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Short- and long-term neuropsychological impairment following COVID-19

English title Short- and long-term neuropsychological impairment following COVID-19
Applicant Péron Julie
Number 198438
Funding scheme NRP 78 Covid-19
Research institution FPSE Université de Genève
Institution of higher education University of Geneva - GE
Main discipline Psychology
Start/End 01.10.2020 - 30.06.2023
Approved amount 561'282.00
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All Disciplines (2)

Discipline
Psychology
Neurology, Psychiatry

Keywords (6)

Neuropsychology; Neurology; COVID-19; Emotion; Cognition; short and long-term sequelae

Lay Summary (German)

Lead
In der Akutphase kann COVID-19 schwere Hirnfunktionsstörungen verursachen. Über die kurz- und langfristigen Auswirkungen auf den Intellekt und die Emotionen wissen wir dagegen noch wenig. Mit diesem Projekt werden die neurokognitiven Defizite nach einer COVID-19-Erkrankung untersucht.
Lay summary

Hintergrund

COVID-19 geht in der akuten Phase der Infektion häufig mit neurologischen und kognitiven Beeinträchtigungen einher. Als mögliche Ursachen wurden Neuroimmun- oder Gefässerkrankungen identifiziert. Deshalb ist die Wahrscheinlichkeit hoch, dass neuropsychologische Folgen zurückbleiben, selbst bei milden und moderaten Verläufen von COVID-19. Wichtig ist auch, die neuropsychiatrischen Probleme zu berücksichtigen, die durch Präventionsmassnahmen wie Lockdown, durch Ansteckungsangst oder posttraumatische Belastungsstörungen entstehen, da diese die kognitive Leistung und Reserve ebenfalls erheblich beeinflussen.

Forschungsziele

Das Ziel der COVID-COG besteht darin, die neuropsychologischen Folgen von COVID-19 sechs und zwölf Monate nach der Infektion zu erfassen. Überdies möchten wir in Erfahrung bringen, ob diese allfälligen kurz- und langfristigen Auswirkungen einen Zusammenhang mit der Schwere der Krankheit in der Akutphase ausweisen - und/oder mit vermuteten neuropsychiatrischen Krankheiten nach dieser einschneidenden Gesundheitskrise, beispielsweise Angst-, Stress- oder posttraumatischen Belastungsstörungen.

Erwartete Ergebnisse und angestrebte Produkte

Aufgrund der aktuellen Hypothesen über neurologische Schädigungen nach schweren COVID-19-Infektionen erwarten wir auch sechs oder sogar zwölf Monate nach der Erkrankung schädliche Auswirkungen auf die neuropsychologischen Funktionen und damit eine Beeinträchtigung der Leistungsfähigkeit und der Lebensqualität. Zusätzlich möchten wir abklären, ob neuropsychologische Beeinträchtigungen nur bei schweren Verläufen und Intensivpflege auftreten oder auch bei moderaten oder sogar milden Erkrankungen. Schliesslich werden wir die psychotraumatischen Folgen der Präventionsmassnahmen, etwa des Lockdowns, auf diese neuropsychologischen Beeinträchtigungen untersuchen. 

Spezifischer Beitrag zur Bekämpfung der aktuellen Pandemie

Es ist extrem wichtig, diese Fragen zu klären, damit die prädiktiven klinischen, epidemiologischen und neuropsychiatrischen Variablen für eine Entstehung kognitiver Beeinträchtigungen nach COVID-19 identifiziert werden können. So können wir möglichst bald spezifische Rehabilitationsprogramme entwickeln, welche die kognitive Leistung der Betroffenen stärken und langfristige wirtschaftliche Mehrkosten der Pandemie vermeiden.

Direct link to Lay Summary Last update: 23.12.2020

Lay Summary (French)

Lead
Dans sa phase aigüe, le COVID-19 peut provoquer des dysfonctionnements cérébraux sévères, mais nous ignorons encore son impact à court et long terme sur la cognition et les émotions. L’objectif de ce projet consiste à étudier les déficits neurocognitifs post-COVID-19.
Lay summary

Contexte

Le COVID-19 est souvent associé à des troubles neurologiques et cognitifs dans la phase aigüe de l’infection. Des pathologies neuro-immunologiques ou vasculaires ont été identifiées comme causes potentielles de ces défaillances. La probabilité de conséquences neuropsychologiques à long terme est donc élevée, même pour les formes légères et modérées de COVID-19. Il importe également de considérer les problèmes neuropsychiatriques provoqués par les mesures sanitaires telles que le confinement, la crainte d’être infecté, ou les signes de syndrome de stress post-traumatique, qui ont aussi un impact majeur sur la cognition et la réserve cognitive.

Objectifs de recherche

L’objectif du projet COVID-COG est d’évaluer les conséquences neuropsychologiques du COVID-19 six et douze mois après l’infection. En outre, nous souhaitons établir s’il existe une corrélation entre ces effets potentiels à court et à long terme et la gravité de la maladie dans la phase aigüe, et/ou entre ces effets et les affections neuropsychiatriques attendues dans le sillage de cette crise majeure de santé publique, telles que l’anxiété, le stress ou le syndrome de stress post-traumatique.

Résultats et produits envisagés

Sur la base des hypothèses actuelles relatives aux dommages neurologiques qui suivent une infection grave au COVID-19, nous nous attendons à observer un effet délétère sur les fonctions neuropsychologiques qui continuera d’affecter le fonctionnement et la qualité de vie des patients 6 mois et même 12 mois après l’infection. Nous souhaitons de plus déterminer si les dysfonctionnements neuropsychologiques apparaissent uniquement chez des patients atteints de formes graves nécessitant des soins intensifs, ou s’ils surviennent aussi chez ceux souffrant de formes modérées ou légères de l’infection. Pour finir, nous explorerons l’impact, sur ces troubles neuropsychologiques, des conséquences psychotraumatologiques des mesures de prévention telles que le confinement par exemple.

Contribution à la lutte contre la pandémie actuelle

Il est extrêmement important de répondre à ces questions pour identifier les variables cliniques, épidémiologiques et neuropsychiatriques pertinentes permettant de prédire le développement d’altérations cognitives suite au COVID-19. Cela nous permettra de développer le plus tôt possible des programmes de réadaptation spécifiques, tant pour améliorer la santé cognitive des patients individuels que pour éviter tout coût économique supplémentaire à long terme de la pandémie.

Direct link to Lay Summary Last update: 23.12.2020

Lay Summary (English)

Lead
In the acute phase, COVID-19 can provoke severe brain dysfunction, but we do not yet know its impact on cognition and emotions over the short and long term. This project aims at studying post-COVID-19 neurocognitive deficits.
Lay summary

Background

COVID-19 is frequently associated with neurological and cognitive disorders in the acute phase of the infection. Neuroimmunological and vascular diseases have been identified as the potential causes of these impairments. Therefore, there is a high probability of long-term neuropsychological consequences, even for mild and moderate forms of COVID-19. It is also important to consider the neuropsychiatric problems induced by health measures such as lockdown, the fear of being infected and symptoms of post-traumatic stress disorder, which also have a major impact on cognition and cognitive reserve.

Research aims

The objective of the COVID-COG project is to assess the neuropsychological consequences of COVID-19 at 6 and 12 months after infection. Furthermore, we want to determine whether these possible short- and long-term effects correlate with the severity of the disease in the acute phase, and/or with anticipated neuropsychiatric disorders in the wake of this massive public health crisis, such as anxiety, stress and post-traumatic stress disorder.

Expected results and envisaged products

Based on current hypotheses regarding neurological damage following severe infection with COVID-19, we expect to observe a harmful impact on neuropsychological functions that continues to impair patients’ functioning and quality of life 6 months and even 12 months post-infection. In addition, we aim to ascertain whether neuropsychological dysfunction occurs solely in patients with severe forms requiring intensive care, or also in patients with moderate or even mild forms of the infection. Finally, we will explore the impact of the psycho-traumatological consequences of containment measures such as lockdown and others on these neuropsychological impairments. 

Specific contribution to tackle the current pandemic

It is extremely important to address these questions in order to identify the relevant predictive clinical, epidemiological and neuropsychiatric variables for developing cognitive impairment following COVID-19. This will enable us to develop specific rehabilitation programmes as early as possible, with a view to increasing individual patients’ cognitive health as well as avoiding any additional long-term economic costs of the pandemic.

Direct link to Lay Summary Last update: 23.12.2020

Responsible applicant and co-applicants

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Project partner

Abstract

Initially characterized as a severe acute respiratory syndrome-related coronavirus (SARS-CoV-2), new clinical observations in the acute phase of the infection suggest that COVID-19 is also frequently associated with neurological disorders. These observations are supported by recent cohort studies indicating the presence of such disorders in patients with severe COVID-19 infection, in some cases even before the usual respiratory symptoms appear. Mao et al. (2020) found that 36.4% of COVID-19 infected patients had neurological symptoms involving the central nervous system, peripheral nervous system, and skeletal muscles. Encephalopathy is the most common neurological manifestation observed during the acute phase among patients followed in intensive care, but stroke has also been observed. A direct role of the virus is suspected, but cumulative data indicate that an over-exuberant immune response to the virus, which can involve pro-inflammatory cytokines (cytokine storm syndrome), could explain both the acute respiratory disease syndrome and the encephalopathy. At the neuropsychological level, confusion, severe executive dysfunction, and major attention fluctuations are the most commonly reported features (Helms et al., 2020). Although neurological and neuropsychological hypotheses predict their presence, we do not yet know whether there are any short- or long-term neuropsychological sequelae to COVID-19. If there are, another critical question is whether these effects are only present in patients with the most severe forms followed in intensive care, or if they are also present in patients with far milder and even asymptomatic forms. Moreover, are these possible short- and long-term effects correlated with epidemiological risk factors such as age, sex, sociocultural level, body mass index, brain lesions, comorbidities, or the expected neuropsychiatric disease in the wake of this massive public health crisis? These questions are of critical importance regarding the clinical characterization of the virus in humans, and thus fully aligned with the priority areas of the RNP 78 SNSF call (Module 4). In this context, the objective of the COVID-COG project is to assess the possible short- and long-term neuropsychological consequences of COVID-19 at 3-6 months and 12 months after the infection. We will compare patients divided into three groups according to the gravity of the respiratory syndrome during the acute phase of the infection: 1) patients who were followed in intensive care; 2) patients who were hospitalized but did not require intensive care; and 3) patients who tested positive but did not require hospitalization. To this end, we will carry out a comprehensive neuropsychological assessment evaluating cognition, emotion and mood, as well as a brain MRI. Based on observations during the acute phase, we expect to observe executive and attentional disorders among patients without stroke. For patients with stroke, we expect to observe additional deficits, depending on the location of the lesion. The intensity of these deficits may be proportional to the severity of the symptoms during the acute phase, but this question remains totally open. The project will be supervised by Doctor Julie Péron and Professor Frédéric Assal. Dr Péron is Head Neuropsychologist at the Adult Neurology Department of University Hospitals of Geneva (HUG), and Director of the Clinical and Experimental Neuropsychology Laboratory at the Faculty of Psychology and Educational Sciences of Geneva University. Prof. Assal is Head Behavioural Neurologist at HUG’s Adult Neurology Department, and Associate Professor of Neurology at Geneva University’s Faculty of Medicine. The project will also involve six medical doctors involved in the acute-phase care of patients with COVID-19 and will be implemented at HUG, in order to secure a sufficient number of patients, as well as provision of the necessary skills and equipment.
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