Variables asociadas a alteraciones cognitivas en una cohorte de personas sobrevivientes por COVID-19 en hospital de tercer nivel de México

IF 2.9 4区医学 Q2 CLINICAL NEUROLOGY

Neurologia Pub Date : 2025-06-01 DOI:10.1016/j.nrl.2023.05.005

M. Rodríguez-Rodríguez , Y. Rodríguez-Agudelo , F.J. Soto-Moreno , A. García-Santos , D. López-González , M. González-Navarro , F. Paz-Rodríguez , M. Chávez-Oliveros , S. Lozano-Tovar , K. González-Alonso , A. Castorena-Maldonado , R. Carrillo-Mezo , O. Marrufo-Meléndez , A. Gutiérrez-Romero , M. del Río Quiñones , A. Arauz-Góngora , S. Avila-Rios

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引用次数: 0

Abstract

Background

Cognitive impairments are one of the most common, insidious, and disabling symptoms of post-COVID-19 syndrome (PC-19), which have been correlated with damage to different brain structures.

Objective

To describe cognitive impairments in PC-19, identify associated variables, and compare the impact of mechanical ventilation on cognitive and neuroimaging outcomes.

Methods

A cohort of COVID-19 survivors was evaluated with neuropsychological tests (NPT) and cranial magnetic resonance imaging (MRI) 12 weeks after hospital discharge. Patients were classified into two groups based on whether they required invasive mechanical ventilation (IMV) or non-invasive mechanical ventilation (NIMV).

Results

Sixty patients completed the study, 41 received IMV and 19 NIMV, with an average age of 57.11 years. 66% scored below 26 points on the MoCA test and 83.3% reported everyday memory failures (EMF). 85% showed impairments in at least one NPT. When comparing results between groups, significant differences were observed in the total MoCA test score (p = 0,045) and EMF (p = 0,032). Significant relationships were observed between the Boston Naming Test (−.287; P = .035), the Rey Figure Recall Test (−.324; P = .017) with parietal atrophy, as well as phonological verbal fluency with frontal atrophy (−.276; P = .042). The HVLT (learning trial) test was related to hippocampal hyperintensity (−.266; P = .050) and cingulate hyperintensity (.311; P = .021). The TMT-B test was related to white matter hyperintensity (.345; P = .010). The presence of poor functional prognosis was correlated with anxiety (P < .001), depression (P < .001), elevated D-dimer levels (P = .002) and the increase in days of intubation (P = .005).

Conclusion

Our study suggests that COVID-19 survivors who had moderate-to-severe infection experience subjective complaints and cognitive impairments in executive function, attention, and memory, regardless of whether invasive mechanical ventilation was used during treatment. We found white matter lesions and cerebral atrophy in frontal and parietal regions that were associated with cognitive deficits. Our findings highlight the clinical need for longitudinal programs capable of evaluating the real impact of SARS-CoV-2 infection on the central nervous system, particularly in the cognitive and emotional domains.

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与墨西哥三级医院COVID-19幸存者群体认知障碍相关的变量

认知障碍是covid -19后综合征（PC-19）最常见、最隐蔽、最致残的症状之一，与不同大脑结构的损伤有关。目的描述PC-19患者的认知功能障碍，确定相关变量，并比较机械通气对认知和神经影像学结果的影响。方法采用神经心理测试（NPT）和颅磁共振成像（MRI）对一组新冠肺炎患者出院后12周进行评估。根据患者是否需要有创机械通气（IMV）或无创机械通气（NIMV）将患者分为两组。结果60例患者完成研究，其中41例接受IMV， 19例接受NIMV，平均年龄57.11岁。66%的人在MoCA测试中得分低于26分，83.3%的人报告了日常记忆失败（EMF）。85%的患者至少有一个NPT受损。当比较两组之间的结果时，观察到MoCA测试总分（p = 0,045）和EMF （p = 0,032）的显著差异。波士顿命名检验(- 0.287；P = .035)， Rey图回忆检验(- .324；P = 0.017)伴有顶叶萎缩，以及言语语音流畅性伴额叶萎缩(- 0.276；p = .042)。HVLT（学习试验）测试与海马高强度相关(−.266；P = .050)和扣带高强度(P = .311；p = .021)。TMT-B测试与白质高强度相关(.345；p = .010)。功能预后不良与焦虑相关(P <；.001)，抑郁(P <；.001)、d -二聚体水平升高（P = .002）和插管天数增加（P = .005）。结论我们的研究表明，中重度感染的COVID-19幸存者无论在治疗期间是否使用有创机械通气，都会出现主观主诉和执行功能、注意力和记忆方面的认知障碍。我们发现前额和顶叶区域的白质病变和脑萎缩与认知缺陷有关。我们的研究结果强调了临床对纵向项目的需求，这些项目能够评估SARS-CoV-2感染对中枢神经系统的实际影响，特别是在认知和情感领域。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Neurologia 医学-临床神经学

CiteScore

5.90

自引率

2.60%

发文量

135

审稿时长

48 days

期刊介绍： Neurología es la revista oficial de la Sociedad Española de Neurología y publica, desde 1986 contribuciones científicas en el campo de la neurología clínica y experimental. Los contenidos de Neurología abarcan desde la neuroepidemiología, la clínica neurológica, la gestión y asistencia neurológica y la terapéutica, a la investigación básica en neurociencias aplicada a la neurología. Las áreas temáticas de la revistas incluyen la neurologia infantil, la neuropsicología, la neurorehabilitación y la neurogeriatría. Los artículos publicados en Neurología siguen un proceso de revisión por doble ciego a fin de que los trabajos sean seleccionados atendiendo a su calidad, originalidad e interés y así estén sometidos a un proceso de mejora. El formato de artículos incluye Editoriales, Originales, Revisiones y Cartas al Editor, Neurología es el vehículo de información científica de reconocida calidad en profesionales interesados en la neurología que utilizan el español, como demuestra su inclusión en los más prestigiosos y selectivos índices bibliográficos del mundo.