Neurologic Manifestations of Long COVID Differ Based on Acute COVID-19 Severity.

OBJECTIVE: To characterize neurologic manifestations in post-hospitalization Neuro-PASC (PNP) and non-hospitalized Neuro-PASC (NNP) patients. METHODS: Prospective study of the first 100 consecutive PNP and 500 NNP patients evaluated at a Neuro-COVID-19 clinic between 5/2020 and 8/2021. RESULTS: PNP were older than NNP patients (mean 53.9 vs 44.9 y; p < 0.0001) with a higher prevalence of pre-existing comorbidities. An average 6.8 months from onset, the main neurologic symptoms were "brain fog" (81.2%), headache (70.3%), and dizziness (49.5%) with only anosmia, dysgeusia and myalgias being more frequent in the NNP compared to the PNP group (59 vs 39%, 57.6 vs 39% and 50.4 vs 33%, all p < 0.003). Moreover, 85.8% of patients experienced fatigue. PNP more frequently had an abnormal neurologic exam than NNP patients (62.2 vs 37%, p < 0.0001). Both groups had impaired quality of life in cognitive, fatigue, sleep, anxiety, and depression domains. PNP patients performed worse on processing speed, attention, and working memory tasks than NNP patients (T-score 41.5 vs 55, 42.5 vs 47 and 45.5 vs 49, all p < 0.001) and a US normative population. NNP patients had lower results in attention task only. Subjective impression of cognitive ability correlated with cognitive test results in NNP but not in PNP patients. INTERPRETATION: PNP and NNP patients both experience persistent neurologic symptoms affecting their quality of life. However, they harbor significant differences in demographics, comorbidities, neurologic symptoms and findings, as well as pattern of cognitive dysfunction. Such differences suggest distinct etiologies of Neuro-PASC in these populations warranting targeted interventions. ANN NEUROL 2023;94:146-159.

Memory precision for salient distractors decreases with learned suppression.

Attention operates as a cognitive gate that selects sensory information for entry into memory and awareness (Driver, 2001, British Journal of Psychology, 92, 53-78). Under many circumstances, the selected information is task-relevant and important to remember, but sometimes perceptually salient nontarget objects will capture attention and enter into awareness despite their irrelevance (Adams & Gaspelin, 2020, Attention, Perception, & Psychophysics, 82[4], 1586-1598). Recent studies have shown that repeated exposures with salient distractor will diminish their ability to capture attention, but the relationship between suppression and later cognitive processes such as memory and awareness remains unclear. If learned attentional suppression (indicated by reduced capture costs) occurs at the sensory level and prevents readout to other cognitive processes, one would expect memory and awareness to dimmish commensurate with improved suppression. Here, we test this hypothesis by measuring memory precision and awareness of salient nontargets over repeated exposures as capture costs decreased. Our results show that stronger learned suppression is accompanied by reductions in memory precision and confidence in having seen a color singleton at all, suggesting that such suppression operates at the sensory level to prevent further processing of the distractor object.