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.

即使在疫情爆发之后，COVID-19 的持续流行仍继续对社会产生不利影响。 快速开发安全有效的疫苗。大流行最严重的阶段造成了系统性的 以及教育、工作、商业、社会关系、甚至悲伤过程中的文化转变。这 SARS-CoV-2 病毒已夺去了全球 650 万人的生命，美国超过 100 万人的生命，以及近 23,000 人的生命。 退伍军人在 VA 系统中接受护理。传染性极强的 Omicron 变种已造成最大的 病例激增，并在 2022 年 1 月中旬达到峰值。这种变体会导致较轻的症状，但更严重 对目前的疫苗有抵抗力。虽然受影响最严重的新冠患者理所当然是焦点 在许多研究中，病情较轻的患者也可能表现出持久的变化。一个重要的 Al-Aly、Xie 和 Bowe（2021）的研究确定了所有未住院的退伍军人至少患有一种 SARS-CoV-2 检测呈阳性且诊断后存活 30 天的人。六个月后，那些 新冠肺炎对呼吸系统疾病、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。跟进 研究发现，其中许多情况可以持续至少一年（Xie et al., 2022a,b）。在 此外，患有多种感染的退伍军人出现不良健康结果的风险会增加（Al-Aly 等人， 预印本）。尽管流行病学研究有助于确定人口水平趋势，但一个关键因素是 退伍军人对自己的精神和身体症状的评级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人们所面临的挑战 患有新冠肺炎后病症的退伍军人。退伍军人的独特需求包括更高的 通常与新冠肺炎负面结果风险较高相关的合并症（糖尿病、 高血压和心血管疾病）。新冠病毒感染后持续存在的认知问题也可能 对就业和日常运作产生负面影响。认知功能障碍位列第三 在对 Long Covid 社区的一项调查中，这是常见报告的症状（Davis 等人，2021 年），但“大脑” “雾”的研究仍然很少，特别是在退伍军人中。拟议的观察性研究将有一个 两组、前瞻性、重复测量（3 个时间点）设计，其中包括一个研究组和一个密切关注的小组 匹配的健康对照组。研究小组将由退伍军人（n=300）组成，他们的检测结果呈阳性 过去 3-24 个月内患有 SARS-CoV-2，但未住院。这个人口包括 大多数 VA 患者的 SARS-CoV-2 检测结果呈阳性（约 85-90%）。他们的结果将 与健康退伍军人对照进行比较，这些对照在人口统计学变量、预先存在的精神病学方面相匹配 状况和主要合并症（n=300）。后续测试将在六个月和十二个月内进行 几个月后。该项目将随着时间的推移获得认知表现的客观衡量标准 探索它们与心理健康（焦虑、抑郁、创伤后应激障碍）和其他持续性急性后应激障碍的关系 COVID-19 幸存者中 SARS-CoV-2 (PASC) 症状（失眠、疲劳）的后遗症。协变量将 调整基线分数、疫苗数量和诊断后的时间。我们还将检查 多重感染对心理健康和认知结果的影响。经过验证的基于网络的测试 平台将获得持续关注、执行功能、间歇性的客观可靠的衡量标准 记忆力和工作记忆力。更好地了解认知功能的具体弱点 需要时间来确定对患有持续性后遗症的退伍军人群体的未来干预目标 新冠肺炎情况。我们的研究还将确立监测心理健康的重要性 从 COVID-19 中康复的退伍军人。有持续症状者可参考 适当的服务来改善他们的生活质量。