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Meta-analysis of Cognitive Function Following Non-severe SARS-CoV-2 Infection

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Abstract

To effectively diagnose and treat subjective cognitive symptoms in post-acute sequalae of COVID-19 (PASC), it is important to understand objective cognitive impairment across the range of acute COVID-19 severity. Despite the importance of this area of research, to our knowledge, there are no current meta-analyses of objective cognitive functioning following non-severe initial SARS-CoV-2 infection. The aim of this meta-analysis is to describe objective cognitive impairment in individuals with non-severe (mild or moderate) SARS-CoV-2 cases in the post-acute stage of infection. This meta-analysis was pre-registered with Prospero (CRD42021293124) and utilized the PRISMA checklist for reporting guidelines, with screening conducted by at least two independent reviewers for all aspects of the screening and data extraction process. Fifty-nine articles (total participants = 22,060) with three types of study designs met our full criteria. Individuals with non-severe (mild/moderate) initial SARS-CoV-2 infection demonstrated worse objective cognitive performance compared to healthy comparison participants. However, those with mild (nonhospitalized) initial SARS-CoV-2 infections had better objective cognitive performance than those with moderate (hospitalized but not requiring ICU care) or severe (hospitalized with ICU care) initial SARS-CoV-2 infections. For studies that used normative data comparisons instead of healthy comparison participants, there was a small and nearly significant effect when compared to normative data. There were high levels of heterogeneity (88.6 to 97.3%), likely reflecting small sample sizes and variations in primary study methodology. Individuals who have recovered from non-severe cases of SARS-CoV-2 infections may be at risk for cognitive decline or impairment and may benefit from cognitive health interventions.

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Availability of Data and Materials

The authors declare that the data supporting the findings of this study are available within the primary paper and its supplementary information files. Data extracted from individual studies will be made available from the primary author upon reasonable request.

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Funding

This research is supported by the Department of Veterans Affairs Office of Academic Affiliations Advanced Fellowship Program in Mental Illness Research and Treatment, the VISN 17 Center of Excellence for Research on Returning War Veterans, and the Central Texas Veterans Health Care System. Dr. Lu acknowledges the support of the Relief Funding Award from the Office of the Vice Provost for Research and Scholarship and the Office of Faculty Affairs and the Department of Public Health Sciences 2023 Copeland Foundation Project Initiative Award, University of Miami. Dr. Austin was supported by a Career Development Award (1IK2RX004764) from the VA Rehabilitation Research and Development Service. Dr. Bergman acknowledges the support for this work from the National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health (T32-AR07080). Dr. Lantrip acknowledges the support of the VA Clinical Science Research and Developmental Career Development Award 1 IK2 CX002101-01A2. Dr. Twamley gratefully acknowledges the support of a VA Rehabilitation Research and Development Research Career Scientist Award.

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Author notes

  1. Crystal Lantrip and Elizabeth W. Twamley have shared position as last author.

Authors and Affiliations

  1. The VISN 17 Center of Excellence for Research on Returning War Veterans, 4800 Memorial Drive, Waco, TX, 76711, USA

    Tara A. Austin, Sarah Parr, Mikayla Catazaro & Crystal Lantrip

  2. Center of Excellence for Stress and Mental Health, San Diego Healthcare System, San Diego, CA, USA

    Tara A. Austin, Delaney Pickell & Elizabeth W. Twamley

  3. Research Service, VA San Diego Healthcare System, San Diego, CA, USA

    Tara A. Austin & Elizabeth W. Twamley

  4. Department of Psychology, Colorado State University, Colorado Springs, Fort Collins, USA

    Michael L. Thomas

  5. University of Miami, Miami, FL, USA

    Min Lu

  6. Department of Psychology, Brigham Young University, Provo, UT, USA

    Cooper B. Hodges

  7. Harold B. Lee Library, Brigham Young University, Provo, UT, USA

    Emily S. Darowski

  8. Chronic Pain and Fatigue Research Center, Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA

    Rachel Bergmans

  9. Department of Psychology and Neuroscience, Baylor University, Waco, TX, USA

    Sarah Parr, Mikayla Catazaro & Crystal Lantrip

  10. Department of Psychiatry, University of California San Diego, San Diego, CA, USA

    Elizabeth W. Twamley

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  1. Tara A. Austin
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Tara Austin: conceptualization, methodology, analysis, data curation, writing, project administration. Michael Thomas: methodology, analysis, writing—review and editing. Min Lu: methodology, analysis, writing—review and editing. Cooper Hodges: conceptualization, methodology, analysis, writing—original draft. Emily Darowski: conceptualization, methodology, data curation, writing—original draft. Rachel Bergmans: conceptualization, resources, writing—review and editing. Sarah Parr: analysis, data curation, writing—review and editing. Delaney Pickell: data curation, writing—review and editing. Mikayla Catazaro: data curation, writing—original draft. Crystal Lantrip: conceptualization, supervision, writing—review and editing. Elizabeth Twamley: methodology, supervision, writing—review and editing.

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Correspondence to Tara A. Austin.

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Austin, T.A., Thomas, M.L., Lu, M. et al. Meta-analysis of Cognitive Function Following Non-severe SARS-CoV-2 Infection. Neuropsychol Rev (2024). https://doi.org/10.1007/s11065-024-09642-6

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