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The cognitive consequences of the COVID-19 epidemic: collateral damage?…
The cognitive consequences of the COVID-19 epidemic: collateral damage? Ritchie et al, 2020
The majority of persons suffering from COVID-19 will recover; recovery being principally defined in terms of re- mission of respiratory tract symptoms.
Possible Causes: Neurological symptoms and sub-clinical cognitive dysfunction, likely to result from multiple and interacting causes
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no clear aetiological pathway has been established between infection and human neurological diseases, the neuropathogenicity of HCoV is being increasingly recognized in humans
The virus may directly infect neurons in the periphery or olfactory sensory neurones and thus use axonal transport to gain access to the CNS (Dahm et al., 2016)
Permeability of the blood brain barrier (Koyuncu et al., 2013; Miner and Diamond 2016)
Inflammatory Porcesses eg: ARDS (Han and Mallampalli, 2015)
Human Coronovirus info
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respiratory coronaviruses may penetrate into the brain and cerebrospinal fluid (Bohmwald et al., 2018)
Middle East respira- tory syndrome (MERS-CoV), diffuse lesions were identi- fied in several brain regions, including white matter and the subcortical areas of the frontal, temporal and parietal lobes (Arabi et al., 2015
SARS-CoV genome sequences throughout the cortex and hypothalamus (Gu et al., 2005)
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Impact
Ventilated patients in general: impairments in atten- tion, memory, verbal fluency, processing speed and executive functioning in 78% of patients 1 year after dis- charge and around half of patients up to 2 years ( Mikkelsen et al., 2012)
Adhikari et al. (2011) observed self-reported memory problems persisting up to 5 years after acute respiratory distress syndrome
anxiety, depression and post- traumatic stress syndrome are also common in ARDS
Psychological Distress
Study of patients quarantined for sus-pected or confirmed MERS-CoV (n =40), estimated that 70.8% of confirmed patients who survived the illness (n = 24) exhibited psychiatric symptoms, including hallucinations and psychosis, with 40% receiving a psychiatric diagnosis during their hospital admittance
Study of 90 SARS-CoV cases with a 97% response rate similarly showed high levels of psycho- logical distress with 59% diagnosed with psychiatric dis- orders and a continuing prevalence of 33% at 30month follow-up. Severity of psychological symptoms was found to be related to severity of illness and functional impair- ment (Mak et al., 2009; Wing and Leung, 2012)
Measuring may be complicated: higher rates of psychiatric symptoms might be expected in the general population following the epi-demic due to exposure to traumatic life events (loss of in- come, fear, death of friends and relatives), nested within this group may be persons whose cognitive and psycho- logical disorders are directly related to HCoV brain changes. T
Conclusion
current epidemic is likely to be accompanied by a significant increase in the prevalence of longer-term cognitive dysfunction impacting on ability to return to everyday functioning
The current coronavirus outbreak is unlikely to be the last (with SARS and MERS, COVID-19 this is the third coronavirus epidemic in 10years). It is therefore impera- tive that the medical-scientific community look beyond the current acute crisis to the links between coronavirus infection and long-term neurological sequelae.