Post‐COVID‐19 acute cognitive syndromes

Post-COVID-19 acute cognitive syndromes Further to Gaber & Eltemamy’s report of post-COVID-19 aphantasia,1 I suggest that other apparently acute cognitive syndromes are likely to be seen post-COVID-19. A previously healthy 49-year-old woman was referred with a complaint of forgetting following confirmed COVID-19 infection 9 months earlier characterised by cough and fever but not requiring hospitalisation. Prior to this acute illness she reported her memory to be excellent, even for remote details that other family members could not recall. Because of her symptoms, she could no longer pursue her occupation of teaching. Cognitive testing and structural brain imaging disclosed no cause for her symptoms. Inconsistency between self-reported and objective performance was in keeping with a proposed operational definition of functional cognitive disorder (FCD).2 This clinical observation, which I suspect is far from unique, is problematic for metacognitive models of FCD,3 as are other instances of acute onset FCD, such as the dissociative amnesia type,4 which imply sudden rather than gradual change in synaptic neuromodulation. These entities share a clear stressful precipitating event, physical or psychological, the severity of which may be disproportionate to the subsequent cognitive symptoms. The mechanism(s) that underpin acute post-COVID-19 cognitive syndromes such as FCD remain to be determined but might include neurovascular and immunological dysfunction.