Cognitive impairment after COVID-associated pneumonia: results of a prospective cohort study of risk factors

Objective. To assess the incidence, types, and predictors of cognitive dysfunction 3 months after COVID-associated pneumonia. Material and methods. The prospective cohort study included 340 survivors of COVID-associated pneumonia patients and 34 controls. A comprehensive examination 3 months after discharge from the mono-infectious hospital included the assessment of cognitive functions (MoCA scale, SDMT, Münsterberg test), asthenia (MFI-20 scale), quality of life (SF-36 scale), as well as the analysis of a broad range of clinical and laboratory parameters of the acute period of the disease. Results. Cognitive impairment was identified in 24.4% (n=83) of patients. Analysis of individual domains of the MoCA scale showed impaired memory in 50.6% (n=168) of patients and visual and constructive skills in 50.3% (n=171). A significant effect of age was observed; in patients ≥60 years, the impairment was more common and more pronounced (p<0.05). Visual-spatial disorders were significantly more common in females (59.4% vs. 39% in males, p<0.05). An association was found between high levels of pro-inflammatory markers (tumor necrosis factor-α, interleukin-1, and high-sensitivity C-reactive protein) in the acute period and a decrease in attention and memory scores after 3 months (p<0.05). Mental asthenia was associated with increased cognitive impairment (39.1% vs. 11.9% without asthenia, p<0.05). A correlation between the MoCA score and the «General Health» score of the SF-36 scale (r=0.21; p<0.05). Conclusion. The development of cognitive dysfunction in the post-COVID period is a multifactorial process associated with age, gender, the severity of systemic inflammation in the acute period, and the presence of mental asthenia. The obtained data support the need for neurocognitive monitoring for risk groups.