Cognitive, behavioral, neuroimaging and inflammatory biomarkers after hospitalization for COVID-19 in Brazil

Post-COVID-19 Condition (PCC) refers to a multisystemic syndrome that persists for months after SARS-CoV-2 infection. Cognitive deficits, fatigue, depression, and anxiety are common manifestations of the condition, but the underlying mechanisms driving these long-lasting neuropsychiatric features are still unclear. We conducted a prospective multi-method investigation of post-hospitalization COVID-19 patients in Rio de Janeiro, Brazil. Months after hospital admission (mean = 168.45 +/- 90.31 days; range = 75.00-365.00 days), COVID-19 survivors (n = 72) presented significant difficulties in tests tapping global cognition, episodic memory, working memory and inhibitory control relative to controls and to validated normative scores. A considerable proportion of participants suffered from fatigue (36.1 %), anxiety (27.8 %), and depressive symptoms (43.1 %). Elevated blood levels of TNF-alpha, during hospitalization, and TNF-alpha and IL-1 beta, at follow-up, correlated with changes in brain microstructural diffusion indices (beta = 0.144, p = 0.005). These neuroimaging markers were associated with decreased episodic memory (beta = -0.221, p = 0.027), working memory (beta = -0.209, p = 0.034) and inhibitory control (beta = -0.183, p = 0.010) at follow-up. Severity of depressive symptoms correlated with deficits in global cognition in post-COVID-19 cases (beta = -0.366, p = 0.038). Our study provides preliminary evidence that longterm cognitive dysfunction following COVID-19 may be mediated by brain microstructural damage, triggered by persistent neuroinflammation. In addition, depressive symptoms may contribute to prolongated global cognitive impairments in those cases.

Automated summary

Post-COVID-19 Condition (PCC) is a multisystemic syndrome that persists for months after SARS-CoV-2 infection, affecting cognitive function and neuropsychiatric features. A study on COVID-19 survivors in Brazil found that these patients experienced significant difficulties in overall cognition, memory, working memory, and inhibitory control, as well as fatigue, anxiety, and depressive symptoms. In addition, elevated levels of inflammatory markers in the blood were associated with brain microstructural damage and cognitive impairments.