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

The DOI matches its Crossref record; 39 of the 41 references it cites were found in a registry or an index; none of the 13 sources its claims cite is checked for support yet.

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, Cen, Yuan, Xu, Cheng, Zhu, Jie, Li, Wei, Wang, Ye-Ran, Zhang, Li-Li, Liu, Juan, Xu, Zhi-Qiang, Wang, Yan-Jiang·2022·JAMA Neurology

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.

Overview

Integrity signals

Registry

Crossref · 10.1001/jamaneurol.2022.0461

Cites

39 of 39 references verified0 citation errors · 0 not checkable

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Claims the paper makes

45 Own result · 8 Own method · 7 Not checked yet · 7 Own interpretation · 1 No basis given

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  • It may state two separate claims as one. 5
  • Probably not a substantial claim. 3
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.”
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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
Venue
JAMA Neurology
Published
2022-05-01
Volume
79
Issue
5
Pages
509
ISSN
2168-6149 (ISSN-L)
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 › Clinical 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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