Long-Term Effects of COVID-19 on Cognitive Function and Mental Health

COVID-19 对认知功能和心理健康的长期影响

• 批准号: 10703171
• 负责人: DIANE SWICK
• 金额: --
• 依托单位: VA NORTHERN CALIFORNIA HEALTH CARE SYS
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-07-01 至 2026-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10703171
• 关键词: 2019-nCoV; Address; Affect; Anxiety; Anxiety Disorders; COVID diagnosis; COVID-19; COVID-19 diagnosis; COVID-19 impact; COVID-19 pandemic; COVID-19 patient; COVID-19 survivors; COVID-19 test; Cardiovascular system; Caring; Cognitive; Commerce; Communities; Development; Diabetes Mellitus; Diagnosis; Disease; Education; Employment; Episodic memory; Fatigue; Follow-Up Studies; Future; Health; Healthcare Systems; Heart Diseases; Hypertension; Impaired cognition; Impairment; Individual; Infection; Intervention; Investigation; Literature; Long COVID; Measures; Mental Depression; Mental Health; Metabolic Diseases; Minority; Modeling; Monitor; Observational Study; Occupational; Online Systems; Outcome; Outcome Measure; Participant; Patient Self-Report; Patients; Performance; Persons; Phase; Population; Post-Acute Sequelae of SARS-CoV-2 Infection; Post-Traumatic Stress Disorders; Printing; Process; Psyche structure; Quality of life; Recording of previous events; Reporting; Resistance; Risk; SARS-CoV-2 B.1.1.529; SARS-CoV-2 positive; Services; Short-Term Memory; Sleep; Sleeplessness; Societies; Surveys; Survivors; Symptoms; System; Testing; Time; Trauma; Vaccines; Variant; Veterans; Virus; Work; associated symptom; brain fog; breakthrough infection; cognitive function; cognitive performance; cognitive testing; comorbidity; comparison control; comparison group; coronavirus disease; daily functioning; design; epidemiology study; executive function; follow-up; improved; long term consequences of COVID-19; military veteran; neurocognitive disorder; pandemic disease; persistent symptom; physical symptom; post-COVID conditions; post-COVID-19; prospective; respiratory; selective attention; social; social relationships; sustained attention; trend; unvaccinated; web platform

The ongoing pandemic of COVID-19 continues to have a detrimental impact on society, even after the rapid development of safe and effective vaccines. The worst phases of the pandemic caused systemic and cultural shifts in education, work, commerce, social ties, and even the process of grieving. The SARS-CoV-2 virus has taken 6.5 million lives worldwide, over 1 million lives in the US, and nearly 23,000 Veterans receiving care in the VA system. The highly infectious Omicron variant has caused the largest surge of cases yet, with a peak in mid-January 2022. This variant causes milder symptoms but is more resistant to current vaccines. While the most severely affected COVID patients are rightfully the focus of many investigations, patients with milder disease may show lasting changes as well. An important study by Al-Aly, Xie, and Bowe (2021) identified all non-hospitalized Veterans who had at least one SARS-CoV-2 positive test and who survived 30 days after diagnosis. Six months later, those who had COVID had an excess burden of respiratory conditions, metabolic disorders, cardiovascular conditions, insomnia, fatigue, anxiety disorders, trauma-related disorders, and neurocognitive disorders. Follow-up studies found that many of these conditions can persist for at least one year (Xie et al., 2022a,b). In addition, the risk of adverse health outcomes increases in Veterans with multiple infections (Al-Aly et al., preprint). Although epidemiological studies have been helpful in identifying population-level trends, a key missing perspective can be provided by Veterans’ ratings of their own mental and physical symptoms. This is critical because future interventions require a deeper understanding of the challenges faced by Veterans with post-COVID conditions. The unique needs of Veterans include higher rates of the comorbidities commonly associated with a greater risk of negative COVID outcomes (diabetes, hypertension, and cardiovascular conditions). Ongoing cognitive issues after a COVID infection can also have a negative impact on employment and daily functioning. Cognitive dysfunction was the third most commonly reported symptom in a survey of the Long Covid community (Davis et al., 2021), yet "brain fog" remains scantly investigated, especially in Veterans. The proposed observational study will have a two group, prospective, repeated measure (3 time points) design with a study group and a closely matched healthy comparator group. The study group will be Veterans (n=300) who had a positive test for SARS-CoV-2 within the last 3-24 months but were not hospitalized. This population comprises the majority of VA patients with positive tests for SARS-CoV-2 (approximately 85-90%). Their results will be compared to healthy Veteran controls matched on demographic variables, pre-existing psychiatric conditions, and major comorbidities (n=300). Follow-up tests will be conducted six months and 12 months later. The project will obtain objective measures of cognitive performance over time and explore their relationship to mental health (anxiety, depression, PTSD) and other persistent post-acute sequelae of SARS-CoV-2 (PASC) symptoms (insomnia, fatigue) in COVID-19 survivors. Covariates will adjust for baseline scores, number of vaccines, and time since diagnosis. We will also examine the impact of multiple infections on mental health and cognitive outcomes. A validated web-based testing platform will obtain objective and reliable measures of sustained attention, executive function, episodic memory, and working memory. A better understanding of specific weaknesses in cognitive function over time is necessary to identify future intervention targets in the Veteran population with persistent post- COVID conditions. Our study will also establish the importance of monitoring the mental health of Veterans who have recovered from COVID-19. Those with persistent symptoms can be referred to appropriate services to improve their quality of life.

持续的COVID-19大流行继续对社会产生不利影响，即使在 快速开发安全有效的疫苗。大流行病最严重的阶段造成了系统性 以及教育、工作、商业、社会关系甚至是悲伤过程中的文化转变。的 SARS-CoV-2病毒在全球范围内夺走了650万人的生命，美国超过100万人， 退伍军人在VA系统中接受护理。传染性极强的奥密克隆变种已经造成了 病例激增，高峰在2022年1月中旬。这种变异引起的症状较轻，但更多 对目前的疫苗有抵抗力。虽然受影响最严重的COVID患者理所当然地成为焦点， 在许多调查中，病情较轻的患者也可能表现出持久的变化。一个重要 Al-Aly，Xie和Bowe（2021）的研究确定了所有非住院退伍军人，他们至少有一个 SARS-CoV-2检测阳性，并在诊断后存活30天。六个月后，那些 COVID给呼吸系统疾病、代谢紊乱、心血管疾病， 失眠、疲劳、焦虑症、创伤相关疾病和神经认知障碍。后续行动 研究发现这些病症中的许多可持续至少一年（Xie等人，2022 a，B）。在 此外，在患有多种感染的退伍军人中，不良健康结果的风险增加（Al-Aly等人， 预印本）。虽然流行病学研究有助于确定人口一级的趋势， 退伍军人对自己精神和身体症状的评价可以提供缺失的观点。 这一点至关重要，因为未来的干预措施需要更深入地了解 退伍军人与后COVID条件.退伍军人的独特需求包括更高的 通常与阴性COVID结果风险更大相关的合并症（糖尿病， 高血压和心血管疾病）。COVID感染后持续的认知问题也可能 对就业和日常运作产生负面影响。认知功能障碍是第三大 在一项对长期新冠肺炎社区的调查中，2021），但“大脑 雾”仍然很少调查，特别是在退伍军人。拟议的观察性研究将包括 两组、前瞻性、重复测量（3个时间点）设计，包括一个研究组和一个密切相关的 匹配的健康对照组。研究组将是退伍军人（n=300），他们的 在过去3-24个月内感染SARS-CoV-2，但未住院。这一人口构成了 大多数VA患者SARS-CoV-2检测呈阳性（约85-90%）。他们的结果将 与人口统计学变量匹配的健康退伍军人对照组相比， 条件和主要合并症（n=300）。后续测试将在6个月和12个月内进行 月后该项目将获得随着时间的推移认知表现的客观衡量标准， 探讨他们与心理健康（焦虑，抑郁，创伤后应激障碍）和其他持续性急性 COVID-19幸存者的SARS-CoV-2（PASC）症状后遗症（失眠、疲劳）。协变量将 根据基线评分、疫苗接种次数和诊断后的时间进行调整。我们亦会研究 多重感染对心理健康和认知结果的影响。经过验证的基于Web的测试 平台将获得客观和可靠的措施，持续的注意力，执行功能，情节 记忆和工作记忆。更好地了解认知功能的具体弱点， 需要时间来确定退伍军人人群中持续性后- 新冠疫情。我们的研究还将确立监测儿童心理健康的重要性。 从COVID-19中康复的退伍军人。症状持续者可转诊 提供适当的服务，以提高他们的生活质量。