Cognitive dysfunction and psychiatric multimorbidity among patients with post-COVID-19 syndrome

Introduction: As many as 70 % of patients diagnosed with COVID-19 have been reported to experience persisting post infectious symptoms. Neuropsychological symptoms relating to executive functions, working memory and verbal fluency have been observed. Also, symptoms of trauma may be expected among patients omitted to in-patient acute care. Mental health issues may arise because of the length of symptom duration. Rehabilitation for post-COVID-19 syndrome is available at primary care level. However, the multimorbid facet of the condition and the symptom duration may be challenging for existing rehabilitation services. The aim of this data collection was to present suggestions for clinical screening of conditions that may call for adjustments for post-COVID-19 syndrome, within first line rehabilitation at primary care level. Methods: Patients with persisting symptoms after COVID-19 infection in Linköping, Östergötland City Council, received rehabilitation by occupational therapists, physiotherapists and physicians within primary care. If the anticipated outcome of rehabilitation were not met, patients could be referred to a multidisciplinary team for assessment at specialist level. If psychiatric symptoms or cognitive dysfunction were hypothesized to have a negative impact on the rehabilitation process, patients were assessed by a psychologist. The purpose of the psychological assessment was to screen for psychiatric disorders and to detect cognitive dysfunction, that could call for adjusted rehabilitation or reprioritizing of treatment modalities. Instruments: Data from neuropsychological tests (Wais, WMS, Brief, Ruff 2&7, Rbans) and self-report forms (MFI, GAD-7, PHQ-9, ISI, PCL-5, Raads-14, ASRS, EQ 5D and EQ Vas) were collected consecutively from February 2021 to May 2022. Results: Concerning multimorbidity, 61 % (n=22) of the patients suffered from depressive symptoms. Clinical insomnia was reported by 64 % (n=23) and symptoms of anxiety by 58 % (n=21). Unexpectedly, indication of either Attention Deficit Hyperactivity Disorder (ADHD) or Autism Spectrum Disorder (ASD) were found in 39% (n=14) of the patients. Also, further assessment of Post Traumatic Stress Disorder (PTSD) was indicated for 44% (n=16). Cognitive dysfunction was indicated for 55.6 % (Moca) (n=10) of tested patients. Overall cognitive ability (WAIS) was within the average range for the majority (69%, n=11). However, 38 % (6 patients) performed at borderline level at subscales Processing Speed Index and Working Memory Index, respectively. Cognitive dysfunction (Rbans Total Scale Index) was found among 64 % (n=7). On the Attention Scale Index specifically, 92% (n=11) performed borderline or extremely low. Also, on the Visuospatial/Construction Scale 58 % (n=7) performed borderline or extremely low. Likewise, 54 % (n=7) performed borderline or extremely low on the Language Scale. Executive dysfunction (Brief) were found on group level on sub-scales Shift (Mpercentile = 88.05), Initiate (M=82.95), Working memory (M=90.86) and Plan/Organize (M=84.29). Subscale working memory stands out as 21 of 31 tested patients showed clinically relevant difficulties (cut-off at 94th percentile). Conclusions: Patients with post-COVID-19 syndrome displays symptoms of cognitive and executive dysfunction as well as psychiatric symptoms. In those cases where sufficient progress is not reached after rehabilitation on primary care level, adjustments on pace and content might be necessary. We suggest that screening for trauma, depression, anxiety and insomnia might be important for prioritizing of treatment modalities. We also suggest that screening for neuropsychological deficits may help to adapt rehabilitation based on patients’ prerequisites. Lastly, we recommend cognitive rehabilitation with adjusted pace and content for those patients who score borderline or extremely low on cognitive assessment.