Management of Cognitive Deficits Associated with COVID-19
A comprehensive approach for managing cognitive deficits in COVID-19 should include early assessment, cognitive rehabilitation, psychological support, and lifestyle modifications tailored to the severity of symptoms.
Assessment of Cognitive Impairment
Early screening and assessment of cognitive function is crucial for patients with post-COVID cognitive symptoms 1
Recommended assessment tools include:
Studies show cognitive impairments in long COVID can be as debilitating as intoxication at the UK drink driving limit or equivalent to 10 years of cognitive aging 3
Cognitive deficits may worsen over time, with occurrence in 16% of patients at 2 months and increasing to 26% at 12 months post-infection 3
Rehabilitation Strategies
Cognitive Rehabilitation
- Implement patient-led integrated cognitive behavioral therapy (CBT) which has shown effectiveness in managing cognitive symptoms of long COVID 4
- Key components of cognitive rehabilitation:
- Symptom monitoring
- Graded pacing of activities
- Behavioral experiments to gradually increase cognitive load 4
Psychological Support
- Establish prompt identification and assessment of adverse mental states, which affect more than 60% of COVID-19 patients 3
- For mild adverse mental states: implement psychological self-adjustment techniques including:
- Breath relaxation training
- Mindfulness training 3
- For moderate to severe mental states: combine medication with psychotherapy 3
- Provide psychological first aid, stress management, and brief cognitive behavioral interventions 3
Physical Rehabilitation
- Implement pulmonary rehabilitation training as soon as possible when oxygenation and hemodynamics are stable 3
- Traditional Chinese exercises that have shown benefit:
- Baduanjin
- Tai Chi
- 6-character breathing exercise 3
- These exercises have demonstrated improvement in quality of life for COVID-19 recovery patients 3
Metabolic Support
Medium-chain triglyceride (MCT) supplementation is recommended as primary treatment for altered glucose metabolism in the brain 1
- MCTs provide an alternative energy source that can bypass impaired cerebral glucose metabolism
- This may improve cognitive function in long COVID patients 1
For diabetic patients with long COVID, avoid overbasalization with insulin as this may worsen cerebral glucose metabolism 1
Follow-up Care
- Continue mental health and psychosocial support after hospital discharge 3
- Monitor for improvement in cognitive symptoms, as partial recovery often occurs over time 5
- Screen for post-traumatic stress disorder, which affects approximately 43% of patients at one-month follow-up 5
Special Considerations
- Cognitive impairment in long COVID manifests independently of mental health conditions like anxiety and depression 3
- Some patients with cognitive impairment may not recognize or report their symptoms, making objective testing important 3
- Age is a significant factor in cognitive outcomes, with older patients typically experiencing more severe deficits 5
Pitfalls to Avoid
- Don't assume cognitive symptoms will resolve without intervention - evidence shows they can persist for at least 2 years 1
- Don't overlook the need for multidisciplinary care - coordination between primary care, neurology, psychiatry, and rehabilitation specialists is essential 4
- Don't focus solely on respiratory symptoms - cognitive deficits occur at similar rates in both hospitalized and non-hospitalized patients 3
By implementing this comprehensive management approach, healthcare providers can effectively address the cognitive deficits associated with COVID-19 and improve patients' quality of life and functional outcomes.