Post‐Omicron cognitive decline is largely reversible: Two‐year multicenter cohort study of domain‐specific outcomes in hospitalized patients

Neuroimmune determinants of cognitive and psychological burden in post‐ COVID syndrome: A cross‐sectional study in a Caucasian cohort

Post‐COVID syndrome is increasingly recognized as a multidimensional condition characterized by persistent cognitive, psychological, and functional impairment. Emerging evidence suggests a role for systemic inflammation; however, the integration of inflammatory, neuropsychological, and functional domains remains insufficiently explored. In this cross‐sectional study, 360 individuals with prior SARS‐CoV‐2 infection were evaluated. Systemic inflammatory markers, including interleukin‐6 (IL‐6) and C‐reactive protein (CRP), were assessed alongside validated neuropsychological measures, including PHQ‐9, BDI, STAI, and MoCA. Composite indices were constructed to quantify inflammatory burden, neuropsychological burden, and functional impairment. Correlation analyses and multivariable regression models were applied to evaluate independent associations between variables. Inflammatory burden demonstrated strong positive correlations with neuropsychological burden ( ρ ≈0.6, p < .001) and was independently associated with long COVID‐related neurological manifestations in regression models. Neuropsychological burden was strongly associated with functional impairment ( ρ ≈0.6, p < .001), indicating clinically meaningful translation of cognitive and affective dysfunction into real‐world disability. Disease severity during acute infection was positively associated with long‐term neurological burden, while time since infection showed an inverse relationship, suggesting partial recovery dynamics. Vascular risk burden did not demonstrate a consistent positive association with cognitive impairment after adjustment. Systemic inflammatory burden is strongly associated with neurocognitive and psychological dysfunction in post‐COVID syndrome, with downstream effects on functional status. These findings support a neuroimmune‐associated framework linking inflammation to persistent neurological burden and highlight the potential role of inflammatory markers in risk stratification. Further longitudinal and interventional studies are required to clarify causal mechanisms and therapeutic implications.

Neurocognitive and Neuropsychiatric Trajectories in a Post-COVID Cohort: A Descriptive Longitudinal Study

Introduction: Cognitive dysfunction (“brain fog”) is a common manifestation of post-acute COVID-19 syndrome (PACS) and may persist long after the acute infection. While cross-sectional studies have described cognitive deficits, longitudinal evidence on recovery trajectories remains limited. Methods: We conducted a longitudinal observational study of neurocognitive performance and neuropsychiatric symptoms in patients with PACS. Participants underwent assessment with 20 standardized tests covering five cognitive domains (memory, attention, language, executive functions, psychomotor processing speed); anxiety, depression, and sleep quality were assessed at three time points. Changes were analysed using the Friedman test. Results: Forty-two patients were included (median age 57 years; 35.7% female) from a predominantly hospitalized cohort (81% hospitalised; 66.7% requiring respiratory support). Patients who completed all three assessments (completers, n = 42) were compared with those who attended the first evaluation but did not complete follow-up (non-completers, n = 544); completers were more severely ill during the acute phase rather than healthier or more motivated. At the group level, statistically significant improvements over time were observed across the whole sample in verbal short-term learning, visuospatial memory, working memory, constructional praxis, phonological verbal fluency, and psychomotor processing speed (all p ≤ 0.05); after Benjamini–Hochberg adjustment across the twenty cognitive outcomes, visuospatial span forward and backward and psychomotor processing speed remained significant (all FDR-adjusted p ≤ 0.013), with the change confined to the first six months. Sleep quality also improved (p < 0.0001). Conclusion: In this cohort, group-level performance improved in six of the twenty tests administered, of which three remained significant after correction for multiple comparisons, while 28 of 42 patients (66.7%) still scored in the impaired range on at least one test at 12 months, and 17 (40.5%) on two or more. These findings highlight the importance of long-term neuropsychological monitoring and integrated cognitive-psychiatric evaluation in post-COVID care. Given the small, predominantly hospitalized sample, improvements should be interpreted cautiously and confirmed in larger controlled studies, although the use of alternate forms for part of the battery makes task-specific learning an incomplete explanation.

Pre‐Fracture Cognitive Assessment Using the DASC‐21 and Postoperative Delirium Risk

ABSTRACT Background Postoperative delirium (POD) is a common complication in older adults after hip fracture surgery. Although cognitive impairment is a key risk factor, accurately assessing baseline cognition in acute settings remains challenging. Informant‐based tools may better reflect premorbid cognitive status; however, their utility in hip fracture populations is unclear. Methods This retrospective analysis used data from a prospective cohort of patients aged ≥ 80 years who underwent hip fracture surgery at two acute hospitals in Japan. Pre‐fracture cognitive status was assessed using the Dementia Assessment Sheet for Community‐based Integrated Care System (DASC‐21), primarily based on reports from informants. For selected patients without available informants and with Mini‐Mental State Examination (MMSE) scores ≥ 21, structured patient interviews and clinical observations were used. The DASC‐21 categories were classified as normal cognition, mild impairment and moderate‐to‐severe impairment. Cognitive function at admission was evaluated using the MMSE. POD was assessed using the Confusion Assessment Method within the first three postoperative days. Multivariable logistic regression analyses were performed. Results Among 368 patients, 137 (37.2%) developed POD. POD incidence increased with worsening pre‐fracture cognitive impairment (5.6%, 44.3% and 48.7% for normal, mild and moderate‐to‐severe impairment, respectively; p < 0.001). Each 1‐point increase in the MMSE score was associated with lower odds of POD (OR 0.91, 95% CI 0.88–0.94). Compared with normal cognition, the adjusted ORs for POD were 14.11 (95% CI 5.08–39.24) for mild impairment and 15.39 (95% CI 5.56–42.61) for moderate‐to‐severe impairment. Discrimination was similar between MMSE and DASC‐21 (area under the receiver operating characteristic curve 0.75 vs. 0.74). Conclusions Pre‐fracture cognitive impairment, including DASC‐21‐defined mild impairment, was associated with POD. The DASC‐21 categories showed comparable discriminative performance to the MMSE and may help estimate baseline cognitive vulnerability in acute clinical settings.

Evaluating the Relationship Between Early Non‐Motor Symptoms and Late Diagnosis of Parkinson's Disease Based on the PPMI Database From 2012 to 2018: A Retrospective Cross‐Sectional Study

Socio‐demographic variables, rather than individual non‐motor symptoms, demonstrate the strongest independent associations with diagnostic timing in this cohort, highlighting the need for socio‐demographically tailored screening strategies in the prodromal phase of PD.

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Prevalence and Latent Profiles of Cognitive Impairment in Patients with Heart Failure: A Secondary Data Analysis

Background/Objectives: Cognitive impairment can weaken self-management competency in heart failure (HF) patients. This study estimated domain-specific cognitive impairment prevalence using actuarial criteria and identified latent cognitive profiles among Korean HF outpatients. Methods: Using a previously collected cross-sectional dataset of 106 HF outpatients, cognitive function was assessed with the Seoul Neuropsychological Screening Battery-II. Actuarial criteria determined domain-specific impairment, and latent profile analysis (LPA) derived cognitive profiles based on domain composite z-scores. Results: Any cognitive impairment (≥1 impaired domain) was present in 32.1% (95% confidence interval [CI], 24.0–41.5%), most frequently affecting executive function (17.9%) and memory (15.1%). LPA identified three exploratory profiles: relatively preserved (30.2%), memory-vulnerable (45.3%), and globally vulnerable (24.5%). In exploratory models, anxiety symptoms were associated with higher odds of memory-vulnerable profile membership (odds ratio [OR] = 2.81, 95% CI, 1.03–7.64) and overall vulnerability in a Firth penalized analysis (OR = 3.39, 95% CI, 1.46–8.11), whereas depressive symptoms showed no significant association. No associations remained statistically significant after false discovery rate correction. Conclusions: Cognitive vulnerability in HF outpatients is phenotypically heterogeneous and showed a possible, unconfirmed association with anxiety symptoms that did not remain statistically significant after correction for multiple comparisons. Outpatient HF care planning may benefit from considering both domain-specific deficits and latent cognitive profile patterns; however, these exploratory findings require validation in larger cohorts.