Prevalence and Predictors of Prolonged Cognitive and Psychological Symptoms Following COVID-19 in the United States

Abstract

Background/objectives: Little is known regarding the prevalence and predictors of prolonged cognitive and psychological symptoms of COVID-19 among community-dwellers. We aimed to quantitatively measure self-reported metrics of fatigue, cognitive dysfunction, anxiety, depression, and sleep and identify factors associated with these metrics among United States residents with or without COVID-19.

Methods: We solicited 1000 adult United States residents for an online survey conducted February 3-5, 2021 utilizing a commercial crowdsourcing community research platform. The platform curates eligible participants to approximate United States demographics by age, sex, and race proportions. COVID-19 was diagnosed by laboratory testing and/or by exposure to a known positive contact with subsequent typical symptoms. Prolonged COVID-19 was self-reported and coded for those with symptoms ≥ 1 month following initial diagnosis. The primary outcomes were NIH PROMIS/Neuro-QoL short-form T-scores for fatigue, cognitive dysfunction, anxiety, depression, and sleep compared among those with prolonged COVID-19 symptoms, COVID-19 without prolonged symptoms and COVID-19 negative subjects. Multivariable backwards step-wise logistic regression models were constructed to predict abnormal Neuro-QoL metrics.

Results: Among 999 respondents, the average age was 45 years (range 18-84), 49% were male, 76 (7.6%) had a history of COVID-19 and 19/76 (25%) COVID-19 positive participants reported prolonged symptoms lasting a median of 4 months (range 1-13). Prolonged COVID-19 participants were more often younger, female, Hispanic, and had a history of depression/mood/thought disorder (all P < 0.05). They experienced significantly higher rates of unemployment and financial insecurity, and their symptoms created greater interference with work and household activities compared to other COVID-19 status groups (all P < 0.05). After adjusting for demographics, past medical history and stressor covariates in multivariable logistic regression analysis, COVID-19 status was independently predictive of worse Neuro-QoL cognitive dysfunction scores (adjusted OR 11.52, 95% CI 1.01-2.28, P = 0.047), but there were no significant differences in quantitative measures of anxiety, depression, fatigue, or sleep.

Conclusion: Prolonged symptoms occurred in 25% of COVID-19 positive participants, and NeuroQoL cognitive dysfunction scores were significantly worse among COVID-19 positive subjects, even after accounting for demographic and stressor covariates. Fatigue, anxiety, depression, and sleep scores did not differ between COVID-19 positive and negative respondents.

Keywords: COVID-19; Community Dwellers; cognitive; long-hauler; post-acute sequelae of SARS-CoV-2 infection; stressors.

FIGURE 1

Symptoms in the month prior to interview in subjects with prolonged COVID-19 symptoms, COVID-19 without prolonged symptoms and COVID-19 negative subjects. *P < 0.05 comparing across all three groups; ^#P < 0.05 comparing COVID positive to COVID negative.

FIGURE 2

Socio-economic stressors in the month prior to interview in subjects with prolonged COVID-19 symptoms, COVID-19 without prolonged symptoms and COVID-19 negative subjects. *P < 0.05 comparing across all three groups; ^#P < 0.05 comparing COVID positive to COVID negative.

FIGURE 3

Abnormal NeuroQoL T-scores in subjects with prolonged COVID-19 symptoms, COVID-19 without prolonged symptoms and COVID-19 negative subjects. Abnormal T-scores were defined as: T-score > 55 for anxiety, depression, fatigue, or sleep and <45 for cognition. *P < 0.05 comparing across all three groups; ^#P < 0.05 comparing COVID positive to COVID negative.

FIGURE 4

Distribution of Neuro-QoL T-scores by age. There is a suggestion of a bimodal peak in worse depression, cognitive and sleep score with peaks around ages 30–35 and again around ages 60–65.