The Cognitive Complications of COVID-19

At this time, the long-term complications of COVID-19 remain unknown although there is evidence of changes aside from acute symptoms referred to as “long COVID.” Several case studies have reported neurological problems in severely affected COVID-19 patients – such complications may arise from associated stroke, inflammatory syndrome, immune responses, and other health factors.

Currently, there is little clinical information concerning the nature and prevalence of cognitive consequences post-COVID infection, the full spectrum of their severity, or the connection between hospitalization status. Emerging evidence points to potential cognitive deficits associated with the virus, revealing significant brain function impacts in the worst cases of infection, according to a recent non-peer-reviewed study.

Cognitive Performance in COVID-19 Survivors

Led by Imperial College London doctor, Adam Hampshire, the study encompassed a cohort of over 84,000 participants who performed cognitive tests aimed at assessing brain performance, including word recall and puzzles. Data for analysis was gathered from the Great British Intelligence Test. The research team controlled results for age, gender, education level, income, racial-ethnic group, and pre-existing medical conditions.

The study revealed that participants who recovered from suspected or confirmed COVID-19 performed worse on cognitive tests in multiple domains than expected given their age and demographic profiles. Observed cognitive defects were of “substantial effect size,” especially among individuals who had been hospitalized with COVID-19. Furthermore, deficits scaled with symptom severity with the worst cases of illness showing a cognitive impact equivalent to a 10-year decline in global performance in patients aged between 20 and 70 years.

“Our analyses … align with the view that there are chronic cognitive consequences of having COVID-19,” the researchers wrote in a report of their findings. “People who had recovered, including those no longer reporting symptoms, exhibited significant cognitive deficits.”

Study Limitations

Hampshire and his team’s results are worrisome, however, their findings are yet to be reviewed by other researchers. Experts warn that the latest results should be interpreted with caution as the cognitive health of participants pre-COVID infection was not known or accounted for in the study. In addition, the study’s findings do not reflect long-term recovery, indicating that the cognitive effects may only be present for the short term. Study’s findings can not be entirely reliable as they do not compare before and after scores, involved a large number of people who self-reported having COVID-19 with no positive test measure

Nonetheless, the latest study alongside other emerging research on the potential cognitive repercussions of COVID-19 illness add to a growing list of concerns. While current literature signals potential for cognitive complications, it warrants further investigation and understanding of the duration of such cognitive deficits. Forthcoming studies should aim to identify the extent to which cognition is affected after infection and whether permanent neurological damage to brain function is possible.

November Partner of the Month: Karger

Get to know an Editor-in-Chief: Brant E. lsakson (Journal of Vascular Research)

1. Can you tell us a little about yourself?

I was raised in the middle part of the United States, which is predominantly flat farmland. Even though I live on the East Coast of the US now, I am still nostalgic for that part of the US. I enjoy reading history, playing with my kids, coffee, and working outside.

2. You are a professor of molecular physiology and biological physics and part of an ambitious interdisciplinary research effort to understand how cells communicate. How did you become interested in your field?

I first became interested in cell-cell communication while an undergraduate student. I took an independent study class on endocrinology and thought it was fantastic! Because of this class, I applied to graduate school and worked on calcium signaling and gap junctions between cell types with Dr. Scott Boitano for my PhD, and further focused on heterocellular communication between the endothelium and smooth muscle during my post-doc with Dr. Brian Duling. Both professors were quite instrumental in fostering my passion for the topic. I have been hooked ever since, and cellular communication remains the essential theme of my lab.

3. Which other exciting developments are currently taking place in the field?

From a very biased perspective based on my science, I see purinergic signaling having a resurgence of interest and activity with a lot of high-impact work coming out in the pannexin and CALHM channel fields. Although the receptors for purinergic signaling have been known for some time, how the purinergic signal escapes the cell has been unknown. The discovery of non-red blood cell hemoglobin and its potential physiological roles has also been quite interesting.

4. What advice would you give to someone just starting their career?

Create your own niche and do something different, i.e., focus on being creative. I am an advocate of not following the canonical pathway, in life or science! Science can get weighed down by dogmatic assumptions. It’s your job to break free from those assumptions and make the novel discoveries.

5. What do you feel makes the Journal of Vascular Research special in the publishing landscape and are there papers you would like to see submitted to JVR?

JVR is one of the oldest journals dedicated to vascular research. The journal is run by active researchers who understand how important quality and reproducible science is to the scientific community to move forward. In terms of papers I would like to see in JVR, my preference would be for manuscripts with novel ideas that push the boundaries of our current vascular biology using new technology or testing new concepts. New methods, especially genetic models, would also be of great interest to JVR.

Brant E. Isakson, PhD
Professor of Molecular Physiology and Biophysics, Resident Faculty of the Robert M. Berne Cardiovascular Research Center, UVA School of Medicine Pinn Scholar, University of Virginia School of Medicine

Humanizing Virtual Care for Patient Satisfaction

Although only 8% of American patients had previously attended a telehealth visit before the pandemic, up to 83% expect to continue telehealth visits even after the pandemic subsides. In 2019, only 28% of physicians reported using telehealth technologies. Now, virtual consultations and online visits are beginning to replace the traditional model of in-office appointments.

Growing Demand, Declining Patient Satisfaction

While some healthcare professionals have expressed concern about the impact of telehealth on patient-provider relationships, arguing that digital care will be hinderance to personal connections, the past few months have revealed that virtual visits can effectively support and even deepen relations with patients. However, the effective delivery of online care requires strategic efforts that go beyond traditional patient-provider interactions.

Although patient demand and desire for digital visits continues to rise, overall patient satisfaction with such services is reportedly decreasing. “As patients become more engaged, informed, and involved with their health care decisions, and demand better access to care, virtual health solutions will play an important role in meeting expectations,” a recent report by Deloitte highlights. Virtual healthcare needs to continue efforts aimed at humanizing online care by extending the patient-centered care delivery model.

Humanizing Virtual Care

There are several ways to connect with patients virtually, all of which work to strengthen the patient-provider relationship. Some, such as automated messaging services, can even help lessen clinician workload by handling mundane administrative tasks while continuing to foster the patient-provider connection. Primarily, healthcare professionals need to prioritize using technological solutions to their advantage and as communication tools to develop a consistent relationship with patients.

Life-Centric Care:

The ubiquity of technology in our lives, ranging from smartphones to smart watches, allows for continuous tracking, monitoring, and communication. Focusing on embedding virtual healthcare into a patient’s digital life, providers can leverage the technology and tools they use on a daily basis to foster patient engagement. This can include utilizing data and content sharing applications to create personalized, high-quality interactions, sending reminders, and other communications that emphasize a life-centric care model.

Two-Way Texting:

As a decreasing proportion of the population now accepts incoming phone calls and many do not even check their voicemail, text messaging has become the preferred method of communication; up to 47% of patients express wanting to be able to text back and forth with their healthcare provider. With quick, efficient communications, two-way texting is an important step toward humanizing the virtual relationship.

Educational Communications:

Regularly sharing educational content, such as newsletters, blogs, and emails, can reinforce the feeling that providers care about their patients’ health. During the pandemic in particular, it is important to consistently communicate with patients by sending targeted educational information – to at-risk individuals especially – that provide individualized recommendations for staying healthy.

Automated Post-Visit Calls or Emails:

The majority of patients fail to remember all of the details of recommendations and treatment instructions provided during visits. Here, the use of automated messaging – including phone calls, voicemails, texts, and emails – can help remind patients of post-appointment care instructions. Such reminders will also improve treatment adherence while reinforcing the message that providers care about patients and their health.

Appointment and Billing Reminders:

Another facet of care can easily be automated using messaging systems; sending patients automated reminders of upcoming appointments and overdue bills can be used to increase touch points, triggering name recognition as well as remembrance. Patients will likely recognize and appreciate these efforts to simplify their lives, benefiting the overall relationship they have with their medical practice as convenience is increasingly valued.

The modern medical practice can leverage this ongoing shift toward digital care, taking advantage of the many virtual opportunities for connection and communication with their patients. While in-person interactions may be limited at this time, patient-provider relationships need not  fall to the wayside. With a healthcare industry primed for expanding adoption of telehealth, virtual health will increasingly become a part of consumers’ daily routines. If clinicians commit to telemedicine at a personal and organizational level, they can take advantage of the growing opportunities to deliver connected, coordinated, and comprehensive care.