4 Neurophenotypes and recovery trajectories following laboratory-confirmed SARS-CoV-2 infection

• Published in: Journal of the International Neuropsychological Society 2023-11, Vol.29 (s1), p.877-879
• Main Authors: Prabhakaran, Divya, Day, Gregory S, Munipalli, Bala, Rush, Beth, Pudalov, Lauren, Niazi, Shehzad, Brennan, Emily, Powers, Harry R, Athreya, Arjun, Blackmon, Karen
• Format: Article
• Language: English
• Subjects: Anosmia; Cognition; Cognitive ability; Comorbidity; Complications; COVID-19; Elbow; Electronic medical records; Executive function; Fatigue; Infections; Infectious Disease (HIV/COVID/Hepatitis/Viruses); Memory; Neuropsychology; Olfaction disorders; Patients; Phenotypes; Post traumatic stress disorder; Poster Session 09: Psychiatric Disorders | Mood & Anxiety Disorders | Addiction | Social Cognition | Cognitive Neuroscience | Emotional and Social Processing; Severe acute respiratory syndrome coronavirus 2; Socioeconomic factors; Variance analysis
• ISSN: 1355-6177; 1469-7661
• DOI: 10.1017/S1355617723010810

Objective:Cognitive sequelae are reported in 20-25% of patients following SARS-CoV-2 infection. It remains unclear whether post-infection sequelae cluster into a uniform cognitive syndrome. In this cohort study, we characterized post-COVID neuropsychological outcome clusters, identified factors associated with cluster membership, and examined 6-month recovery trajectories by cluster.Participants and Methods:The Mayo Clinic Institutional Review Board approved study protocols. Informed consent was obtained from all participants. Participants (> 18 years old) were recruited from a hospital-wide registry of Mayo Clinic Florida patients who tested positive for SARS-CoV-2 infection from July 2020 to Feb 2022. We abstracted participant health history and COVID-19 disease severity (NIAID score) from the electronic health record and retrieved Area Deprivation Index (ADI) scores as a measure of neighborhood socioeconomic disadvantage. We assessed objective cognitive performance with the CNS Vital-Signs (CNSVS) and subjective neuropsychological symptoms with the Neuropsych Questionnaire-45 (NPQ-45). Results were used as input features in a K-means clustering analysis to derive neurophenotypes. Chi-square and analysis of variance (AnOvA) tests were used to identify clinical and sociodemographic factors associated with cluster membership. Participants repeated the CNS Vital Signs, NPQ-45, as well as the Medical Outcomes Survey (MOS SF-36) and a posttraumatic stress disorder (PTSD) checklist (PCL-C 17) 6 months following initial testing. Repeated-measures ANOVA was used to assess change in neurocognitive performance over time by cluster. Significance was set at P < 0.05.Results:Our cohort consisted of 205 participants (171 ambulatory, 34 hospitalized) who completed post-acute outcome assessment a mean of 5.7 (± 3.8) weeks following testing positive for SARS-CoV-2. K-means clustering with elbow method fitting identified three subgroups (see figure). The first cluster (N = 31) is characterized by executive dysfunction, greater socioeconomic disadvantage, and higher rates of obesity. The second cluster (N = 32) is characterized by memory and speed impairment, higher COVID severity, prevalent anosmia (70%), and greater severity of memory complaints, depression, anxiety, and fatigue. The third and largest cluster (N = 142) is absent cognitive impairment. Approximately 39% of participants completed the 6-month outcome assessment (N=79). Regardless of cluster membership, verba