scholarly journals Frequency and profile of objective cognitive deficits in hospitalized patients recovering from COVID-19

2020 ◽  
Author(s):  
Abhishek Jaywant ◽  
W. Michael Vanderlind ◽  
George S. Alexopoulos ◽  
Chaya B. Fridman ◽  
Roy H. Perlis ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Cognitive Deficits ◽  
Psychiatric Diagnosis ◽  
Case Reports ◽  
Case Series ◽  
Inpatient Rehabilitation ◽  
Executive Dysfunction ◽  
Hospitalized Patients ◽  
Hypoxemic Respiratory Failure ◽  
Cross Sectional

AbstractBackgroundCognitive impairment is common following critical illness. A number of case reports and case series have suggested that cognitive deficits occur in patients with COVID-19. This study evaluated the frequency, severity, and profile of cognitive dysfunction in hospitalized patients recovering from COVID-19.MethodsWe obtained and analyzed cross-sectional neuropsychological data from a cohort of N=57 patients participating in inpatient rehabilitation. Our primary outcome measure was the Brief Memory and Executive Test (BMET). We calculated the frequency of impairment based on clinician diagnosis and by the BMET subtests using age-normed classification of impairment. We explored associations with intubation and extubation as markers of illness severity and complications, as well as psychiatric diagnosis.OutcomesOur sample was 75% male, 61% non-white, with a mean age of 64.5 (SD = 13.9) years. Patients were evaluated at a mean of 43.2 days post-admission. 88% had documented hypoxemic respiratory failure and 77% required intubation. 81% of patients had cognitive impairment, ranging from mild to severe. Deficits were most common in working memory (55% of patients impaired), set-shifting (47%), divided attention (46%), and processing speed (40%). Executive dysfunction was not significantly associated with intubation length or the time from extubation to assessment, nor was it associated with the presence of a psychiatric diagnosis.InterpretationMedically stable inpatients recovering from COVID-19 commonly have deficits in attention and executive functions. These deficits were not significantly correlated with length of intubation or time since extubation. Findings provide an early benchmark for studying the evolution of cognitive difficulties after COVID-19 and suggest that easy to disseminate interventions that remediate attention and executive dysfunctions may be important in this population.FundingThe authors have no funding for this study to report.

scholarly journals Probable Neuropsychological & Cognitive Complications due to Cytokine Storm in Patients With COVID-19

2021 ◽  
Vol 0 (0) ◽  
pp. 1-37
Author(s):  
Zahra Keshtgar ◽  
◽  
GH. Reza Chalabianloo ◽  
Niloofar Esmaeili ◽  
◽  
...  
Keyword(s):  
Nervous System ◽  
Case Reports ◽  
Case Series ◽  
Executive Dysfunction ◽  
Inflammatory Factors ◽  
Cytokine Storm ◽  
Case Control Studies ◽  
Necrosis Factor Alpha ◽  
Cross Sectional ◽  
Tnf Α

Introduction: COVID-19 (coronavirus disease 2019) was identified in China in December 2019 for the first time and is rapidly spreading throughout the world as a pandemic. As COVID-19 causes mild to severe acute respiratory syndrome, most studies in this context have focused on pathogenesis primarily in the respiratory system. However, evidence shows that the central nervous system (CNS) may also be affected by COVID-19. Since COVID-19 is spreading, it is imperative to study its possible cognitive effects in patients suffering and recovering from COVID-19. Methods: The articles used in this study were searched by keywords such as Cytokine storm and covid-19, covid-19 and executive dysfunction, cognitive disorder and covid-19, CNS and covid 19, Coronavirus, Neuroinvasion in science direct, Scopus, PubMed, Embase, and Web of Science databases based on Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) checklist. The study will assess all observational studies published between December 2019 and April 2021 in peer-reviewed journals, including cross-sectional, cohort, case-control studies, case reports and case series. The search result was 106 articles, of which 73 articles related to Covid-19, the stages of infection by this virus, its effect on the nervous system and neurological symptoms, the cytokine storm caused by this infection, and the possible cognitive consequences caused by this virus in patients, has been reviewed. Other articles were not checked due to their limited relevance to the topic under discussion. Results: Studies show that neurons may be directly affected by SARS-CoV-1 and SARS-CoV-2. Furthermore, various studies indicate that systemic inflammation (so-called "cytokine storm") is also responsible for brain damage induced by infection with SARS-CoV-1 and SARS-CoV-2. Such a way that this patients showed elevated levels of interleukin (IL-), 6, 8, and 10 and of tumor necrosis factor-alpha (TNF- α) in their blood. Conclusion: Various cognitive defects following an increase level of cytokines such as TNF-α and IL-6,8 have been observed. Therefore, due to the increase level of these pro-inflammatory factors in the brains of these patients, cognitive deficits can be expected, which need further investigation.

scholarly journals Oral Manifestations of COVID-19 in Hospitalized Patients: A Systematic Review

2021 ◽  
Vol 18 (23) ◽  
pp. 12511
Author(s):  
Giulia Orilisi ◽  
Marco Mascitti ◽  
Lucrezia Togni ◽  
Riccardo Monterubbianesi ◽  
Vincenzo Tosco ◽  
...  
Keyword(s):  
Systematic Review ◽  
Case Reports ◽  
Oral Candidiasis ◽  
Case Series ◽  
Hospitalized Patients ◽  
Oral Manifestations ◽  
Case Control Studies ◽  
Cross Sectional ◽  
Oral Ulcers ◽  
Global Pandemic

Background: COVID-19 disease first appeared in 2019 and quickly spread worldwide, causing a global pandemic. The oral cavity represents a target of SARS-CoV-2, and oral lesions are observed in both non-hospitalized and hospitalized patients. This systematic review aims to investigate the frequency of oral manifestations in COVID-19 hospitalized patients. Methods: An electronic search was conducted in PubMed, Scopus, and Web of Science databases, including articles published up to September 2021. The review protocol was based on PRISMA-P. The risk of bias of the studies was assessed using the Joana Briggs Institute. The certainty of evidence was assessed using the GRADE instrument. Results: Fifty-nine articles were included: 19 case reports, 17 case series, 2 case-control studies, 13 cross-sectional studies, 4 observational studies, and 4 retrospective studies. Oral ulcers, cheilitis, and tongue lesions were more common in patients before hospitalization, while perioral pressure ulcers, macroglossia, blisters, and oral candidiasis were more recurrent in patients during hospitalization. The first could be related directly to COVID-19, while the latter could be caused by medical devices, treatments, prone position, and immunological impairment. Conclusions: An accurate oral examination during the hospital admission of all confirmed COVID-19 cases is encouraged to recognize oral early manifestations and to apply appropriate treatments.

scholarly journals COVID-19 and Cognitive Impairment: Severity, Evolution, and Functional Impact during Inpatient Rehabilitation

2021 ◽  
Author(s):  
Ruchi Patel ◽  
Irene Savrides ◽  
Christine Cahalan ◽  
Gargi Doulatani ◽  
Michael W. O'Dell ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Cognitive Deficits ◽  
Medical Center ◽  
Academic Medical Center ◽  
Inpatient Rehabilitation ◽  
Prior History ◽  
Rehabilitation Unit ◽  
Minimally Clinically Important Difference ◽  
Cross Sectional ◽  
Functional Gain

Objective: To determine the frequency, magnitude, and change in cognitive impairment in patients with COVID-19 undergoing acute inpatient rehabilitation. We secondarily evaluated correlates of cognitive impairment and the relationship between cognition and functional gain. Design: Cross-sectional observational study with assessments at admission and discharge Setting: Acute inpatient rehabilitation unit within a large, urban academic medical center Participants: 77 patients hospitalized for COVID-19 and subsequently admitted to an inpatient rehabilitation unit between March-August 2020, 45 of whom were re-assessed at discharge. Interventions: N/A Main Outcome Measures: Montreal Cognitive Assessment (MoCA) scores on admission and discharge (when available) and Quality Indicator for Self-Care (QI-SC) scores on admission and discharge. Results: 62/77 (80.5%) of patients demonstrated cognitive deficits on the MoCA at admission: 39/77 (50.6%) were mildly impaired, 20/77 (26%) moderately impaired, and 3/77 (3.9%) severely impaired. Cognitive impairment was associated with a prior history of delirium, but not age or length of acute care hospitalization. 32/45 (71.1%) patients with discharge scores improved and met the MoCA minimally clinically important difference (MCID); however, 35/45 (77.8%) continued to score in the impaired range. Patients who met the MoCA MCID demonstrated significantly greater QI-SC score gains than those that did not meet the MCID (p=.02). Conclusion: Cognitive impairment is common among hospitalized COVID-19 patients requiring acute inpatient rehabilitation. Cognitive impairment improves over the course of inpatient rehabilitation, and is associated with functional gain. Nonetheless, cognitive deficits frequently remain present at discharge, indicating the need for systematic assessment and follow-up, especially given the association with functional outcome.

"Outcomes of Hospitalized Patients with Immune Thrombocytopenia and Splenectomy in 2017: A Nationwide Cross-Sectional Analysis"

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 36-36
Author(s):  
Sunny J Patel ◽  
Mansoor Khalid ◽  
Gagan Kumar ◽  
Creticus P Marak ◽  
Achuta K Guddati
Keyword(s):  
General Population ◽  
Conflicts Of Interest ◽  
Case Reports ◽  
Case Series ◽  
Autoimmune Disorder ◽  
Hospitalized Patients ◽  
Teaching Hospitals ◽  
National Inpatient Sample ◽  
Cross Sectional ◽  
Elective Admission

Background: Immune Thrombocytopenic Purpura (ITP) is an autoimmune disorder characterized by premature platelet destruction. Often considered treatable, patients with ITP can relapse even with initial steroid treatment. Splenectomy is currently regarded as the standard second-line therapy for steroid-refractory ITP. However, the outcomes of patients who have undergone splenectomy for ITP have not been well-assessed. Studies investigating the prevalence and in-hospital mortality of these patients have been limited to case reports and case series. By conducting a retrospective analysis of nationwide data, we sought to elucidate the outcomes of hospitalized patients with ITP who have undergone splenectomy. Methods: Data from the National Inpatient Sample was extracted to identify and characterize outcomes in hospitalized patients with ITP who underwent splenectomy in the year 2017. The National Inpatient Sample is a database maintained by the Agency for Healthcare Quality and Research. The International Classification of Diseases, 9th Edition, Clinical Modification codes were used to identify patients with ITP. Patient demographics of age, gender and race and hospital characteristics of disposition, size, location, region and teaching status were collected. Patient medical expenses and insurances were also obtained. Common associated medical complications and comorbidities such as morbid obesity, chronic kidney disease, pulmonary and autoimmune diseases were studied in ITP patients who died with and without splenectomy. Chi square test was used to determine odds ratios and multiple logistic regression was used to determine independent predictors of mortality. Results: 11,106 patients with ITP were hospitalized in the year 2017. Of these, a total of 218 patients underwent splenectomy. Four patients (1.8%) who underwent splenectomy died. Assessing the general population with ITP, females were affected more than males (58.8% females vs. 41.2% males), but males were more likely to suffer mortality (p=0.0000). Females underwent more splenectomy procedures compared to their male counterparts (129 vs. 85). Large-sized hospitals and teaching hospitals were noted to have the majority of procedures. A majority of patients with splenectomy and ITP were covered by Medicare. Both patients who did or did not undergo splenectomy tended to remain in the hospital for about 2-5 days. Patients with ITP tended to undergo the procedure during an elective admission compared to a non-elective admission despite there being a greater number of non-elective admissions (150 vs. 68, 1,829 vs. 9,257). Assessing cost, patients undergoing splenectomy tended to be in the higher expense group >$25,000. Conclusion: This is the first nationwide study to document the outcomes of splenectomy in hospitalized patients with ITP. This investigation demonstrates that the mortality of patients who undergo splenectomy for ITP is noninferior to the general population with ITP. Regardless of comorbidities, patients did favorably well with splenectomy and tended to have similar hospital stays to patients who did not undergo procedures. Thus, they do not have worse outcomes. Notably, patients admitted non-electively were less likely to undergo the procedure, likely given the increased complications of their hospital course. Further research is needed to better characterize both the short and long-term outcomes in this patient population. Disclosures No relevant conflicts of interest to declare.

scholarly journals Cardio-Pulmonary Sequelae in Recovered COVID-19 Patients: Considerations for Primary Care

2021 ◽  
Vol 12 ◽  
pp. 215013272110237
Author(s):  
Zouina Sarfraz ◽  
Azza Sarfraz ◽  
Alanna Barrios ◽  
Radhika Garimella ◽  
Asimina Dominari ◽  
...  
Keyword(s):  
Primary Care ◽  
Primary Infection ◽  
Clinical Laboratory ◽  
Point Of Care ◽  
Case Reports ◽  
Case Series ◽  
Infectious Complications ◽  
Care Physician ◽  
Cross Sectional ◽  
Infection Period

Background: Current literature lacks characterization of the post-recovery sequelae among COVID-19 patients. This review characterizes the course of clinical, laboratory, radiological findings during the primary infection period, and the complications post-recovery. Primary care findings are presented for long-COVID care. Methods: Adhering to PRISMA guidelines, 4 databases were searched (PubMed, Embase, CINAHL Plus, Scopus) through December 5, 2020, using the keywords “COVID-19 and/or recovered and/or cardiovascular and/or long-term and/or sequelae and/or sub-acute and/or complication.” We included published peer-reviewed case reports, case series, and cross-sectional studies providing the clinical course of COVID-19 infection, and cardiopulmonary complications of patients who recovered from COVID-19, while making healthcare considerations for primary care workers. Results: We identified 29 studies across 9 countries including 37.9% Chinese and 24.1% U.S. studies, comprising 655 patients (Mean Age = 45) with various ethnical backgrounds including Asian and European. Based on the WHO COVID-19 severity classification scale, initial disease severity was mild for 377 patients and severe for 52 patients. Treatments during primary infection included corticosteroids, oxygen support, and antivirals. The mean value (in days) for complication onset after acute recovery was 28 days. Complete blood counts and RT-PCR tests were the most common laboratory results described. In 22 of the studies, patients showed signs of clinical improvement and were prescribed medications such as anticoagulants or corticosteroids. Conclusion: Post-recovery infectious complications are common in long-COVID-19 patients ranging from mild infections to life-threatening conditions. International thoracic and cardiovascular societies need to develop guidelines for patients recovering from COVID-19 pneumonia, while focused patient care by the primary care physician is crucial to curb preventable adverse events. Recommendations for real-time and lab-quality diagnostic tests are warranted to establish point-of-care testing, detect early complications, and provide timely treatment.

The Ten Point Clock Test: A Quick Screen and Grading Method for Cognitive Impairment in Medical and Surgical Patients

1994 ◽  
Vol 24 (3) ◽  
pp. 229-244 ◽  
Author(s):  
Peter J. Manos ◽  
Rae Wu
Keyword(s):  
Cognitive Impairment ◽  
Cognitive Deficits ◽  
Neuropsychological Tests ◽  
Medical Center ◽  
Neuropsychological Test ◽  
Hospitalized Patients ◽  
Surgical Patients ◽  
Tertiary Referral Center ◽  
The Mean ◽  
State Examination

Objective: The objective of this study was to evaluate the clinical utility of the ten point clock test in screening for and grading cognitive deficits in medical and surgical patients. Method: The setting was the hospital and clinics of Virginia Mason Medical Center, a tertiary referral center. Consecutive samples of hospitalized patients, and clinic outpatients—with and without a dementia—were administered the ten point clock test as well as a number of other neuropsychological tests and measures of cognitive impairment. Results: Clock scores correlated with neuropsychological test scores and with the mini-mental state examination. They were stable from rater to rater, and from day to day in stable patients. The mean clock score of elderly outpatient controls was 8.5, significantly different from the mean of 5.5 scored by patients with a dementia. A cut off score of seven identified 76 percent of outpatients with dementia and 78 percent of elderly controls. Clock scores correlated well with nurses' ratings of their inpatients' cognitive deficits (Spearman's rs = −0.61). The test was easy to administer, even to hospitalized patients. Conclusions: The ten point clock test is reliable, valid, and useful as a quick screen and grading method for cognitive deficits in medical and surgical patients.

scholarly journals Impaired abstract thinking may discriminate between normal aging and vascular mild cognitive impairment

2010 ◽  
Vol 68 (2) ◽  
pp. 179-184 ◽  
Author(s):  
Felipe Kenji Sudo ◽  
Gilberto Sousa Alves ◽  
Carlos Eduardo de Oliveira Alves ◽  
Maria Elisa Lanna ◽  
Letice Ericeira-Valente ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Cerebrovascular Disease ◽  
Cognitive Deficits ◽  
Cross Sectional Study ◽  
Abstract Thinking ◽  
Sectional Study ◽  
Cross Sectional ◽  
Elderly Individuals ◽  
Healthy Elderly

OBJECTIVE: Cerebrovascular disease (CVD) is associated with cognitive deficits. This cross-sectional study examines differences among healthy elderly controls and patients with vascular mild cognitive impairment (VaMCI) and vascular dementia (VaD) in performances on CAMCOG subscales. METHOD: Elderly individuals (n=61) were divided into 3 groups, according to cognitive and neuroimaging status: 16 controls, 20 VaMCI and 25 VaD. VaMCI and VaD individuals scored over 4 points on the Hachinski Ischemic Scale. RESULTS: Significant differences in total CAMCOG scores were observed across the three groups (p<0.001). VaD subjects performed worse than those with VaMCI in most CAMCOG subscales (p<0.001). All subscales showed differences between controls and VaD (p<0.001). Performance on abstract thinking showed difference between VaMCI and controls (p<0.001). CONCLUSION: CAMCOG discriminated controls from VaMCI and VaD. Assessment of abstract thinking may be useful as a screening item for diagnosis of VaMCI.

scholarly journals Manual Interventions for Musculoskeletal Factors in Infants With Suboptimal Breastfeeding: A Scoping Review

2018 ◽  
Vol 23 ◽  
pp. 2515690X1881697
Author(s):  
Cheryl Hawk ◽  
Amy Minkalis ◽  
Carol Webb ◽  
Olivia Hogan ◽  
Sharon Vallone
Keyword(s):  
Manual Therapy ◽  
Case Reports ◽  
Research Question ◽  
Case Series ◽  
First Year ◽  
Serious Adverse Events ◽  
Cross Sectional ◽  
Maternal Report ◽  
Suboptimal Breastfeeding ◽  
First Year Of Life

Exclusive breastfeeding for the first 6 months, and continuing for at least the first year of life, is strongly recommended. Suboptimal breastfeeding, which is breastfeeding that does not meet these recommendations, is a multifactorial issue. Some authorities, particularly in the nursing and lactation counseling professions, have identified musculoskeletal issues that may interfere with successful breastfeeding. The purpose of this project was to survey the literature on manual treatments to correct musculoskeletal dysfunctions in infants with suboptimal breastfeeding. Our research question was, “Have manual interventions been used to correct infants’ musculoskeletal dysfunctions thought to be linked to suboptimal breastfeeding?” We searched PubMed and Index to Chiropractic Literature, from inception through July 2018, as well as relevant gray literature. We assessed quality of randomized controlled trials (RCTs) and cohort studies using modified SIGN checklists, and the overall strength of evidence using GRADE. The search yielded 461 articles, with a final inclusion of 27 articles: 7 expert commentaries, 1 high-quality RCT, 1 low-quality cohort, 1 pilot study, 2 cross-sectional surveys, 5 narrative reviews, and 10 case series or case reports. Combining the 10 case series and reports in our search with 18 discussed in narrative reviews included in our review yielded 201 infants who received manual therapy for nursing dysfunction. No serious adverse events were reported and improvement in nursing ability was observed using various outcome measures, usually maternal report. Based on the GRADE criteria, there is moderate positive evidence for the effect of manual therapy on suboptimal breastfeeding.

scholarly journals Prevalence of Autism Spectrum Disorder among Rural, Urban, and Tribal Children (1–10 Years of Age)

2017 ◽  
Vol 08 (03) ◽  
pp. 368-374 ◽  
Author(s):  
Sunil Kumar Raina ◽  
Vishav Chander ◽  
Ashok K. Bhardwaj ◽  
Dinesh Kumar ◽  
Seema Sharma ◽  
...  
Keyword(s):  
Case Reports ◽  
Case Series ◽  
Autism Spectrum ◽  
Second Phase ◽  
Age Group ◽  
Socioeconomic Group ◽  
Cross Sectional ◽  
Geographical Regions ◽  
Evaluation Phase ◽  
Tribal Populations

ABSTRACT Introduction: Studies on autism spectrum disorders (ASDs) have largely focused on children in specific settings. The current scenario of research in ASDs is limited largely to clinic-based case reports, case series, and retrospective chart reviews. The present study is the first population-based prevalence study conducted across rural, urban, and tribal populations in India. Materials and Methods: A cross-sectional two-phase study was conducted cring children in the age group of 1–10 years of age across geographical regions representing rural, urban, and tribal populations. The first phase (screening phase) involved administration of the Hindi version of the Indian Scale for Assessment of Autism. Those identified as suspected of ASD and 10% of all classified as nonsuspects for autism were also evaluated by the clinical team in second phase (evaluation phase). Results: Forty-three children out of a total of 28,070 children in rural, urban, and tribal area in the age group of 1–10 years were diagnosed as cases of ASD yielding a prevalence of 0.15% (95% confidence interval [CI] =0.15–0.25). Logistic regression analysis showed a two times significantly higher risk of diagnosing ASD in rural area as compared to tribal (odds ratio [OR]; 95% CI = 2.17 [1.04–4.52], P = 0.04). Male sex and upper socioeconomic group of head of family/father had a higher risk of getting diagnosed as autism as compared to lower socioeconomic group (OR; 95% CI - 3.23; 0.24–44.28, P = 0.38). Conclusions: Estimation of true prevalence of ASD in India is going to improve policies on developmental disabilities.

scholarly journals Efficacy of nicotine administration on obsessions and compulsions in OCD: a systematic review

2020 ◽  
Vol 19 (1) ◽  
Author(s):  
Daria Piacentino ◽  
Annalisa Maraone ◽  
Valentina Roselli ◽  
Isabella Berardelli ◽  
Massimo Biondi ◽  
...  
Keyword(s):  
Systematic Review ◽  
Ethical Issues ◽  
Case Reports ◽  
Treatment Strategies ◽  
Case Series ◽  
Symptom Improvement ◽  
Open Label ◽  
Cross Sectional ◽  
Positive Effects ◽  
Nicotine Administration

Abstract Background Preliminary studies have tested nicotine as a novel treatment for OCD patients who respond partially/incompletely or not at all to first and second-line treatment strategies, with the former represented by SSRIs or clomipramine, and the latter by switching to another SSRI, or augmentation with atypical antipsychotics, and/or combination with/switching to cognitive–behavioural therapy. Some studies found nicotine-induced reduction of obsessive thoughts and/or compulsive behaviour in OCD patients. We aimed to evaluate the efficacy of nicotine administration in OCD patients. Methods We searched the PubMed, ScienceDirect Scopus, CINHAL, Cochrane, PsycINFO/PsycARTICLES, and EMBASE databases from inception to the present for relevant papers. The ‘Preferred Reporting Items for Systematic Review and Meta-Analyses’ (PRISMA) standards were used. We included all studies focusing on the effects of nicotine administration on OCD patients’ obsessions or compulsions. Studies could be open-label, cross-sectional, randomized controlled trials, case series or case reports. Results A total of five studies could be included. Nicotine administration may ameliorate behavioural features and recurrent thoughts of severe, treatment-resistant OCD patients; however, in one study it was not associated with OC symptom improvement or cognitive enhancement across various executive function subdomains. Conclusions Although encouraging, the initial positive response from the use of nicotine in OCD needs testing in large controlled studies. This, however, raises ethical issues related to nicotine administration, due to its addiction potential, which were not addressed in the limited literature we examined. As an alternative, novel treatments with drugs able to mimic only the positive effects of nicotine could be implemented.

Sign in / Sign up

Export Citation Format

Share Document