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Cognitive impairment, and post acute sequelae among people with the history of COVID-19 in Indonesia

Background

COVID-19 infection has unique symptoms, and it can continue for long-term symptoms. These symptoms can interfere with the life of people with the previous history of COVID-19. The INSPIRASI Project in collaboration with the Ministry of Health will measure the long-term impact of the exposure to COVID-19.

COVID-19 has a wide range of clinical manifestations such as neurological, psychiatric, psychological, and psychosocial disorders.1 One study showed a high incidence of cognitive disorders following COVID-19 infection with cognitive complaints such as dementia, mild cognitive impairment (MCI), or subjective cognitive decline (SCD).2 Previous study demonstrated a relatively high frequency of cognitive impairment among hospitalized patients found several months after patients contracted COVID-19, including impairment of executive functioning, processing speed, category fluency, memory encoding, and recall memory.3 Another study conducted by Alemanno et al., 2021 revealed that 80% of COVID-19 survivors in the subacute phase had cognitive impairment. The examination of cognitive function was done in the outpatients setting by using Mini-Mental State Evaluation (MMSE), Montreal Cognitive Assessment (MoCA), Hamilton Rating Scale for Depression, and Functional Independence Measure (FIM). 1,2

Cognitive impairment may also occur even in mildly symptomatic subjects six months after the disease onset of covid. Tavares et al, 2022, found cognitive impairment among 23% of COVID 19 patient happen in 29% at severe phase, 30% at moderate phase dan 3% at mild phase.1 The cause of the cognitive impairment associated with COVID-19 is the ischemic changes, as cerebrovascular changes indicate a risk of cognitive impairment and dementia also endothelial damage in COVID-19 which make clearance of brain metabolites may be impaired, including beta-amyloid peptides implicated in Alzheimer's disease.4 Cognitive impairment can have some cognitive symptoms and brain fog condition such as memory problems, attention deficit, difficulty concentrating, difficulty in decision-making, slower reaction times, and language disorders.5

One year cohort study in China found that approximately 3.3% of COVID-19 survivors had dementia and 9.1% had MCI at 12 months after discharge and in particular, the incidences of dementia and MCI were 15.00% and 26.15% in individuals with severe cases, respectively associated with long-term cognitive impairment.6 In June 2020, a letter reported that a third of their discharged COVID-19 patients showed a dysexecutive syndrome consisting of inattention, disorientation, or poorly organized movements in response to command.7 Among global population, health workers are one of group population that easily exposed to COVID 19 infection. Study by Carazo et al., showed that cognitive impairment post-COVID 19 infection become a frequent sequela of ambulatory in working age adults.8 Twelve months after discharge, there is 12,45% incidence of cognitive impairment in COVID-19 survivors.6 Cognitive screening among post COVID 19 infection in population are relatively forgotten, yet the prevalence of Post COVID-19 impairments among the population is still poorly studied. This activity aimed to identify the prevalence of Post COVID 19 Cognitive impairment, and post acute sequelae among the population in Indonesia.

Methods

Study design

The study will be conducted with cross-sectional study design. We will perform observational studies among people who have a history of COVID-19 in Indonesia. Participants of this study will be randomly selected people who tested positive of COVID-19 with reverse transcription‐polymerase chain reaction (RT‐PCR) on nasopharyngeal swab performed between January 1st - September 30th 2022 in the five large tertiary hospitals from Sumatera (Sumatera Utara - RSUP Adam Malik), Java (Jawa Tengah - RSUP Karyadi ; Yogyakarta - RSUP dr. Sardjito), Bali (Bali - RSUP Sanglah) and Sulawesi Regions (Sulawesi Selatan - RSUP Wahidin Sudiro Husodo).