A 5-Minute Cognitive Assessment for Safe Remote Use in Patients With COVID-19: Clinical Case Series.
A 5-Minute Cognitive Assessment for Safe Remote Use in Patients With COVID-19: Clinical Case Series.
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DOI：
10.2196/26417
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发表时间：
2021-06-14
影响因子：
2.2
通讯作者：
Hipp D
中科院分区：
文献类型：
--
作者：
Beresford T;Ronan PJ;Hipp D
新冠肺炎大流行期间的早期临床经验已经开始阐明，该病可导致脑功能变化，这些变化可能导致急性和不同恢复期的认知功能受损。有关新冠肺炎患者认知评估的报道往往仅限于定向。进一步的评估可能会给急性新冠肺炎患者带来不适当的负担，其特点是疲劳和困惑，还可能危及检查人员的安全。本研究的目的是在遵守安全预防措施的同时，以简短的形式尽可能全面地评估新冠肺炎患者的认知，并建立评估的外部效度的明确表面价值。我们调整了以前适用于肝移植候选人和内外科住院患者的简短认知评估，供远程使用于住院接受新冠肺炎治疗的患者。本报告从电话管理的评估中收集质量保证数据，提供了一系列6个新冠肺炎案例片段，以说明这个5分钟的评估在脑影响的诊断和治疗中的使用。初级医疗队将这些病例转介给神经精神病学咨询。这些患者的年龄在40年内各不相同，入院时没有一个人能够与周围环境有意义地接触。6~10d后复查，6例患者中有4例恢复了工作记忆，仅1例恢复了计算能力。6例患者中2例有复杂判断反应，无一例额叶执行功能测试在正常范围内。使用这项远程检查对新冠肺炎患者进行的认知评估显示，认知恢复的模式因病例而异，而且比定向丧失复杂得多。在本系列中，对特定的颞叶、顶叶和额叶功能的测试表明，计算能力、判断能力，特别是额叶执行功能可能是新冠肺炎对大脑影响的特征。广泛和连续使用的这种检测方法可能会让我们了解新冠肺炎对大脑的影响以及从病毒中康复的过程。
Early clinical experience during the COVID-19 pandemic has begun to elucidate that the disease can cause brain function changes that may result in compromised cognition both acutely and during variable recovery periods. Reports on cognitive assessment of patients with COVID-19 are often limited to orientation alone. Further assessment may seem to create an inappropriate burden for patients with acute COVID-19, which is characterized by fatigue and confusion, and may also compromise examiner safety. The aims of this study were to assess cognition in patients with COVID-19 as comprehensively as possible in a brief format, while observing safety precautions, and to establish a clear face value of the external validity of the assessment. We adapted a brief cognitive assessment, previously applied to liver transplant candidates and medical/surgical inpatients, for remote use in patients hospitalized for COVID-19 treatment. Collecting quality assurance data from telephone-administered assessments, this report presents a series of 6 COVID-19 case vignettes to illustrate the use of this 5-minute assessment in the diagnosis and treatment of brain effects. Primary medical teams referred the cases for neuropsychiatric consultation. The age of the patients varied over four decades, and none of them were able to engage meaningfully with their surroundings on admission. On follow-up examination 6 to 10 days later, 4 of the 6 patients had recovered working memory, and only 1 had recovered calculation ability. Of the 6 patients, 2 were capable of complex judgment responses, while none of the cases completed frontal executive function testing in the normal range. Cognitive assessment in patients with COVID-19 using this remote examination reveals patterns of cognitive recovery that vary among cases and are far more complex than loss of orientation. In this series, testing of specific temporal, parietal, and frontal lobe functions suggests that calculation ability, judgment, and especially frontal executive functions may characterize the effects of COVID-19 on the brain. Used widely and serially, this examination method can potentially inform our understanding of the effects of COVID-19 on the brain and of healing from the virus.
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