Understanding chronic Covid-19

In their timely study, Hampshire and colleagues show that chronic Covid-19 negatively effects cognitive ability, likening the decrease in ability to the age-related decline in cognition between 50 and 70 years of age.1Hampshire A. Chatfield D.A. Manktelow A. et al.Multivariate profile and acute-phase correlates of cognitive deficits in a COVID-19 hospitalised cohort.eClinicalMedicine. 2022; 47 ([cited 2022 May 10] Available from:): 1-10https://doi.org/10.1016/j.eclinm.2022.101417Summary Full Text Full Text PDF Scopus (7) Google Scholar However, additional information on participant characteristics and severity of medical treatments may help with contextualising the study results. For instance, approximately 59% of participants were female, and according to Townsend and colleagues2Townsend L. Dyer A.H. Jones K. et al.Persistent fatigue following SARS-CoV-2 infection is common and independent of severity of initial infection.PloS One. 2020; 15 ([cited 2022 May 10] Available from:)e0240784https://doi.org/10.1371/journal.pone.0240784Crossref Scopus (309) Google Scholar chronic fatigue following Covid-19 infection is more prevalent in females. Consequently, this may mean that cognitive decline may also be more prevalent in females or that cognitive decline may result from long-term fatigue following infection. Furthermore, about 35% of study participants were mechanically ventilated (MV) and this increases the risk of associated health concerns, especially in patients with comorbidities.3Udi J. Lang C.N. Zotzmann V. et al.Incidence of barotrauma in patients with COVID-19 pneumonia during prolonged invasive mechanical ventilation – a case-control study.J Intens Care Med. 2020; 36 ([cited 2022 May 10] Available from:): 477-483https://doi.org/10.1177/0885066620954364Crossref PubMed Scopus (30) Google Scholar Ibrahim and colleagues4Ibrahim G.S. Alkandari B.M. Shady I.A.A. Gupta V.K Abdelmohsen M.A. Invasive mechanical ventilation complications in COVID-19 patients.Egypt J Radiol Nucl Med. 2021; 52 (226, [cited 2022 May 10] Available from:): 1-13https://doi.org/10.1186/s43055-021-00609-8Crossref Scopus (2) Google Scholar found a prevalence of complications from invasive MV in Covid-19 patients, and that the risk of complications increased when patients had existing health concerns such as obesity, hypertension, chronic renal or cardiac disease. Additionally, MV in animal studies has shown a propensity toward inducing neuroinflammation, neuronal damage, and cognitive impairment, all of which presumably may extinguish cognitive abilities.5Giordano G. Pugliese F. Bilotta F. Neuroinflammation, neuronal damage or cognitive impairment associated with mechanical ventilation: A systematic review of evidence from animal studies.J Critic Care. 2021; 62 ([cited 2022 May 10] Available from:): 246-255https://doi.org/10.1016/j.jcrc.2020.12.017Crossref PubMed Scopus (3) Google Scholar Therefore, the cognitive decline observed by Hampshire and colleagues may have been due to participant characteristics and/or be iatrogenic and a causal association of Covid-19 with the observed decline requires more thorough investigation into these, and potentially other, confounding variables.ContributorsT.M. is the sole contributor.Funding SourcesNone to declare. In their timely study, Hampshire and colleagues show that chronic Covid-19 negatively effects cognitive ability, likening the decrease in ability to the age-related decline in cognition between 50 and 70 years of age.1Hampshire A. Chatfield D.A. Manktelow A. et al.Multivariate profile and acute-phase correlates of cognitive deficits in a COVID-19 hospitalised cohort.eClinicalMedicine. 2022; 47 ([cited 2022 May 10] Available from:): 1-10https://doi.org/10.1016/j.eclinm.2022.101417Summary Full Text Full Text PDF Scopus (7) Google Scholar However, additional information on participant characteristics and severity of medical treatments may help with contextualising the study results. For instance, approximately 59% of participants were female, and according to Townsend and colleagues2Townsend L. Dyer A.H. Jones K. et al.Persistent fatigue following SARS-CoV-2 infection is common and independent of severity of initial infection.PloS One. 2020; 15 ([cited 2022 May 10] Available from:)e0240784https://doi.org/10.1371/journal.pone.0240784Crossref Scopus (309) Google Scholar chronic fatigue following Covid-19 infection is more prevalent in females. Consequently, this may mean that cognitive decline may also be more prevalent in females or that cognitive decline may result from long-term fatigue following infection. Furthermore, about 35% of study participants were mechanically ventilated (MV) and this increases the risk of associated health concerns, especially in patients with comorbidities.3Udi J. Lang C.N. Zotzmann V. et al.Incidence of barotrauma in patients with COVID-19 pneumonia during prolonged invasive mechanical ventilation – a case-control study.J Intens Care Med. 2020; 36 ([cited 2022 May 10] Available from:): 477-483https://doi.org/10.1177/0885066620954364Crossref PubMed Scopus (30) Google Scholar Ibrahim and colleagues4Ibrahim G.S. Alkandari B.M. Shady I.A.A. Gupta V.K Abdelmohsen M.A. Invasive mechanical ventilation complications in COVID-19 patients.Egypt J Radiol Nucl Med. 2021; 52 (226, [cited 2022 May 10] Available from:): 1-13https://doi.org/10.1186/s43055-021-00609-8Crossref Scopus (2) Google Scholar found a prevalence of complications from invasive MV in Covid-19 patients, and that the risk of complications increased when patients had existing health concerns such as obesity, hypertension, chronic renal or cardiac disease. Additionally, MV in animal studies has shown a propensity toward inducing neuroinflammation, neuronal damage, and cognitive impairment, all of which presumably may extinguish cognitive abilities.5Giordano G. Pugliese F. Bilotta F. Neuroinflammation, neuronal damage or cognitive impairment associated with mechanical ventilation: A systematic review of evidence from animal studies.J Critic Care. 2021; 62 ([cited 2022 May 10] Available from:): 246-255https://doi.org/10.1016/j.jcrc.2020.12.017Crossref PubMed Scopus (3) Google Scholar Therefore, the cognitive decline observed by Hampshire and colleagues may have been due to participant characteristics and/or be iatrogenic and a causal association of Covid-19 with the observed decline requires more thorough investigation into these, and potentially other, confounding variables. ContributorsT.M. is the sole contributor. T.M. is the sole contributor. Funding SourcesNone to declare. None to declare.

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