas A, Hotopf, Matthew, Solomon, Tom, Pett, Sarah L, Shaw, Pamela J, Wood, Nicholas, Harrison, Neil A, Miller, Karla L, Jezzard, Peter, Williams, Guy, Duff, Eugene P, Williams, Steven, Zelaya, Fernando, Smith, Stephen M, Keller, Simon, Broome, Matthew, Kingston, Nathalie, Husain, Masud, Vincent, Angela, Bradley, John, Chinnery, Patrick, Menon, David K, Aggleton, John P, Nicholson, Timothy R, Taylor, John-Paul, David, Anthony S, Carson, Alan, Bullmore, Ed, Breen, Gerome, Hampshire, Adam, Michael, Benedict D, Paddick, Stella-Maria, Leek, E Charles
• Format: Journal Article
• Language: English
• Published: 23.09.2024
• ISSN: 1546-170X; 1546-170X
• DOI: 10.1038/s41591-024-03309-8

The spectrum, pathophysiology and recovery trajectory of persistent post-COVID-19 cognitive deficits are unknown, limiting our ability to develop prevention and treatment strategies. We report the 1-year cognitive, serum biomarker and neuroimaging findings from a prospective, national study of cognition in 351 COVID-19 patients who required hospitalization, compared with 2,927 normative matched controls. Cognitive deficits were global, associated with elevated brain injury markers and reduced anterior cingulate cortex volume 1 year after COVID-19. Severity of the initial infective insult, postacute psychiatric symptoms and a history of encephalopathy were associated with the greatest deficits. There was strong concordance between subjective and objective cognitive deficits. Longitudinal follow-up in 106 patients demonstrated a trend toward recovery. Together, these findings support the hypothesis that brain injury in moderate to severe COVID-19 may be immune-mediated, and should guide the development of therapeutic strategies.The spectrum, pathophysiology and recovery trajectory of persistent post-COVID-19 cognitive deficits are unknown, limiting our ability to develop prevention and treatment strategies. We report the 1-year cognitive, serum biomarker and neuroimaging findings from a prospective, national study of cognition in 351 COVID-19 patients who required hospitalization, compared with 2,927 normative matched controls. Cognitive deficits were global, associated with elevated brain injury markers and reduced anterior cingulate cortex volume 1 year after COVID-19. Severity of the initial infective insult, postacute psychiatric symptoms and a history of encephalopathy were associated with the greatest deficits. There was strong concordance between subjective and objective cognitive deficits. Longitudinal follow-up in 106 patients demonstrated a trend toward recovery. Together, these findings support the hypothesis that brain injury in moderate to severe COVID-19 may be immune-mediated, and should guide the development of therapeutic strategies.