Cognitive impairment and neuropsychiatric symptoms among individuals with history of symptomatic SARS-CoV-2 infection: a retrospective longitudinal study.

COVID-19 is a multisystem disease caused by the RNA virus (coronavirus 2 or SARS-CoV-2) that can impact cognitive measures. Objective: To identify the main cognitive and neuropsychiatric symptoms in adults who had no cognitive complaints prior to the infection. Specifically, to observe the trajectory of cognitive and neuropsychiatric performance after 6 months. Methods: This is a retrospective longitudinal study. Forty-nine patients (29 reassessed after 6 months), with a positive PCR test, with no prior cognitive complaints that only presented after the infection and without a history of structural, neurodegenerative or psychiatric neurological diseases. A brief cognitive assessment battery (MoCA), the Trail Making Test (TMT-A, B, ∆), and the Verbal Fluency Test were used, as well as the scales (Hospital Anxiety and Depression Scale-HADS, Fatigue Severity Scale-FSS). Correlation tests and group comparison were used for descriptive and inferential statistics. Level of significance of α=5%. Results: Mean age of 50.4 (11.3), 12.7 (2.8) years of education, higher percentage of women (69.8%). No psycho-emotional improvement (depression and anxiety) was observed between the evaluations, and patients maintained the subjective complaint of cognitive changes. The HAD-Anxiety scale showed a significant correlation with TMT-B errors. The subgroup participating in cognitive stimulation and psychoeducation showed improvement in the global cognition measure and the executive attention test. Conclusion: Our results corroborate other studies that found that cognitive dysfunctions in post-COVID-19 patients can persist for months after disease remission, as well as psycho-emotional symptoms, even in individuals with mild infection. Future studies, with an increase in casuistry and control samples, are necessary for greater evidence of these results.

A COVID-19 é uma doença multissistêmica causada pelo vírus RNA (coronavírus 2 ou SARS-CoV-2) que pode ocasionar repercussão em medidas cognitivas. Objetivo: Identificar os principais sintomas cognitivos e neuropsiquiátricos em adultos sem queixas cognitivas anteriores à infecção. Especificamente, verificar a trajetória do desempenho cognitivo e neuropsiquiátrico após 6 meses. Métodos: Trata-se de um estudo retrospectivo e longitudinal. Foram incluídos 49 pacientes (29 reavaliados após 6 meses), com exame de PCR positivo, sem queixas cognitivas prévias que só se apresentaram após a infecção ou histórico de doenças neurológicas estruturais ou neurodegenerativas. Foram utilizados a bateria de avaliação cognitiva breve (MoCA), o Teste de Trilhas (TMT-A, B e ∆) e o Teste de Fluência Verbal; assim como a Escala Hospitalar de Ansiedade e Depressão (HADS), e a escala de Severidade da Fadiga (ESF/BR). Testes de correlação e comparação de grupos foram utilizados para estatística descritiva e inferencial. Esta ocorreu através de. Nível de significância de α=5%. Resultados: idade média de 50,4 anos (11,3), anos de escolaridade 12,7 (2,8), maior proporção de mulheres (69,8%). Não foi observada melhora psicoemocional (depressão e ansiedade) entre as avaliações, assim como os pacientes mantiveram a queixa subjetiva de alteração cognitiva. A escala HAD-Ansiedade apresentou correlação significativa com os erros do TMT-B. O subgrupo que participou da estimulação cognitiva e psicoeducação apresentou melhora na medida de cognição global e no teste de atenção executiva. Conclusão: Nossos resultados corroboram com os demais estudos que constataram que a disfunção cognitiva em pacientes pós-COVID-19 pode persistir por meses após a remissão da doença, assim como sintomas psicoemocionais, mesmo em indivíduos com quadros leves da infecção. Estudos futuros, com aumento de casuística e amostras de controle, são necessários para maior evidência desses resultados.

Cognitive impairment and neuropsychiatric symptoms among individuals with history of symptomatic SARS-CoV-2 infection: a retrospective longitudinal study / Comprometimento cognitivo e sintomas neuropsiquiátricos entre indivíduos com histórico de infecção sintomática por SARS-CoV-2: um estudo longitudinal retrospectivo

ABSTRACT. COVID-19 is a multisystem disease caused by the RNA virus (coronavirus 2 or SARS-CoV-2) that can impact cognitive measures. Objective: To identify the main cognitive and neuropsychiatric symptoms in adults who had no cognitive complaints prior to the infection. Specifically, to observe the trajectory of cognitive and neuropsychiatric performance after 6 months. Methods: This is a retrospective longitudinal study. Forty-nine patients (29 reassessed after 6 months), with a positive PCR test, with no prior cognitive complaints that only presented after the infection and without a history of structural, neurodegenerative or psychiatric neurological diseases. A brief cognitive assessment battery (MoCA), the Trail Making Test (TMT-A, B, ∆), and the Verbal Fluency Test were used, as well as the scales (Hospital Anxiety and Depression Scale-HADS, Fatigue Severity Scale-FSS). Correlation tests and group comparison were used for descriptive and inferential statistics. Level of significance of α=5%. Results: Mean age of 50.4 (11.3), 12.7 (2.8) years of education, higher percentage of women (69.8%). No psycho-emotional improvement (depression and anxiety) was observed between the evaluations, and patients maintained the subjective complaint of cognitive changes. The HAD-Anxiety scale showed a significant correlation with TMT-B errors. The subgroup participating in cognitive stimulation and psychoeducation showed improvement in the global cognition measure and the executive attention test. Conclusion: Our results corroborate other studies that found that cognitive dysfunctions in post-COVID-19 patients can persist for months after disease remission, as well as psycho-emotional symptoms, even in individuals with mild infection. Future studies, with an increase in casuistry and control samples, are necessary for greater evidence of these results.

RESUMO. A COVID-19 é uma doença multissistêmica causada pelo vírus RNA (coronavírus 2 ou SARS-CoV-2) que pode ocasionar repercussão em medidas cognitivas. Objetivo: Identificar os principais sintomas cognitivos e neuropsiquiátricos em adultos sem queixas cognitivas anteriores à infecção. Especificamente, verificar a trajetória do desempenho cognitivo e neuropsiquiátrico após 6 meses. Métodos: Trata-se de um estudo retrospectivo e longitudinal. Foram incluídos 49 pacientes (29 reavaliados após 6 meses), com exame de PCR positivo, sem queixas cognitivas prévias que só se apresentaram após a infecção ou histórico de doenças neurológicas estruturais ou neurodegenerativas. Foram utilizados a bateria de avaliação cognitiva breve (MoCA), o Teste de Trilhas (TMT-A, B e ∆) e o Teste de Fluência Verbal; assim como a Escala Hospitalar de Ansiedade e Depressão (HADS), e a escala de Severidade da Fadiga (ESF/BR). Testes de correlação e comparação de grupos foram utilizados para estatística descritiva e inferencial. Esta ocorreu através de. Nível de significância de α=5%. Resultados: idade média de 50,4 anos (11,3), anos de escolaridade 12,7 (2,8), maior proporção de mulheres (69,8%). Não foi observada melhora psicoemocional (depressão e ansiedade) entre as avaliações, assim como os pacientes mantiveram a queixa subjetiva de alteração cognitiva. A escala HAD-Ansiedade apresentou correlação significativa com os erros do TMT-B. O subgrupo que participou da estimulação cognitiva e psicoeducação apresentou melhora na medida de cognição global e no teste de atenção executiva. Conclusão: Nossos resultados corroboram com os demais estudos que constataram que a disfunção cognitiva em pacientes pós-COVID-19 pode persistir por meses após a remissão da doença, assim como sintomas psicoemocionais, mesmo em indivíduos com quadros leves da infecção. Estudos futuros, com aumento de casuística e amostras de controle, são necessários para maior evidência desses resultados.

Long COVID neuropsychological follow-up: Is cognitive rehabilitation relevant?

BACKGROUND: Duration of neuropsychological disorders caused by long COVID, and the variables that impact outcomes, are still largely unknown. OBJECTIVE: To describe the cognitive profile of patients with long COVID post-participation in a neuropsychological rehabilitation program and subsequent reassessment and identify the factors that influence recovery. METHODS: 208 patients (mean age of 48.8 y.o.), mostly female, were reevaluated 25 months after their first COVID infection and 17 months after their initial evaluation. Patients underwent subjective assessment, Barrow Neurological Institute Screen for Higher Cerebral Functions (BNIS), Phonemic Verbal Fluency and Clock Drawing Tests (NEUPSILIN) for executive functions, Hospital Anxiety and Depression Scale (HADS) and WHOQol-Bref. RESULTS: We noted a discrete improvement of neuropsychological symptoms 25 months after the acute stage of COVID-19; nonetheless, performance was not within the normative parameters of standardized neuropsychological testing. These results negatively impact QoL and corroborate patients' subjective assessments of cognitive issues experienced in daily life. Improvement was seen in those who participated in psychoeducational neuropsychological rehabilitation, had higher levels of education, and lower depression scores on the HADS. CONCLUSION: Our data reveal the persistence of long-term cognitive and neuropsychiatric disorders in patients with long COVID. Neuropsychological rehabilitation is shown to be important, whether in-person or online.

Inhibitory Control of Adjacent Finger Movements while Performing a Modified Version of the Halstead Finger Tapping Test: Effects of Age, Education and Sex.

OBJECTIVE: Selective motor inhibition is known to decline with age. The purpose of this study was to determine the frequency of failures at inhibitory control of adjacent finger movements while performing a repetitive finger tapping task in young, middle-aged and older adults. Potential education and sex effects were also evaluated. METHODS: Kinematic recordings of adjacent finger movements were obtained on 107 healthy adults (ages 20-80) while they performed a modified version of the Halstead Finger Tapping Test (HTFF). Study participants were instructed to inhibit all finger movements while tapping with the index finger. RESULTS: Inability to inhibit adjacent finger movements while performing the task was infrequent in young adults (2.9% of individuals between 20 and 39 years of age) but increased with age (23.3% between the ages of 40 and 59; 31.0% between ages 60 and 80). Females and males did not differ in their inability to inhibit adjacent finger movements, but individuals with a college education showed a lower frequency of failure to inhibit adjacent finger movements (10.3%) compared to those with a high school education (28.6%). These findings were statistically significant only for the dominant hand. CONCLUSION: Selective motor inhibition failures are most common in the dominant hand and occur primarily in older healthy adults while performing the modified version of the HFTT. Monitoring selective motor inhibition failures may have diagnostic significance.

Kinematic recordings while performing a modified version of the Halstead Finger Tapping Test: Age, sex, and education effects.

Introduction: This study attempts to demonstrate that kinematic recordings of finger movements help explain the well-known effects of age, education, and sex on the Halstead Finger Tapping Test (HFTT). Method: High-speed kinematic recordings were obtained on 107 healthy adults (ages 21 to 80 years) while they performed a modified version of the Halstead Finger Tapping Test (HFTT). The number of "valid" taps and "invalid" taps (i.e., lever movements that did not produce an increase in the mechanical number count), tapping speed variability, "learning" and "fatigue" effects was obtained. Results: Previous age, education, and sex effects were replicated. Males had faster start and stop times when finger tapping and these measures correlated with the number of valid taps per 10 s. Educational level correlated with start times, not stop times. Age correlated only with the number of valid taps. Variability of tapping movements correlated with the number of invalid taps, but not valid taps. Females had more invalid taps than males. Fatigue and learning effects were independent of the person's age, education, and sex. Conclusion: Kinematic recordings of finger tapping help explain the well-known age, education, and sex effects on finger tapping speeds. A modified method of administrating the HFTT is also introduced to assess fatigue and learning effects while performing this task.

Empowering preadolescents with ABI through metacognition: preliminary results of a randomized clinical trial.

PURPOSE: The aim of this randomized clinical trial study was to evaluate the efficacy of an intervention program based on social mediation, cooperative learning and metacognition (Metacognitive Dimension) in preadolescents with acquired brain injury (ABI). PARTICIPANTS/METHODS: Participants were 29 ABI preadolescents: 14 in the experimental group and 15 in the control group (average age, 10.4 y.o.; average time of lesion, 5.3 years). Evaluations were conducted 3 months after the start of the intervention, using the Evaluation Scale of Elementary School Learning Strategies (ESESLS) to assess metacognitive strategies, Self-Concept Scale for Children (SCSC) and Behavioral Rating Inventory of Executive Functions (BRIEF). RESULTS: The experimental group had superior outcomes to the control. The results of metacognitive strategies (ESESLS) and self-concept (SCSC) were better in the experimental than in the control group (p< 0.05). BRIEF did not reveal any significant differences between the groups, although we observed better results in the experimental group for 5 sub items of the scale, in the broader index and global executive composite score. CONCLUSION: Three months of an intervention based on cooperative learning helped preadolescents with acquired brain injury develop metacognitive strategies and improve self-concept, thereby helping empower the preadolescents in their social relationships.

Computerized procedure for analyzing hand kinematics with a peg-moving task (Sarah-Pegworks).

This article describes Sarah-Pegworks, a computerized procedure for analyzing hand kinematics based on the peg-moving task. The procedure, developed in Visual Basic 6 programming language, includes (1) processing raw data from an infrared motion-tracking system, (2) identifying movement components, and (3) analyzing and presenting hand kinematic information in numerical and graphic outputs. Fifty-five normal adults set the parameters relative to filtering and movement identification. A case was presented to illustrate the clinical value of this procedure.

Hand skill assessment with a reduced version of the Peg Moving Task (PMT-5) in children: normative data and application in children with cerebral palsy.

This paper proposes a simple method of hand skill assessment in children that can be useful in clinical practice. A reduced 5-hole version of Annett's Peg Moving Task was used to quantify hand skill bilaterally in 435 normally developing preschool and school-children, and adolescents aged 3-18 years from Brazil. The cross-cultural validity of the normative data obtained in Brazil was verified in 157 school-children aged 6-11 years from France. An application in 76 children with cerebral palsy (hemiplegia 21, diplegia 34, triplegia 6, mixed type 15) showed very important variability of the deficits in hand function within each subtype of cerebral palsy (CP). Hand deficits were more severe in children in special schools than in children in regular schools within each CP subtype. A qualitative analysis showed which difficulties during the execution of the task were specific to children with CP and which were also observed in normally developing children.

Quality-of-life: child and parent perspectives following severe traumatic brain injury.

PURPOSE: Traumatic brain injury (TBI) can produce temporary or permanent impairment. Quality-of-life (QoL) after TBI has been well studied in adults, but less so in children. The aim of this study was to assess the QoL of children with TBI and compare the findings with the evaluations of parents and children without brain injury. METHODS: Participants were 23 children with TBI, mean age 11 years, who had been treated at the SARAH Network of Rehabilitation Hospitals. Participants were matched by age, sex, parents' socio-cultural level and place of residence with 23 other children who had no history of brain injury. The instruments used were the SARAH QoL Questionnaire for Children and Adolescents, Wechsler Intelligence Scale for Children, the SARAH Physical-Functional Classification of the Child and Adolescent and a structured interview with parents. RESULTS: The results demonstrated that, in an average 4 years after the accident, all of the children with TBI were attending school and most could walk independently. The parents' reports about post-TBI problems were marginally associated with the children's self-evaluations. The parents showed important concerns regarding their child across all dimensions of life. CONCLUSIONS: Children with TBI report significantly reduced QoL compared to a control group in the physical, psychological, cognitive and total score dimensions. However, TBI children with average academic performance (65%) obtained the same QoL scores as the control group.

Brain activation in a myoelectric prosthetic hand: the role of the brain in the rehabilitation of amputees.

BACKGROUND: Historically, rehabilitation of amputees has focused on developing prostheses, adjusting them to fit the limb, and then submitting the patient to extensive "training" programs. The objective of this study was to investigate whether stimuli from the sensorimotor cortex, observed through functional magnetic resonance imaging, comprises a neuronal network that permits the control of a myoelectric prosthetic hand. METHODS: A comprehensive review of the subject was conducted, and a specific case is presented to illustrate the hypothesis. In a self-controlled designed study, a 13-year-old girl with congenital amputation of the right hand was tested to verify if the brain can control fine motor movement of a myoelectric prosthetic hand. Functional magnetic resonance images were conducted to assess whether there was a relationship between brain activation and control of the prosthesis. Functional magnetic resonance imaging data were collected to investigate brain activation during the actual opening and closing of the existent hand and during the contraction of the remaining stump muscles used for opening and closing the myoelectric prosthetic hand. RESULTS: Similar activation was found in the brain hemispheres that control the myoelectric and existing hands. When the patient moved the prosthetic hand, activation was observed in the brain's sensorimotor and visual cortexes and the cerebellum. These data suggest that the patient was controlling and also perceiving that the artificial hand was performing movements. CONCLUSIONS: This study suggests that it may be possible to control speed, force, and modulation of a myoelectric prosthesis through impulses emitted by specific brain areas. CLINICAL RELEVANCE: Further research in brain control and improvement of myoelectric prosthesis will lead to a more holistic approach in the development of a man-machine complex.

Manual skill, hand skill asymmetry, and neuropsychological test performance in schoolchildren with spastic cerebral palsy.

Bilateral hand skill assessment with a computerised version of the Peg Moving Task, and neuropsychological testing, were performed in 30 children aged 7 to 8 years with spastic cerebral palsy (CP) and without mental retardation, diplegia (n = 10), right hemiplegia (n = 10), or left hemiplegia (n = 10), and in 30 controls. Compared to controls: (i) 30% of the hemiplegic children showed impairment of the unaffected hand and 70% of the diplegic children showed impairment in both hands; (ii) children with CP were impaired only in oral repetition and in visual-motor tasks. Results of neuropsychological testing were not significantly different between the three groups of children with CP. Right minus left asymmetry in hand skill was not related to neuropsychological testing; however, degree of impairment of the right hand was associated with phonological and metaphonological skills, and of the left hand with visuospatial and counting performance. Hand skill was related to the ability to perform many daily living manual activities. It is concluded that impairment of hand function, rather than the side of the more affected hand, is related to neuropsychological deficits in children with cerebral palsy.

Degree of illiteracy and phonological and metaphonological skills in unschooled adults.

Phonological and metaphonological skills are explored in 97 Brazilian illiterate and semiliterate adults. A simple letter- and word-reading task was used to define the degree of illiteracy. Phonemic awareness was strongly dependent on the level of letter and word reading ability. Phonological memory was very low in illiterates and unrelated to letter knowledge. Rhyme identification was relatively preserved in illiterates and semiliterates, and unrelated to letter and word reading level. Phonetic discrimination (minimal pairs) was fairly good and marginally related to reading ability. These results suggest that phonological sensitivity, phonological memory, rhyme identification, and phonemic awareness are distinctive cognitive processes, and that only phonemic awareness is clearly and strongly dependent on the alphabetical acquisition.