Cognition and Memory after Covid-19 in a Large Community Sample
Adam Hampshire, Adriana Azor, Christina Atchison, et al
N Engl J Med 2024; 390:806-818
DOI: 10.1056/NEJMoa2311330
Abstract
BACKGROUND
Cognitive symptoms after coronavirus disease 2019 (Covid-19), the disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), are well-recognized. Whether objectively measurable cognitive deficits exist and how long they persist are unclear.
患COVID-19后的认知症状已得到广泛认可。可客观测量的认知缺陷是否存在以及持续多久，目前尚不清楚。
METHODS
We invited 800,000 adults in a study in England to complete an online assessment of cognitive function. We estimated a global cognitive score across eight tasks. We hypothesized that participants with persistent symptoms (lasting ≥12 weeks) after infection onset would have objectively measurable global cognitive deficits and that impairments in executive functioning and memory would be observed in such participants, especially in those who reported recent poor memory or difficulty thinking or concentrating (“brain fog”).
我们在英国一项研究中邀请800,000成人完成认知功能在线评估。我们估算了八项任务的整体认知评分。本研究假设，感染后有持续症状（持续≥12周）的参与者会出现可客观测量的整体认知缺陷，并且在这些参与者中可观察到执行功能和记忆力受损，尤其是在报告近期记忆力差或者难以思考或集中注意力（“脑雾”）的参与者中。
RESULTS
Of the 141,583 participants who started the online cognitive assessment, 112,964 completed it. In a multiple regression analysis, participants who had recovered from Covid-19 in whom symptoms had resolved in less than 4 weeks or at least 12 weeks had similar small deficits in global cognition as compared with those in the no–Covid-19 group, who had not been infected with SARS-CoV-2 or had unconfirmed infection (−0.23 SD [95% confidence interval {CI}, −0.33 to −0.13] and −0.24 SD [95% CI, −0.36 to −0.12], respectively); larger deficits as compared with the no–Covid-19 group were seen in participants with unresolved persistent symptoms (−0.42 SD; 95% CI, −0.53 to −0.31). Larger deficits were seen in participants who had SARS-CoV-2 infection during periods in which the original virus or the B.1.1.7 variant was predominant than in those infected with later variants (e.g., −0.17 SD for the B.1.1.7 variant vs. the B.1.1.529 variant; 95% CI, −0.20 to −0.13) and in participants who had been hospitalized than in those who had not been hospitalized (e.g., intensive care unit admission, −0.35 SD; 95% CI, −0.49 to −0.20). Results of the analyses were similar to those of propensity-score–matching analyses. In a comparison of the group that had unresolved persistent symptoms with the no–Covid-19 group, memory, reasoning, and executive function tasks were associated with the largest deficits (−0.33 to −0.20 SD); these tasks correlated weakly with recent symptoms, including poor memory and brain fog. No adverse events were reported.
在开始认知在线评估的141,583名参与者中，112964人完成了评估。在一项多元回归分析中，症状在4周内或至少12周消退的COVID-19康复者的轻微整体认知缺陷与未患COVID-19组（未感染SARS-CoV-2或未确诊感染）相似（分别为－0.23 SD[95%置信区间{CI}，－0.33~－0.13]和－0.24 SD[95% CI，－0.36~－0.12]）；与未患COVID-19组相比，持续症状未消退参与者有较严重认知缺陷（－0.42 SD；95% CI，－0.53~－0.31）。在原始病毒或B.1.1.7变异株为主要流行株时期感染SARS-CoV-2的参与者与在后续变异株时期感染的参与者相比（例如B.1.1.7变异株 vs. B.1.1.529变异株为−0.17 SD；95% CI，－0.20~－0.13），前者有较严重认知缺陷；住院参与者与未住院参与者相比，前者有较严重认知缺陷（例如进入重症监护病房，－0.35 SD；95% CI，－0.49~－0.20）。分析结果与倾向评分匹配分析结果相似。在持续症状未消退组与未患COVID-19组的比较中，记忆、推理和执行功能任务的缺陷最严重（－0.33~－0.20 SD）；这些任务与近期症状（包括记忆力差和脑雾）弱相关。未报告任何不良事件。
CONCLUSIONS
Participants with resolved persistent symptoms after Covid-19 had objectively measured cognitive function similar to that in participants with shorter-duration symptoms, although short-duration Covid-19 was still associated with small cognitive deficits after recovery. Longer-term persistence of cognitive deficits and any clinical implications remain uncertain. (Funded by the National Institute for Health and Care Research and others.)
在COVID-19后持续症状消退的参与者中，可客观测量的认知功能与较短期症状参与者相似，但较短期COVID-19仍与康复后轻微认知缺陷相关。认知缺陷是否长期持续及其临床影响仍不确定。（由英国国家卫生和医疗研究所[National Institute for Health and Care Research]等资助）。
来源：NEJM医学前沿
链接：https://www.nejmqianyan.cn/article-info?permalinks=YXQYoa2311330&sg=AbW1N
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