Many people who have been hospitalised with Covid-19 continue to have cognitive and psychiatric problems even two to three years post-infection, according to research.
A study conducted by a group of researchers led by the universities of Oxford and Leicester has highlighted the persistent and significant nature of these symptoms as well as the emergence of new symptoms years after Covid-19 was first present.
Worryingly from a workplace health perspective, a significant proportion of the trial participants (one in four) reported that these symptoms, and their ongoing poor health, had forced them to change their occupation.
The research, published in the journal Lancet Psychiatry, was conducted with 475 participants as part of the PHOSP-Covid study. This is a consortium of scientists from across the UK who are researching long-term health outcomes for patients hospitalised with Covid-19.
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They were invited to complete a set of cognitive tests via their computer and to report their symptoms of depression, anxiety, fatigue and their subjective perception of memory problems. They were also asked whether they had changed their occupation and why.
The researchers found two to three years after being infected with Covid-19, participants scored on average significantly lower in tests of attention and memory than expected.
The average deficit was equivalent to 10 IQ points. Additionally, a substantial proportion reported severe symptoms of depression (about one in five people), anxiety (one in eight), fatigue (one in four), and subjective memory problems (one in four). Moreover, these symptoms worsened over time.
Although in many people these symptoms at two to three years were already present six months post-infection, some people also experienced new symptoms two to three years after their infection that they had not experienced before.
New symptoms often emerged in individuals who already exhibited other symptoms at six months post-infection.
This, the research team argued, suggests that early symptoms can be predictive of later, more severe, issues, so underscoring the importance of timely management.
More than one in four participants reported changing their occupation and many gave poor health as a reason. Occupation change was strongly associated with cognitive deficits and not with depression or anxiety, the researchers argued.
This suggested that many people who changed occupation in the months and years after Covid-19 did so because they could no longer meet the cognitive demands of their job rather than for lack of energy, interest or confidence, the researchers said.
The degree of recovery at six months post-Covid-19 is a strong predictor of longer-term psychiatric and cognitive outcomes.
Intervening early to manage symptoms could prevent the development of more complex syndromes and improve overall recovery trajectories, they also argued.
Dr Maxime Taquet, NIHR academic clinical lecturer in the Department of Psychiatry at Oxford University, who led the study said: “These findings help us understand the burden of brain symptoms that people experience years after hospitalisation for Covid-19, who is most at risk, and their impact on their ability to work.
“This is important for policymakers and clinicians, and to help target preventive interventions,” he added.
Professor Chris Brightling, clinical professor of respiratory medicine at the University of Leicester, said: “This study reveals important long-term brain-related symptoms following Covid-19 and highlights the urgent need for better disease understanding of long-Covid, and new treatments.”
The researchers however cautioned that, while this study provides insights into the long-term effects of Covid-19, further research is essential to develop effective interventions.
Understanding the biological mechanisms driving these symptoms and identifying therapeutic strategies to promote cognitive recovery or prevent further decline are crucial next steps, they said.
Moreover, the study sample was made up of individuals who were hospitalised during the first wave of the pandemic (and hence not vaccinated at the time of the infection) and who consented to follow-up assessments (only 20% of those invited).
This may mean the findings are not generalisable to others (for example, people who did not require admission due to Covid-19), they cautioned.
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