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The ‘third wave’: impending cognitive and functional decline in COVID-19…
The ‘third wave’: impending cognitive and functional decline in COVID-19 survivors. Baker et al. 2021
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Risk Factors of Severe Covid - baseline neurocognitive frailty that can increase susceptibility to cog
advanced age,13 medical comorbidities, most commonly hypertension (40e60%), diabetes mellitus (20e40%), obesity (40e50%),14 and smoking.15
his population overlaps significantly with at-risk groups for MCI and cognitive decline, which include advanced age, traumatic brain injury, obesity, hypertension, current smoking, and diabetes mellitus.16
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Mechanisms
Cognitive impairment is frequently seen in patients with chronic hypoxaemia, including chronic obstructive pulmonary disease (COPD) and obstructive sleep apnoea.19,20 Similarly, patients with COVID- 19 acute respiratory distress syndrome (ARDS) can exhibit severe hypoxaemia despite relatively well-preserved lung mechanics.21
Neuroinflammation can cause cognitive dysfunction by compromising the BBB.10 In both animals and humans, in- flammatory insults can cause upregulation of pro- inflammatory cytokines and inflammatory mediators in the serum and CNS.11 Peripheral pro-inflammatory cytokines such as interleukin-1 (IL-1), IL-6, and tumour necrosis factor alpha (TNF-a) compromise BBB permeability via cyclooxygenase-2 (COX-2) upregulation and matrix metalloprotease (MMP) acti- vation
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raise serious concerns regarding subsequent devel- opment of cognitive and functional decline in these patients, as cognitive decline is largely an insidious process after a heralding neurological or neurocognitive insult.
manifests in reduced quality of life and impaired ability to perform activities of daily living (ADLs) and instrumental ADLs (IADLs)
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may benefit our cumulative research efforts to consider the long-term effects of COVID-19 in alignment with anaes- thesia and surgery, which are known precipitants of inflammation-related cognitive and functional decline.
Vast body of literature addressing perioperative neurocognitive disor- ders, which have a similar inflammatory component, may facilitate advances in strategies for both, and other neurolog- ical injuries, in a relatively short timeframe.