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Cognitive functioning and brain MRI findings six months after acute COVID-19. A prospective observational study
Janne Pihlajamaa1, Henriikka Ollila2, Juha Martola1
1HUS Medical Imaging Centre, Radiology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
Introduction:
COVID-19 has been linked to many neurological complications, including cognitive impairment and findings in brain imaging. However, limited data exist regarding the link between magnetic resonance imaging (MRI) findings and cognitive functioning in COVID-19 patients.In this observational prospective study, we investigated the association between brain MRI findings, particularly cerebral microbleeds (CMBs) and white matter hyperintensities (WMHs), and cognitive functioning in COVID-19 survivors.
Methods:
Six months after acute COVID-19 diagnosed in 2020, 67 ICU-treated, 44 ward-treated, and 44 home-isolated patients, as well as 48 non-COVID-19 controls, underwent MRI and comprehensive neuropsychological evaluation. We applied multivariable linear regression models to investigate the independent associations of total cognitive score and domain scores separately with CMBs, WMHs and other factors.
Results:
Age (p < 0.001, β = -0.36) and educational level (p < 0.001, β = 0.42) predominantly explained the differences in cognitive functioning. A lower total cognitive score was associated with the number of CMBs (p = 0.0016), but not with COVID-19 (p = 0.714). Among COVID-19 patients, treatment in a regular ward (p = 0.007, β = -0.46), a high burden of WMHs (p = 0.004, β = -1.35), and having one to three CMBs (p = 0.01, β = -0.43) were associated with lower total cognitive scores.
Conclusion:
We observed a significant association between the presence of CMBs and lower cognitive scores, regardless of COVID-19 history. However, our results do not support CMBs to be independently associated with cognitive functioning. Additionally, WMH burden was associated with lower cognitive scores.
Insights
Cerebral microbleeds (CMBs) and white matter hyperintensities (WMHs) on MRI are linked to lower cognitive scores in COVID-19 survivors. These brain imaging findings, particularly WMHs, impact cognitive function regardless of COVID-19 history.
Area of Science:
- Neurology
- Radiology
- Infectious Diseases
Background:
- COVID-19 is associated with neurological complications, including cognitive impairment.
- Limited data exist on the relationship between specific magnetic resonance imaging (MRI) findings and cognitive function in COVID-19 survivors.
Purpose of the Study:
- To investigate the association between brain MRI findings (cerebral microbleeds [CMBs] and white matter hyperintensities [WMHs]) and cognitive functioning in COVID-19 survivors.
- To determine if these MRI findings are independently associated with cognitive decline post-COVID-19.
Main Methods:
- An observational prospective study involving COVID-19 survivors (ICU-treated, ward-treated, home-isolated) and non-COVID-19 controls.
- Six months post-acute infection, participants underwent MRI and comprehensive neuropsychological evaluation.
- Multivariable linear regression models were used to analyze associations between cognitive scores and MRI findings, controlling for factors like age and education.
Main Results:
- Age and educational level were primary determinants of cognitive functioning.
- A lower total cognitive score was associated with the number of CMBs (p=0.0016), irrespective of COVID-19 status.
- Among COVID-19 patients, ward treatment, high WMH burden, and 1-3 CMBs were linked to lower total cognitive scores.
Conclusions:
- A significant association exists between CMBs and lower cognitive scores, independent of COVID-19 history.
- WMH burden was also associated with diminished cognitive functioning.
- While CMBs show an association, the study does not support them as independently associated with cognitive functioning in this cohort.
