SARS-CoV-2 と COVID-19 に関する備忘録 Vol.35

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SARS-CoV-2 と COVID-19 に関するメモ・備忘録

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◆Long COVID Symptoms Improve With Cognitive Behavioral Therapy【AJCM　2024年12月19日】

Patients with post-COVID-19 condition (PCC) experienced effective and safe improvements in physical function during a brief outpatient rehabilitation program that applied cognitive and behavioral approaches, according to a study published in JAMA Network Open.

Long COVID or PCC is the ongoing persistence of symptoms like fatigue, dyspnea, and cognitive dysfunction for 3 months or longer following an infection with SARS-CoV-2 combined with major functional impairments and no other condition that could explain the symptoms. Long COVID is a major burden for patients, caretakers, the health care system, and society.

Endothelial dysfunction, autoimmune reactions, persistent viral reservoirs or inflammation, and direct tissue damage are potential mechanisms of the pathophysiologic characteristics of long COVID. Psychosocial factors like loneliness, neuroticism, worrying tendencies, depression, anxiety, and psychological distress are linked with persistent PCC, symptoms, and disabilities.

About 8.4% of US adults have reported experiencing some form of PCC, with 3.6% currently affected and 2.3% experienced activity-limiting symptoms, according to the 2023 National Health Interview Survey. Data has found vaccinated individuals decrease their risk of both COVID-19 and PCC compared with unvaccinated individuals.

Prior research methods have found cognitive behavioral therapy designed for long COVID and postinfective fatigue syndrome could result in fatigue improvement and functional capacity. Given the limited clinical evidence on long-COVID and fatigue, study authors sought to gather additional data to inform future clinical guidelines on a global scale.

A 2-arm, pragmatic randomized clinical trial was conducted based on assessments performed at enrollment, immediately after completion of intervention, and 12 months after enrollment. The program was a structured, 2-stage process that aimed to restore physical function, consisting of 2 to 8 outpatient encounters with about 2 to 6 weeks between each encounter.

There were 314 total patients with mild to moderate PCC included in the study with 43 years as the mean age (female, n = 225). Common symptoms included fatigue, cognitive difficulties, and postexertional malaise (PEM) that also correlated among each other as well as most other symptoms.

About 310 patients began treatment, with 154 patients in the intervention group and 156 patients in the care as usual (CAU) group. Only 253 patients completed treatment, and 227 patients completed the entirety of the follow-up period, leaving 35% of individuals with incomplete data. There were 2 out of the 9 participants who actively withdrew based on treatment. Around 158 protocol deviations were identified, the most common were loss to follow-up and primary end point missing.

Data collected between February 22, 2022 until April 15, 2024, included self-reported physical function on the SF-36-PFS at the primary outcome which improved more in the intervention group compared with the CAU group. At long-term analysis, the difference between the 2 groups was practically identical, indicating a sustained effect.

Secondary outcomes results were in favor of the intervention group. Physical problems like breathlessness and sleep problems were not significant at the primary endpoint but were significant at the secondary endpoint. Individuals in the intervention group (17%) and the CAU group (20%) met the recovery threshold at baseline.

Primary endpoint criteria were also met in 50% of individuals in the intervention group and 32% of those in the CAU group.

Adverse events (AEs) and serious adverse events (SAEs) were lower in the intervention group with a total of 4 SAEs recorded. None of the SAEs were considered related to the intervention except for 1 that may have been due to diagnostic delay. There were 9 individuals who were in the intervention group that had a decreased self-report of physical function from baseline to the primary outcome compared with 25 in the CAU group. Finally, 4 participants in the intervention program had an increase in PEM from baseline to the primary outcome compared with 31 in the CAU group.

This study had several limitations, including its single-center design and the lack of blinding due to the nature of the intervention. Participants were generally non-hospitalized with moderate impairment, potentially limiting the generalizability of findings to patients with more severe affects. Additionally, the broad and self-reported nature of the long COVID diagnosis and the absence of objective functional measures may have influenced the results.

“Future research should explore which elements of this approach are the most effective and identify subgroups for whom the current treatment is most relevant,” concluded study authors.

◆Cognitive inhibition deficit in long COVID-19: An exploratory study【Frontiers in Neurology　2023年4月14日】

Background and objectives: An increasing number of research studies point toward the importance and prevalence of long-term neurocognitive symptoms following infection with COVID-19. Our objectives were to capture the prevalence of cognitive impairments from 1 to 16 months post-COVID-19 infection, assess the changes in neuropsychological functions over time, and identify factors that can predict long-term deficits in cognition.

Methodology: A cross-sectional research design was adopted to compare four sub-samples recruited over a 16-month timeframe (1–4, 5–8, 9–12, and 13–16 months). Phone interviews were conducted at least 6 weeks after being infected by COVID-19. Sociodemographic and clinical questionnaires were administered followed by standardized neurocognitive and psychological tests and health questionnaires screening cognitive symptoms, anxiety, depression, fatigue, and autonomy.

Results: Regarding general health questionnaires, 55.2% of the 134 participants had symptoms of psychiatric illness, while 21.6% of patients had moderate-to-severe anxiety or depression. Cognitive efficiency was diminished in 19.4% of our population. Executive dysfunction was screened in 56% of patients, and an impairment of cognitive flexibility and inhibition was revealed in 38.8%. Depression, hospital or intensive care unit (ICU) admission, and the duration of hospital or ICU stay were associated with an inhibition deficit. The duration elapsed from the initial infection, and the neurocognitive assessment was not associated with a decrease in inhibition deficit. The prevalence of cognitive impairments, other than inhibition deficit, tended to decrease during the study period.

Discussion: This study supports the extensive literature on the cognitive and neuropsychiatric sequelae of COVID-19 and highlights long-lasting inhibition deficits, while other cognitive functions seemed to improve over time. The severity of infection could interact as a catalyst in the complex interplay between depression and executive functions. The absence of a relation between inhibition deficits and sociodemographic or medical factors reinforces the need for cognitive screening in all COVID-19 patients. Future research should focus on inhibition deficits longitudinally to assess the progression of this impairment.

◆Long COVID and recovery from Long COVID: quality of life impairments and subjective cognitive decline at a median of 2 years after initial infection【BMC Infectious Diseases　2024年11月5日】

Abstract

Background

Recovery from SARS CoV-2 infection is expected within 3 months. Long COVID occurs after SARS-CoV-2 when symptoms are present for more than 3 months that are continuous, relapsing and remitting, or progressive. Better understanding of Long COVID illness trajectories could strengthen patient care and support.

Methods

We characterized functional impairments, quality of life (QoL), and cognition among patients who recovered from SARS-CoV-2 infection within 3 months (without Long COVID), after 3 months (Recovered Long COVID), or remained symptomatic (Long COVID). Among 7305 patients identified with previous SARS-CoV-2 infection between March 2020 and December 2021, confirmed in the medical record with laboratory test or physician diagnosis, 435 (6%) completed a single self-administered survey between March 2022 and September 2022. Multi-domain QoL and cognitive concerns were evaluated using PROMIS-29 and the Cognitive Change Index-12.

Results

Nearly half the participants (47.7%) were surveyed more than 2 years from initial infection (median = 23.3 months; IQR = 18.6, 26.7) and 86.7% were surveyed more than 1 year from infection. A significantly greater proportion of the Long COVID (n = 215) group, (Current and Recovered combined), had moderate-to-severe impairment in all health domains assessed compared to those Without Long COVID (n = 220; all p < 0.05). The Recovered Long COVID group (n = 34) had significantly lower prevalence of fatigue, pain, depression, and physical and social function impairment compared to those with Current Long COVID (n = 181; all p < 0.05). However, compared to patients Without Long COVID, the Recovered Long COVID group had greater prevalences of fatigue, pain (p ≤ 0.06) and subjective cognitive decline (61.8% vs 29.1%; p < 0.01). Multivariate relative risk (RR) regression indicated Long COVID risk was greater for older age groups (RR range 1.46–1.52; all p ≤ 0.05), those without a bachelor’s degree (RR = 1.33; 95% CI = 1.03–1.71; p = 0.03), and those with 3 or more comorbidities prior to SARS-CoV-2 infection (RR = 1.45; 95% CI = 1.11–1.90; p < 0.01). Conclusions

Long COVID is associated with long-term subjective cognitive decline and diminished quality of life. Clinically significant cognitive complaints, fatigue, and pain were present even in those who reported they had recovered from Long COVID. These findings have implications for the sustainability of participation in work, education, and social activities.

◆Cognitive impact and brain structural changes in long COVID patients: a cross-sectional MRI study two years post infection in a cohort from Argentina【BMC Neurology　2024年11月18日】

Abstract

Objective

Long COVID is a condition characterised by persistent symptoms after a SARS-CoV-2 infection, with neurological manifestations being particularly frequent. Existing research suggests that long COVID patients not only report cognitive symptoms but also exhibit measurable cognitive impairment. Neuroimaging studies have identified structural alterations in brain regions linked to cognitive functions. However, most of these studies have focused on patients within months of their initial infection. This study aims to explore the longer-term cognitive effects and brain structural changes in long COVID patients, approximately two years post-infection, in a cohort from San Martín, Buenos Aires, Argentina.

Methods

We conducted a cross-sectional study involving 137 participants: 109 with long COVID symptoms and 28 healthy controls. The participants underwent an initial clinical assessment, completed a structured questionnaire and standardised scales, underwent a cognitive assessment, and had a brain MRI scan. Structural MRI images were processed via FreeSurfer and FSL to obtain volumetric measures for subcortical and cortical regions, along with regional cortical thickness. Differences between groups for these variables were analysed using ANCOVA, with permutation tests applied to correct for multiple comparisons.

Results

Long COVID patients reported persistent cognitive symptoms such as memory problems and brain fog, with higher levels of fatigue and reduced quality of life compared to controls. Despite subjective cognitive complaints, cognitive tests did not reveal significant differences between groups, except for the TMT-A (p = 0.05). MRI analysis revealed decreased volume in the cerebellum (p = 0.03), lingual gyrus (p = 0.04), and inferior parietal regions (p = 0.03), and reduced cortical thickness in several areas, including the left and right postcentral gyri (p = 0.02, p = 0.03) and precuneus (p = 0.01, p = 0.02).

Conclusions

This study highlights the enduring impact of long COVID on quality of life and physical activity, with specific brain structural changes identified two years post-infection. Although cognitive tests did not show clear impairment, the observed brain atrophy and significant reduction in quality of life emphasize the need for comprehensive interventions and further longitudinal studies to understand the long-term effects of long COVID on cognition and brain health.

◆Did the Pandemic Break Our Brains?【TIME　2024年9月16日】

Not long ago, Mark Chiverton, a 33-year-old in the U.K., noticed he was making a lot of silly mistakes. He’d mix up words when writing emails, or blank on a basic term while talking to his wife. None of these slip-ups were all that concerning on their own—but they were happening frequently enough that Chiverton worried he was, to put it bluntly, “getting dumber.”

“At first I thought, ‘Maybe it’s just general aging, or maybe I bashed my head and didn’t realize it,’” he says. But eventually, a thought occurred to him: could COVID-19 be the reason for his mental slips? Chiverton thinks he caught the virus in early 2020, before tests were widely available, and he knows for sure he had it in 2022. Though he has no lingering physical effects from those infections (and has periods of time when his brain cramps get better), he sometimes wonders whether those mental slips are mild signs of Long COVID, the name for chronic symptoms following an infection.

He’s not alone in experiencing these problems—and he may not be wrong that COVID-19 is to blame. In the U.S. alone, about a million more working-age adults reported having serious difficulty remembering, concentrating, or making decisions in 2023 compared to before the pandemic, according to a New York Times analysis of Census Bureau data.

Every mental mistake isn’t cause for concern, says Andrew Petkus, an associate professor of clinical neurology at the University of Southern California’s Keck School of Medicine. Blunders like forgetting why you walked into a room or spacing out on an appointment can be totally normal parts of being busy, distracted, often under-rested humans. Even though you likely did those things before and brushed them off as nothing, they may seem more significant in the wake of a life-altering event like the pandemic. “If we didn’t have COVID, you might have still forgotten,” Petkus says.

Still, it’s not outlandish to think the pandemic has had an effect on our minds, says Jonas Vibell, a cognitive and behavioral neuroscientist at the University of Hawaii at Manoa. Vibell is currently trying to measure post-COVID inflammation and neuronal damage in the brains of people who report symptoms like brain fog, sluggishness, or reduced energy. When he began publicizing the study, he says, “I got so many emails from lots of people saying the same thing”: that they’d never fully bounced back after the pandemic.

But why? It’s probably a mix of things, Vibell says. The SARS-CoV-2 virus can affect the brain directly, as many studies have now shown. But the pandemic may have also affected cognition in less-obvious ways. Months or years spent at home, living most of life through screens, may have left a lingering mark. Even though society is now mostly back to normal, the trauma of living through a terrifying, unprecedented health crisis can be hard to shake.

Your brain on SARS-CoV-2

It’s clear by now that SARS-CoV-2 is not just a respiratory virus, but also one that can affect organs throughout the body—including the brain. Researchers are still learning about why that is, but leading hypotheses suggest that SARS-CoV-2 may cause persistent inflammation in the brain, damage to blood vessels in the brain, immune dysfunction so extreme it affects the brain, or perhaps a combination of all the above. Studies have even found that people’s brains can shrink after having COVID-19, a change potentially associated with cognitive issues.

COVID-19 has been linked to serious cognitive problems, including dementia and suicidal thinking. And brain fog, a common symptom of Long COVID, can be so profound that people are unable to live the lives and work the jobs they once did. But COVID-19 also seems able to affect the brain in subtler ways. A 2024 study in the New England Journal of Medicine compared the cognitive performance of people who’d fully recovered from COVID-19 with that of a similar group of people who’d never had the virus. The COVID-19 group did worse, equivalent to a deficit of about three IQ points.

That’s not a dramatic difference. Our cognitive abilities naturally fluctuate a little from day to day—and in a July interview with TIME, study co-author Adam Hampshire, a professor of cognitive and computational neuroscience at King’s College London, said a three-point IQ difference is “well within” the range of that normal fluctuation, so small that some people might not even notice it.

But could such a drop be enough to lead to, say, extra typos and absentmindedness? Maybe. In Hampshire’s study, people who’d had COVID-19 consistently performed worse on cognitive tests than people who hadn’t.

If the brain suffers “mild but ubiquitous” changes after an infection, Vibell says, those effects could feasibly “impact the brain, behavior, and social behavior in so many subtle, but maybe [cumulatively] quite bad, ways.”

Beyond the virus

Even for the lucky few who have never been infected, living through a pandemic can impact the brain.

For a recent study in PNAS, researchers conducted pairs of MRI brain scans on a small group of U.S. adolescents: one in 2018 and one in either 2021 or 2022. Over those years, they observed a notable thinning in parts of the kids’ (and especially girls’) brains, including those that control social cognition tasks like processing facial expressions and emotions. Although the researchers did not analyze the effects of SARS-CoV-2 infections, they concluded that the stress of living through pandemic lockdowns was likely to blame for the change, which they likened to an extra four years of brain aging for girls and an extra year for boys.

Stress and trauma have well-documented effects on the brain. Plenty of studies show that people who experience trauma tend to be at greater risk for cognitive decline as they age. Stress can also impair someone’s ability to think clearly, reason, and remember, studies suggest.

“COVID was a generational traumatic event,” says USC’s Petkus. “Everybody was exposed to it.” It’s feasible, then, that the population at large is suffering some of these side effects from trauma and stress.

Even beyond the mental toll of living through a scary and unsettling time, many people had to abandon habits that are good for the brain—things like socializing, staying physically and cognitively active, and seeking out novel experiences—when they were stuck at home early on, Petkus says. It’s too soon to say whether that dramatic but short-lived period will have long-lasting effects—but four years after the virus emerged, some things are still not as they were.

For example, student test scores are recovering but have still not bounced back to pre-pandemic levels; declines have been particularly dramatic in low-income school districts as well as those that had remote learning in place for a long time, says Sean Reardon, a professor at Stanford University’s Graduate School of Education and one of the leaders of the Education Recovery Scorecard, a research project focused on pandemic learning loss. The long recovery process probably speaks to a combination of things, Reardon says: not only did kids miss in-person school for a while, they also experienced seismic disruptions in their lives, endured a period of significant stress and anxiety, and are now being asked to learn new material in school while also making up for pandemic-related learning gaps.

“Falling behind on your math skills or your reading skills is not really about a change in your intelligence,” Reardon says. “It’s a change in your skills, how much you’ve had the opportunity to learn.”

It’s hard to say whether the same trends appear among adults, because grownups aren’t taking standardized tests every year at work. Adults were certainly exposed to the same mix of stress, trauma, boredom, and isolation as kids—but Reardon says his hunch is that adults may have an easier time rebounding, since they’ve already developed the skills they lean on to perform complex tasks.

Returning to normal

“There might have been a shock for a couple years, but things are getting back to normal,” Petkus agrees.

Those who feel like their minds melted a little during the pandemic can likely benefit from adopting or resuming the kinds of brain-boosting habits that fell by the wayside during Netflix-fueled lockdowns, like social interaction and mental and physical exercise, Petkus says. Even the effects of stress and trauma can often be counterbalanced with social support and healthy coping strategies, he says. People who recover well from hard events sometimes even experience what’s known as post-traumatic growth, a blossoming of their mental and emotional health after a difficult period.

It’s harder to say whether brain changes that result directly from SARS-CoV-2 infections are reversible, as researchers are still studying that question. But there are some positive signs. Some of the potential causes of chronic brain fog—like persistent inflammation or damage to blood vessels—are theoretically reversible with the right treatments.

Even in Hampshire’s study on post-COVID IQ differences, there was cause for optimism. Hampshire’s team found that people with Long COVID symptoms were, on average, about six IQ points beneath people who’d never had COVID-19. But those whose Long COVID symptoms resolved over time also saw their cognitive scores improve.

That finding is “quite positive,” he said. “There could be some hope for people who are struggling.”

◆COVID-19 Can Leave a Lasting Mark on the Brain—Especially for Older People【TIME　2024年7月19日】

COVID-19 no longer poses the urgent public-health threat it once did. But recent research points to a good reason to keep the virus in mind: it could leave a lasting stamp on yours.

Studies suggest that COVID-19 is associated with possibly long-lasting changes to the brain, potentially contributing to cognitive problems like brain fog, mental fatigue, and memory loss, as well as neurological and mental-health issues. The virus seems able to damage blood vessels and support cells in the brain and may kickstart changes to the immune system that also affect brain function, says Dr. Wes Ely, co-director of the Center for Critical Illness, Brain Dysfunction, and Survivorship at Vanderbilt University Medical Center.

What does that mean for the average person as the virus once again circulates widely?

Many people of all ages recover just fine, mentally and physically, after a COVID-19 case. But lingering cognitive effects are a real risk, particularly for older people, Ely says. Older adults are more likely to experience severe COVID-19, which has long been linked to a higher risk of long-term complications. And they may have had preexisting cognitive issues that become worse after infection.

“They don’t have as far to fall before they experience a clinical awareness that they’re having problems,” Ely says. Research has shown that a COVID-19 case can accelerate mental decline in older adults with dementia.

The virus may also raise the chances of developing dementia for the first time, suggests a research review of 11 previous studies that was posted online in February before being peer-reviewed. Adults older than 60 who survived COVID-19 had a significantly higher risk of developing dementia a year later, compared to similar-aged people who hadn’t had a respiratory infection. Cognitive impairment was almost twice as likely among people who’d had COVID-19 compared to an uninfected control group.

Dan Shan, co-author of the study and a former junior researcher at Columbia University, wrote in an email that more research is required to confirm whether the virus is directly causing dementia, but his team is “pretty confident” there’s a connection.

This link may not be unique to the virus that causes COVID-19. “Numerous studies have shown that respiratory infections like the flu can lead to greater risks of cognitive deficits or dementia,” Shan wrote. “However, these findings haven’t captured public attention as much as COVID-19.”

Age may be an important risk factor for cognitive issues, but younger people shouldn’t feel immune from COVID-19’s effects, either. Ely says there are “people in their 30s and 40s [who] have neurocognitive deficits that look like mild dementia.”

A large study published in the New England Journal of Medicine in February backs up that warning. It suggests that COVID-19 can hinder cognitive performance among adults of all ages, even those who ostensibly recover fully.

In that study, more than 100,000 adults in the U.K. took tests meant to measure cognitive skills. When the researchers compared people who’d had COVID-19 with demographically similar people who’d never had a confirmed case, they found that the COVID-19 survivors, on average, performed worse “across the board, but particularly on measures of memory function, executive function—for example your ability to decision-make and plan—and reasoning,” says study co-author Adam Hampshire, a professor of cognitive and computational neuroscience at King’s College London.

The study didn’t measure differences in individual participants’ performance pre- and post-COVID, and the results don’t necessarily mean that every single person who catches COVID-19 will experience cognitive decline, Hampshire says. But, when looking at the study group as a whole, there were clear differences between those who’d had COVID-19 and those who hadn’t. The results equated to about a three-IQ-point deficit among people who recovered completely from COVID-19 versus those who’d never had it. Among people with unresolved Long COVID symptoms and those who’d been admitted to the ICU, the deficits jumped to six and nine IQ points, respectively.

But there are some reasons for optimism. In the study, cognitive differences were not as pronounced among people who’d gotten vaccinated multiple times, nor those who got COVID-19 later in the pandemic—which suggests risks may be lower now than they were in 2020.

The researchers also didn’t find a dramatic difference between people who’d been infected once versus multiple times. (Other studies, however, have found that repeat infections carry compounding risks of brain complications, as well as other serious health problems.) And people who had Long COVID symptoms but eventually got better “performed at the same [cognitive] level as people who had shorter-duration symptoms,” which suggests some effects of Long COVID may be reversible, Hampshire says.

The data on COVID-19 and cognition are worrying, but more research is required to fully assess the virus’ long-term effects. “These relationships need to be observed over a longer period, potentially 5-10 years, to fully understand the impact of COVID-19 on the development of new-onset dementia, a condition that progresses slowly,” Shan wrote.

Research on if and how COVID-related brain damage can be reversed is ongoing and provides reason for hope, Ely says. But for now, the cognitive risks of COVID-19 are yet another reason to stay up-to-date on vaccines and avoid infection if at all possible.

◆Brain and cognitive changes in patients with long COVID compared with infection-recovered control subjects【OXFORD ACADEMIC BRAIN　2024年4月2日】

Abstract

Between 2.5% and 28% of people infected with SARS-CoV-2 suffer long COVID or persistence of symptoms for months after acute illness. Many symptoms are neurological, but the brain changes underlying the neuropsychological impairments remain unclear. This study aimed to provide a detailed description of the cognitive profile, the pattern of brain alterations in long COVID and the potential association between them.

To address these objectives, 83 patients with persistent neurological symptoms after COVID-19 were recruited, and 22 now healthy control subjects chosen because they had suffered COVID-19 but did not experience persistent neurological symptoms. Patients and controls were matched for age, sex and educational level. All participants were assessed by clinical interview, comprehensive standardized neuropsychological tests and structural MRI.

The mean global cognitive function of patients with long COVID assessed by Addenbrooke’s Cognitive Examination-III screening test [overall cognitive level (OCLz) = −0.39 ± 0.12] was significantly below the infection recovered-controls (OCLz = +0.32 ± 0.16, P < 0.01). We observed that 48% of patients with long COVID had episodic memory deficit, with 27% also with impaired overall cognitive function, especially attention, working memory, processing speed and verbal fluency. The MRI examination included grey matter morphometry and whole brain structural connectivity analysis. Compared to infection recovered controls, patients had thinner cortex in a specific cluster centred on the left posterior superior temporal gyrus. In addition, lower fractional anisotropy and higher radial diffusivity were observed in widespread areas of the patients’ cerebral white matter relative to these controls. Correlations between cognitive status and brain abnormalities revealed a relationship between altered connectivity of white matter regions and impairments of episodic memory, overall cognitive function, attention and verbal fluency. This study shows that patients with neurological long COVID suffer brain changes, especially in several white matter areas, and these are associated with impairments of specific cognitive functions.

◆Predicting dementia from spontaneous speech using large language models【PLOS Digital Health　2022年12月22日】

Abstract

Language impairment is an important biomarker of neurodegenerative disorders such as Alzheimer’s disease (AD). Artificial intelligence (AI), particularly natural language processing (NLP), has recently been increasingly used for early prediction of AD through speech. Yet, relatively few studies exist on using large language models, especially GPT-3, to aid in the early diagnosis of dementia. In this work, we show for the first time that GPT-3 can be utilized to predict dementia from spontaneous speech. Specifically, we leverage the vast semantic knowledge encoded in the GPT-3 model to generate text embedding, a vector representation of the transcribed text from speech, that captures the semantic meaning of the input. We demonstrate that the text embedding can be reliably used to (1) distinguish individuals with AD from healthy controls, and (2) infer the subject’s cognitive testing score, both solely based on speech data. We further show that text embedding considerably outperforms the conventional acoustic feature-based approach and even performs competitively with prevailing fine-tuned models. Together, our results suggest that GPT-3 based text embedding is a viable approach for AD assessment directly from speech and has the potential to improve early diagnosis of dementia.

◆Brain and cognitive changes in patients with long COVID compared with infection-recovered control subjects【OXFORD ACADEMIC CLINICAL NEUROPSYCHOLOGY　2024年6月8日】

Abstract

Objective

Although Coronavirus disease 2019 (COVID-19) is primarily a respiratory infectious disease, it has also been associated with a wide range of other clinical manifestations. It is widely accepted in the scientific community that many patients after recovery continue to experience COVID-19-related symptoms, including cognitive impairment. The aim of this systematic review was to investigate the cognitive profile of patients with long-COVID syndrome.

Methods

A systematic search of empirical studies was conducted through the PubMed/Medline and Scopus electronic databases. Cross-sectional and longitudinal studies published between 2020 and 2023 were included.

Results

Of the 516 studies assessed for eligibility, 36 studies met the inclusion criteria. All included studies support the presence of persistent cognitive changes after COVID-19 disease. Executive function, memory, attention, and processing speed appear to be the cognitive domains that are predominantly associated with long-COVID syndrome, whereas language is an area that has not been sufficiently investigated.

Conclusions

In this review, the high frequency of cognitive impairment after COVID-19 is evident. If we consider that cognitive functioning affects our ability to live independently and is a key determinant of our quality of life, it is imperative to precisely define those factors that may induce cognitive impairment in COVID-19 survivors, with the ultimate goal of early diagnosis of cognitive changes and, consequently, the development of targeted rehabilitation interventions to address them.