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Cited by 225Long-Term Effects of COVID-19Intensive Care Unit Cognitive DisordersCOVID-19 and Mental Health

One-Year Trajectory of Cognitive Changes in Older Survivors of COVID-19 in Wuhan, China: A Longitudinal Cohort Study

Open access
Liu, Yu-Hui, Chen, Yang, Wang, Qing-Hua, Wang, Ling-Ru, Jiang, Li, Yang, Ying, Chen, Xian, Li, Ying +9 more·2022·JAMA Neurology
DOI 10.1001/jamaneurol.2022.0461PMC PMC8905512
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Abstract

Importance: Determining the long-term impact of COVID-19 on cognition is important to inform immediate steps in COVID-19 research and health policy. Objective: To investigate the 1-year trajectory of cognitive changes in older COVID-19 survivors. Design, Setting, and Participants: This cohort study recruited 3233 COVID-19 survivors 60 years and older who were discharged from 3 COVID-19-designated hospitals in Wuhan, China, from February 10 to April 10, 2020. Their uninfected spouses (N = 466) were recruited as a control population. Participants with preinfection cognitive impairment, a concomitant neurological disorder, or a family history of dementia were excluded, as well as those with severe cardiac, hepatic, or kidney disease or any kind of tumor. Follow-up monitoring cognitive functioning and decline took place at 6 and 12 months. A total of 1438 COVID-19 survivors and 438 control individuals were included in the final follow-up. COVID-19 was categorized as severe or nonsevere following the American Thoracic Society guidelines. Main Outcomes and Measures: The main outcome was change in cognition 1 year after patient discharge. Cognitive changes during the first and second 6-month follow-up periods were assessed using the Informant Questionnaire on Cognitive Decline in the Elderly and the Telephone Interview of Cognitive Status-40, respectively. Based on the cognitive changes observed during the 2 periods, cognitive trajectories were classified into 4 categories: stable cognition, early-onset cognitive decline, late-onset cognitive decline, and progressive cognitive decline. Multinomial and conditional logistical regression models were used to identify factors associated with risk of cognitive decline. Results: Among the 3233 COVID-19 survivors and 1317 uninfected spouses screened, 1438 participants who were treated for COVID-19 (691 male [48.05%] and 747 female [51.95%]; median [IQR] age, 69 [66-74] years) and 438 uninfected control individuals (222 male [50.68%] and 216 female [49.32%]; median [IQR] age, 67 [66-74] years) completed the 12-month follow-up. The incidence of cognitive impairment in survivors 12 months after discharge was 12.45%. Individuals with severe cases had lower Telephone Interview of Cognitive Status-40 scores than those with nonsevere cases and control individuals at 12 months (median [IQR]: severe, 22.50 [16.00-28.00]; nonsevere, 30.00 [26.00-33.00]; control, 31.00 [26.00-33.00]). Severe COVID-19 was associated with a higher risk of early-onset cognitive decline (odds ratio [OR], 4.87; 95% CI, 3.30-7.20), late-onset cognitive decline (OR, 7.58; 95% CI, 3.58-16.03), and progressive cognitive decline (OR, 19.00; 95% CI, 9.14-39.51), while nonsevere COVID-19 was associated with a higher risk of early-onset cognitive decline (OR, 1.71; 95% CI, 1.30-2.27) when adjusting for age, sex, education level, body mass index, and comorbidities. Conclusions and Relevance: In this cohort study, COVID-19 survival was associated with an increase in risk of longitudinal cognitive decline, highlighting the importance of immediate measures to deal with this challenge.

Integrity signals

Registry

Crossref · 10.1001/jamaneurol.2022.0461

Cites

39 of 39 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 13 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    Severe COVID-19 was associated with a higher risk of progressive cognitive decline (OR 19.00, 95% CI 9.14-39.51) after adjusting for age, sex, education, BMI, and comorbidities.

    “Severe COVID-19 was associated with a higher risk of early-onset cognitive decline (odds ratio [OR], 4.87; 95% CI, 3.30-7.20),late-onset cognitive decline (OR, 7.58; 95% CI, 3.58-16.03),and progressive cognitive decline (OR, 19.00; 95% CI, 9.14-39.51)”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Adjustment for age, sex, education, BMI, and comorbidities is sufficient to control for confounding of the association between COVID-19 and cognitive decline.
  • Findingown data

    Severe COVID-19 survivors had lower TICS-40 scores at 12 months than nonsevere survivors and uninfected controls.

    “Individuals with severe cases had lower Telephone Interview of Cognitive Status-40 scores than those with nonsevere cases and control individuals at 12 months (median [IQR]: severe, 22.50 [16.00-28.00];nonsevere, 30.00 [26.00-33.00];control, 31.00 [26.00-33.00]).”
    • Also stated in: § Cognitive Impairment 12 Months After Discharge · plain
      “Individuals with severe cases also had lower TICS-40 scores than those with nonsevere cases (median [IQR] severe, 22.50 [16.00-28.00]vs nonsevere, 30.00 [26.00-33.00];P < .001)and control individuals (median [IQR] severe, 22.50 [16.00-28.00]vs control, 31.00 [26.00-33.00];P < .001) at 12 months.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Exclusion of participants with self-reported or diagnosed preinfection cognitive impairment accurately identifies those without preinfection impairment.
  • Findingown data

    Severe COVID-19 survivors had higher IQCODE scores at 6 months than nonsevere survivors.

    “The IQCODE score (higher score indicates larger longitudinal cognitive decline) at 6 months' follow-up was higher in individuals with severe cases than in those with nonsevere cases (median [IQR], 3.63 [3.15-4.36]vs 3.18 [3.00-3.56];P < .001)”
    Quote in the paperSubstantial claim
  • Findingown data

    The proportion of participants with longitudinal cognitive decline during the first 6 months was higher among severe cases than nonsevere cases (60.77% vs 28.86%).

    “The proportion of participants with longitudinal cognitive decline during the first 6 months was higher among those with severe cases than those with nonsevere cases (60.77% vs 28.86%; P < .001)”
    Quote in the paperSubstantial claim
  • Findingown data

    Severe COVID-19 survivors had lower TICS-40 scores than uninfected controls at 6 months.

    “and control individuals (median [IQR], 24.00 [18.25-29.00]vs 30.00 [26.00-33.25];P < .001) at 6 months.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Uninfected spouses are a valid control group for COVID-19 survivors, comparable on factors affecting cognition.
  • May combine two claims. 5
  • Classified as probably not a substantial claim. 3

  • May combine two claims.

    Findingreasoning

    In this study, nonsevere COVID-19 was linked to cognitive impairment at 12 months and late-onset decline in the paired cohort, but not in the whole cohort.

    “In this study, nonsevere COVID-19 was associated with cognitive impairment at 12 months and late-onset cognitive decline in the paired cohort, but not in the whole cohort.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Study design and conductown data

    COVID-19 survivors and controls who completed the 12-month follow-up did not differ in age, sex, education, BMI, or comorbidities.

    “Among the participants who completed the 12-month follow-up, COVID-19 survivors were not different from control individuals in age, sex distribution, education level, BMI, and frequency of comorbidities, including hypertension, diabetes, hyperlipidemia, stroke, coronary heart disease, and COPD (Table 1).”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    The association between IQCODE and TICS-40 scores was analyzed to ensure consistency of the two cognitive assessments.

    “The association between IQCODE and TICS-40 scores was analyzed to ensure the consistency of the 2 cognitive assessments verified in previous studies.20,21”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [20] source

      Not checked in the free run.

    • cites [21] source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Study design and conductown data

    Telephone cognitive assessments were conducted by trained raters.

    “Telephone interviews were conducted to assess cognition by a group of trained raters (L.-R.W., L.J., Y.Y., X.C., Y.L., Y.C).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Study design and conductown data

    In the paired subgroup, COVID-19 survivors were older and had a higher frequency of hypertension than their uninfected spouses.

    “In the paired subgroup of 438 COVID-19 survivors and their uninfected spouses, survivors were older (median [IQR] age, 68 [65-78] vs 67 [66-74]; P < .001)and had a higher frequency of hypertension (47.03% vs 34.47%; P < .001)than their spouses (eTable 3 in the Supplement).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Cross-sectional studies have shown that SARS-CoV-2 infection is linked to an increased risk of cognitive impairment.

    “several cross-sectional studies showing that SARS-CoV-2 infection is associated with an increase in risk of cognitive impairment”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [8] source

      Not checked in the free run.

    • cites [23] source

      Not checked in the free run.

    • cites [25] source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Persistent systemic inflammation following SARS-CoV-2 infection worsens neurodegeneration, which may cause long-term cognitive deficits.

    “Chronic systemic inflammation after SARS-CoV-2 infection exacerbates neurodegeneration, thus potentially leading to long-term cognitive deficits.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [35] source

      Not checked in the free run.

  • May combine two claims.

    Study design and conductnone given

    The mismatch in sample sizes between survivors and controls and the relatively high loss-to-follow-up weakened the power of the findings.

    “the mismatch of sample sizes between survivors and control individuals and the relatively high rate of loss-to-follow-up weakened the power of the findings”
    Quote in the paperNot a substantial claim
8 of 8

  • The paper relies on this without support.

    Adjustment for age, sex, education, BMI, and comorbidities is sufficient to control for confounding of the association between COVID-19 and cognitive decline.

    “when adjusting for age, sex, education level, body mass index, and comorbidities.”

  • The paper relies on this without support.

    Exclusion of participants with self-reported or diagnosed preinfection cognitive impairment accurately identifies those without preinfection impairment.

    “Participants were excluded if they met the following conditions: (1) did not agree to participate, did not understand the items in the questionnaires, or had communicative obstacles owing to language or hearing reasons; (2) had self-reported or diagnosed cognitive impairment preinfection;”

  • The paper relies on this without support.

    The 1-year follow-up period is sufficient to capture the long-term trajectory of cognitive changes after COVID-19.

    “In this study, we investigated the 1-year dynamic trajectory of cognitive changes in older COVID-19 survivors.”

  • The paper relies on this without support.

    Uninfected spouses are a valid control group for COVID-19 survivors, comparable on factors affecting cognition.

    “Uninfected spouses who lived with the patients were recruited as control individuals.”

  • The paper relies on this without support.

    The long-term pattern of cognitive change among COVID-19 survivors is still not clear.

    “Postinfection cognitive outcomes following COVID-19 have been reported but the long-term dynamic trajectory of cognitive changes in COVID-19 survivors remains unclear.”

  • The paper relies on this without support.

    Cognitive decline may be affected by both preexisting cognitive impairment and COVID-19.

    “As cognitive decline might be affected by both preexisting cognitive impairment and COVID-19, we excluded participants with known preexisting cognitive impairment and a family history of dementia.”
6 of 6

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Nonsevere hypertension rate conflicts with Table 1

    Minor

    The text gives 47.28% for hypertension in nonsevere cases, while Table 1 gives 36.16%. The 47.28% figure is the table's male percentage for that group.

  • Control-group later decline count differs from trajectory categories

    Minor

    Table 2 assigns 12 controls to late-onset decline and 10 to progressive decline. Both categories involve decline in the second six months, giving 22 rather than the reported 23.

    Reported 23 · recomputed 22

2 of 2

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2 of the 41 references couldn’t be matched to a known paper.

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Authors
Liu, Y.-H., Chen, Y., Wang, Q.-H., Wang, L.-R., Jiang, L., Yang, Y., Chen, X., Li, Y., Cen, Y., Xu, C., Zhu, J., Li, W., Wang, Y.-R., Zhang, L.-L., Liu, J., Xu, Z.-Q., & Wang, Y.-J.
Affiliations
  • Army Medical University (CN)
  • Department of Neurology and Centre for Clinical Neuroscience, Daping Hospital, Third Military Medical University, Chongqing, China
  • Department of Oncology, General Hospital of the Central Theatre Command of the People’s Liberation Army, Wuhan, China
Corresponding author
Wang, Yan-Jiang
ORCID
Venue
JAMA Neurology
Publisher
American Medical Association (AMA)
Published
2022-05-01
Volume
79
Issue
5
Pages
509
ISSN
2168-6149 (ISSN-L)
DOI
10.1001/jamaneurol.2022.0461
PMC
PMC8905512
OpenAlex
W4220684118
Cited by
225
References
41
Citations by year
2026: 16 · 2025: 32 · 2024: 54 · 2023: 83 · 2022: 39
FWCI
27.38
Type
journal article
Language
en
Open access
Locations
  • JAMA Neurology (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Funders
National Natural Science Foundation of China (81930028)
Topics
  • Health Sciences › Medicine › Neurology › Long-Term Effects of COVID-19
  • Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Intensive Care Unit Cognitive Disorders
  • Social Sciences › Psychology › Clinical Psychology › COVID-19 and Mental Health
Keywords
COVID-19 pandemic, cognitive decline, older adults, long-term cognitive outcomes, cognitive trajectories, post-COVID cognitive impairment, risk factors for cognitive decline, severe COVID-19, long COVID, Wuhan, SARS-CoV-2, dementia risk, hypertension
MeSH terms
COVID-19, SARS-CoV-2, Aged, Cognition, Female, Humans, Longitudinal Studies, Male, Cohort Studies, Survivors, Cognitive Dysfunction

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