Sintomas cognitivos em pacientes com síndrome pós-covid-19 aguda atendidos por um serviço de teleassistência: uma coorte retrospectiva

Abstract

Background: Four years after the onset of the COVID-19 pandemic, the frequency of long-term post-COVID-19 cognitive symptoms is a matter of concern given the impact it may have on the work and quality of life of affected people. Objective: To evaluate the incidence of cognitive symptoms for at least 12 weeks after the acute infection, as well as the associated risk factors in COVID-19 outpatients assisted by a Brazilian public telehealth service. Methods: Retrospective cohort, which included outpatients who had laboratory-confirmed COVID-19 and were assisted by a public telehealth service provided by the Telehealth Network of Minas Gerais (TNMG), during the acute phase of the disease, between December/2020 and March/2022. Data were collected through a structured questionnaire, applied via phone calls, regarding COVID-19 symptoms during the acute phase and their persistence after 12 weeks of the disease. Cognitive symptoms were defined as any of the following: memory loss, problems concentrating, word finding difficulties, and difficulty thinking clearly. Results: From 630 patients who responded to the questionnaire, 23.7% presented cognitive symptoms at 12 weeks after infection. These patients had a higher median age (33 [IQR 25-46] vs 30 [IQR 24-42] years-old, p=0.042) with a higher incidence in the female sex (80.5% vs 62.2%, p<0.001) when compared to those who did not present cognitive symptoms, as well as a lower incidence of smoking (8.7% vs 16.2%, p=0.024). Furthermore, among patients infected in the second wave, 31.0% showed cognitive symptoms at least 12 weeks after infection, while only 21.3% reported the occurrence of these manifestations among those who were infected in the third wave.). In the group of patients with cognitive symptoms, 21.5% needed to seek in-person care in the acute phase of the disease, compared to 9.3% in the group that did not present cognitive symptoms. In multivariate logistic regression analysis, cognitive symptoms were associated with female sex (OR 2.24, CI 95% 1.41-3.57), fatigue (OR 2.33, CI 95% 1.19-4.56), depression (OR 5.37, CI 95% 2.19-13.15) and the need for seek in-person care during acute COVID-19 (OR 2.23, CI 95% 1.30-3.81). Conclusion: In this retrospective cohort of patients with mostly mild COVID-19, cognitive symptoms were present in 23.7% of patients with COVID-19 at 12 weeks after infection. Female sex, fatigue, depression and the need to seek in-person care during acute COVID-19 were the risk factors independently associated with this condition.