Long-term Neurocognitive and Psychiatric Consequences in Severe COVID-19 Survivors.
- Conditions
- Neurocognitive DysfunctionCovid19
- Registration Number
- NCT05019300
- Lead Sponsor
- Pontificia Universidad Catolica de Chile
- Brief Summary
Long-term neurocognitive and psychiatric consequences of COVID-19 remain mostly unknown to date. It has been reported that coronaviruses cause direct central nervous system infection (Needham et al. 2020). Besides that, new or worsening cognitive impairment commonly occurs and persists in survivors of intensive care unit (ICU) stay (Hosey \& Needham. 2020). The purpose of our study is to search and describe the cognitive and psychiatric long-term consequences of COVID-19 on patients who have been discharged from critical care units. This is an ambidirectional cohort study, that attempts to follow adults discharged from critical Care Units Adults due to COVID-19 up to 12 months after discharge, to evaluate the presence of cognitive impairment, linguistic and phonation function, depression, fatigue, functional gastroenterological symptoms, anxiety, or post traumatic disorder, and performance in activities of daily living and physical response to exercise as well.
- Detailed Description
Not available
Recruitment & Eligibility
- Status
- UNKNOWN
- Sex
- All
- Target Recruitment
- 80
- Adults over 18 years of age who have been hospitalized at critical care units, who were admitted for a diagnosis of COVID-19 and who present a score on the MOCA® cognitive test of less than 26 points at the time of hospital discharge .
- History of underlying cognitive disorder. History of underlying primary psychotic disorder. MOCA® cognitive test score greater than or equal to 26 points at the time of hospital discharge.
Study & Design
- Study Type
- OBSERVATIONAL
- Study Design
- Not specified
- Primary Outcome Measures
Name Time Method Cognitive impairment screening 12 months Montreal Cognitive Assessment (MoCA®). Evaluation of cognitive domains (visuospatial, executive function; attention and memory; orientation; language).
Min score: 0 Max score: 30 Cut-off for chilean population: \< 21 for mild cognitive impairment. \< 20 for dementia
Setting: Home and online
- Secondary Outcome Measures
Name Time Method Post Traumatic Stress Disorder 12 months Test: Post Traumatic Checklist for Diagnostic and Statistical Manual of Mental Disorders 5 (DSM-5) score
20-item self-report measure that assesses the 20 DSM-5 symptoms of Post Traumatic Stress Disorder.
The cut-off point suggested is of ≥33 Min score: 0 Max score: 80
Setting: onlinePhysical disability 12 months Test: Barthel Index score
Measures physical disability behaviour relating to activities of daily living.
Scores of 0-20 indicate "total" dependency, 21-60 indicate "severe" dependency, 61-90 indicate "moderate" dependency, and 91-99 indicates "slight" dependency.
Setting: onlineQuality of life related to health 12 months Test: The 5-level EuroQol 5D health questionnaire. (EQ-5D-5L) Self rated.
Min score: 0 Max score: 100 highest score means worst quality of life.
Setting: onlineNeurological Soft Signs 12 months Test: Heidelberg Neurological Soft Signs Scale
16 items on five factors ("motor coordination": Ozeretzki's test, diadochokinesis, pronation/supination, finger-to-thumb opposition, speech and articulation; "sensory integration": gait, tandem walking, two-point discrimination; "complex motor tasks": finger-to-nose test, fist-edge-palm test; "right/left and spatial orientation": right/left orientation, graphesthesia, face-hand test, stereognosis; "hard signs": arm holding test, mirror movements). All items except for gait, tandem gait, Ozeretzki's test, speech and articulation and right/left orientation are assessed separately for both, right and left sites respectively. Ratings are given on a 0-3 point scale (no/slight/moderate/marked abnormality).
Higher scores mean worse outcomes. Min score: 0 Max score: 48 No cut-off point established in the literature.
Setting: HomePain severity 12 months Scale: Stanford pain scale
Min: 0 represents no pain Max: 10 represents unimaginable or unspeakable pain Setting: onlineDysautonomia 12 months Scales: Scales for outcomes in Parkinson's dysfunction-autonomic (SCOPA-AUT), Orthostatic hypotension symptom assessment (OHSA) and Orthostatic hypotension activity scale (OHACT).
Setting: onlineFatigue 12 months Measured by the Modified fatigue impact scale (MFIS). The MFIS is a modified version of the 40-item Fatigue Impact Scale (FIS), which was originally developed to assess the effects of fatigue on quality of life in patients with chronic diseases. The FIS has patients rate the extent to which fatigue has affected their life in the past 4 weeks on a questionnaire consisting of 10 "physical" items, 10 "cognitive" items, and 20 "social" items, with 0 indicating "no problem" and 4 indicating "extreme problem."
The cut-off point suggested is of ≥38 Min score: 0 Max score: 160
Setting: onlineVerbal fluency 12 months Verbal fluency (phonological and sematic) will be assed by requesting the participants to elicit word under 1 minute for letter F, A and S and for the category animals.
Setting: Home and onlinecomplex post-traumatic stress disorder 12 months Test: International Trauma Questionnaire self-report measure for post-traumatic stress disorder (PTSD) and complex post-traumatic stress disorder (CPTSD), corresponding to the diagnostic criteria in the International Classification of Diseases, 11th Revision (ICD-11).
Setting: onlineirritable bowel syndrome 12 months Rome IV criteria Setting: online
Insomnia 12 months Scale: Pittsburgh insomnia rating scale
Seven component scores are derived, each scored 0 (no difficulty) to 3 (severe difficulty). The component scores are summed to produce a global score (range 0 to 21). Higher scores indicate worse sleep quality.
Setting: onlineCognitive performance 12 months Cambridge Neuropsychological Test Automated Battery (CANTAB®)
Included tests:
Reaction time test, (RTI) Paired associate learning (PAL) Spatial Working Memory (SWM) Spatial Span (SSP) Rapid Visual Information Processing (RVP) Cambridge Gambling Task (CGT) Intra/Extra Dimensional Set Shift (IED) Stockings of Cambridge (SOC)
Scores: z-scores normalized by sex and educational level
Setting: HomeGlobal functionality 12 months Post-Covid-19 functional scale 5 levels of severity, where o is non impairment and 5 is the highest level of impairment.
Setting: onlineAnxiety 12 months Test: Generalized Anxiety Disorder-7 score
The seven items assess (1) feeling nervous, anxious, or on edge; (2) being able to stop or control worrying; (3) worrying too much about different things; (4) trouble relaxing; (5) being restless; (6) becoming easily annoyed or irritable; and (7) feeling afraid as if something awful might happen.
Increasing scores on the scale are strongly associated with multiple domains of functional impairment and increasing anxiety.
The cut-off point suggested is of ≥10 Min score: 0 Max score: 21
Setting: onlineDepressive syndrome 12 months Test: Patient Health Questionary-2 (PHQ-2) score for screening of depressive syndrome
The cut-off point suggested is of ≥3 Min score: 0 Max score: 6
Setting: onlineExercise endurance 12 months Performance on 6 minutes- walk test
Evaluation of aerobic capacity and exercise endurance.
Setting: HomeMuscle strength 12 months Dynamometry Setting: Home
Spontaneous Speech 12 months Spontaneous Speech is a useful research tool to assess the scope of language disorders in people with neurological deficits. Short samples be analyzed during a brief interview and based of 10 linguistics parameters, it will characterized level and the type of language deficit. The 10 linguistic parameters are based on the ALEA method
Setting: Home and onlineDyspnea 12 months Test: Chronic obstructive pulmonary disease (COPD) assessment test (CAT).
Min: 0 Max: 40 CAT ≥10 corresponds to either GOLD Group B or D. Group B patients' preferred treatment is to start either on LABA, or LAMA and if persistent symptoms then combination LAMA/LABA therapy-these are the minimum for patients with CAT Score ≥10.
CAT \<10 corresponds to GOLD Group A or C. Group A patients' preferred treatment is to start bronchodilator (LABA or LAMA) and evaluate the effect.
Setting: online
Trial Locations
- Locations (1)
Centro de Investigaciones Médicas, Centro de Investigación Clínica UC, Hospital Clínico UC, San Carlos de Apoquindo, Departamento de Ciencias de la Salud, Escuela de Medicina, Red UC-Christus, Campus Clínico San JoaPontificia Universidad Catolica de Chile
🇨🇱Santiago, Chile