Assessment of cognitive and psychiatric disturbances in people with post-COVID-19 condition: a cross-sectional observational study

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OBJECTIVE: Cognitive and psychiatric symptoms have been increasingly reported after severe acute respiratory syndrome coronavirus 2 infection, developing soon after infection and possibly persisting for several months. We aimed to study this syndrome and start implementing strategies for its assessment. METHODS: Consecutive patients, referred by the infectious disease specialist because of cognitive complaints after COVID-19, were neurologically evaluated. Neurological evaluation included a cognitive screening test (Montreal Cognitive Assessment, MoCA). Moreover, patients were invited to fill out a general symptom questionnaire and a self-administered multidimensional assessment of psychiatric symptoms, followed by a full psychiatric assessment if scores were above validated cutoffs. RESULTS: Of 144 referred patients, 101 (mean age 55.2±13.1, 63.4% females) completed the cognitive screening and the self-administered psychiatric questionnaire. Acute infection severity was low for most patients and the most common persisting symptoms were fatigue (92%), sleep problems (69.5%), and headache (52.4%). MoCA outlined cognitive deficits in ≥1 cognitive domain in 34% of patients, mainly in memory and attention. About 60% of patients presented depressive, anxiety, or stress-related symptoms. Psychiatric scale scores significantly correlated with overall symptom burden and MoCA score. No significant correlation was found between MoCA scores and overall symptom burden. CONCLUSION: We hypothesize that persistent cognitive complaints after COVID-19 might reflect a concomitant or reactive psychopathological condition, possibly coupled with an infection-related impact on cognitive functions. The application of a combined neurological and psychiatric assessment seems crucial to appraise the nature of post-COVID-19 condition.