Long-Term Psychological and Cognitive Outcomes of Patients with COVID-19

Rationale: Intensive care unit (ICU) survivorship has well documented physical disability1,2 psychological sequelae, and cognitive dysfunction3,4 all combined under the umbrella of Post-Intensive Care Syndrome (PICS). The COVID-19 pandemic is concerning for overwhelming health care resources in the short-term, but the longterm consequences of this large cohort of patients surviving critical illness remains ill-defined. It also remains unclear if the unique context of health care delivery such as lack of visitors and cohorting patients during the pandemic exacerbates the psychological and cognitive impairments of PICS. Methods: All patients admitted to the ICU with COVID-19 were eligible for enrollment in this prospective observational study. We performed a global assessment of cognitive function (using the Montreal Cognitive Assessment tool (T-MoCA)), posttraumatic stress disorder (using the Impact event scale (IES-Revised)), and depression/anxiety (using Hospital Anxiety and Depression scale (HADS)) in ICU survivors at 6 months after hospital discharge. Interviews were conducted via telephone or in-person when possible. Results: From April 10, 2020 thru November 17th, 2020 one hundred patients were enrolled upon hospital discharge. Eighty-two patients reached the 6-month milestone after hospital discharge and 22 (26.8%) of these patients required invasive mechanical ventilation. Of this eligible cohort, seven patients died, two were cognitively unable to complete the evaluations, four refused to participate, and thirteen were lost to follow-up. Fifty-six patients completed the evaluation with 74.7% follow-up (56/75 alive patients). Symptoms of probable post-traumatic stress disorder were reported in 2 patients (3.6%). Depression and Anxiety was reported in 5 patients (8.9%) respectively. Cognitive impairment was present in 47.3% of patients with a median T-MoCA score of 18 [15.5-19]. There was no difference in T-MoCA scores based on whether patients required invasive mechanical ventilation (IMV) (IMV 17 [15-20.5] vs not intubated 18 [16-19];p=0.89). Conclusions: Our preliminary long-term follow-up data suggest that symptoms of post-traumatic stress after COVID-19 infection are rare. In addition, less than 10% of patients reported anxiety and depression six months after hospital discharge. Interestingly, cognitive impairment as measured by T-MOCA was present in almost half of the patients. Further follow-up on the long term effects of COVID-19 related critical illness is warranted as we adapt during this pandemic.