The MoCA is a cognitive screening tool designed to be more sensitive for mild forms of cognitive impairment and specific cognitive domain functions compared to other measures such as the MMSE and has been validated in multiple populations, , ].
With this in mind, the investigators sought to examine if a commonly used screening tool for cognitive impairment, the Montreal Cognitive Assessment (MoCA), would be clinically useful at screening for neurocognitive deficits in patients with PASC, thus facilitating further investigation, including neuroimaging and formal testing. However, to the general post-COVID population seeking care, formal neuropsychological testing may be difficult to access, with limitations as far as cost, availability, and length of time to complete. The above findings indicate that those who have recovered from COVID-19 infection may experience neurocognitive impairment, and that subjective cognitive complaints in the context of PASC warrant investigation. Independent predictors of impairment in this population included acute COVID-19 symptoms, current depression score, number of medical comorbidities, and subjective cognitive complaints in the areas of memory, language, and executive functions. The study also showed that individuals seeking care for cognitive complaints in the areas of memory, language and higher cognition, as measured in this by the Patient Assessment of Own Functioning (PAOF) inventory, scored significantly lower than population-based normative values on NP tests of attention, processing speed, memory, and executive function. Results from the study indicated that over one-fourth (27%) of participants had extremely low NP test performance. This research group has reported neuropsychiatric findings from a cross-sectional assessment of 60 participants enrolled in a longitudinal investigation of neuropsychological, medical, and psychiatric sequelae of COVID-19. In contrast, a 2022 study from England examined post-hospitalized patients versus a control group found relatively severe cognitive impairment, which authors described as similar in magnitude to ageing 20 years. Recent studies that employed formal NP testing had mixed findings, with some finding minimal to no deficits and others finding minimal deficits, attributing the deficits to other symptoms such as mood, poor sleep, and fatigue.
The studies included in this review relied primarily on screening measures such as the Montreal Cognitive Assessment (MoCA) and the Mini Mental State Exam (MMSE), with few using formal neuropsychological (NP) assessment.
A comprehensive review of 12 studies of post-COVID-19 cognitive impairment found global impairment in 15–80% of participants, including deficits in memory, attention, executive function, and verbal fluency. These symptoms have been found to frequently co-occur with psychiatric symptoms such as depression, anxiety, fatigue, and sleep disorders. These post-acute symptoms of COVID-19 (PASC) include fatigue, respiratory and cardiac manifestations, as well as cognitive and psychiatric symptoms.Ĭognitive complaints reported by those suffering from PASC (often called “brain fog” by patients) include inattention, poor concentration, problems with memory and difficulties multitasking. It is increasingly evident that even after recovering from the acute illness, many individuals experience unexpected long-term symptoms. According to the World Health Organization, SARS-CoV-2, the virus which causes COVID-19, has infected over 260 million people worldwide.
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