Cognitive sequelae of the biological effects of COVID-19 on the nervous system in a health disparity population
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This application for an ancillary study to UG3NS105565 is very responsive to NOT-NS-20-051. Early reports of Covid-19 patients demonstrate a high prevalence of neurological symptoms, but the long-term neurological and cognitive outcomes are still unknown. Patients with cognitive complaints at high risk of cognitive decline may be especially vulnerable to neurological sequelae of Covid-19. The 5-Cog study is ongoing single-blind, randomized clinical trial in 1,200 older primary care patients presenting with cognitive complaints who will be randomized to receive either the 5- Cog battery or a 5-minute health literacy. The primary outcome is ‘Improved dementia care’ defined as new Mild Cognitive Impairment syndrome or dementia diagnoses as well investigations or treatments for cognitive impairment. As of June 2020, 453 participants (African-American 34% and non-Black Hispanic 54%) were enrolled in the trial. We propose to cross-enroll all participants to study the long-term effects of Covid-19 infection on cognitive trajectories over a one-year period using remote assessments. Covid status will be ascertained by medical interviews, electronic medical records or serological test results. We hypothesize that COVID-19 infection will be associated with worse cognitive functioning in the months following infection and on long term follow-up, with severity of infection, hospitalization, complexity of treatment and prior cognitive impairment moderating the presentation. We propose the following two aims. Aim 1: To determine the cognitive consequences of Covid-19 infection in older adults with cognitive complaints in a health disparity population. We will track cognitive status using conventional (neuropsychological tests) and novel cognitive assessments (non-linguistic vocal biomarkers). To eliminate risk of disease transmission, all cognitive assessments will be done remotely by telephone every 3 months over a one-year period. Cognitive trajectories will be compared by Covid-19 status as well as by race/ethnicity (African-American and Hispanic). Aim 2: To examine the impact of the clinical severity of Covid-19 infection on cognitive outcomes in a health disparity population. Severity will be assessed clinically as mild or asymptomatic, moderate (require hospitalization) or severe (ICU admission) Covid-19 survivors. The cognitive trajectories will be reported within each clinical severity strata, and compared between Africa-American and Hispanic participants.
