Clinical neuropsychological evaluation of patients referred from a post-COVID subspeciality clinic

Objective: To describe neuropsychological assessment findings of patients referred from a post-COVID subspecialty clinic. Methods: Clinical data were examined for 54 patients referred between March 2021 and May 2023. Assessment included objective cognitive performance, performance validity testing, self-report of cognitive symptoms (BRIEF-A), depressive and anxiety symptoms (BDI-II/BAI), and fatigue (PROMIS Fatigue-4a). Objective cognitive measures were grouped into domains and examined through (1) one sample t-tests comparing each domain score to the normative mean characterized using Cohen's d, and (2) the frequency of impaired performance and elevated symptoms (±1.5 SD). Clinically elevated symptoms of depression, anxiety, and fatigue were examined. Results: Exclusion criteria resulted in a final sample of 46 (mean age= 48.5; 72% female). The mean cognitive domain scores of the sample all fell within 1 SD of expectations based on normative data. Examination of effect sizes using Cohen's d suggested that verbal comprehension and perceptual reasoning were significantly above the mean (small effect) while executive function, language, and processing speed were reduced (small effect). The Metacognition index of the BRIEF-A was elevated driven by Working Memory (80.5%). Elevated symptoms of depression (59.1%)/anxiety (75.0%) were frequent and not associated with objective cognitive scores. Elevated fatigue (56.5%) was associated with impaired processing speed performance. Conclusions: Individuals with long COVID reported significant difficulty with working memory capacity. Participants demonstrated a pattern of reduced performance in domains of executive function, language, and processing speed, although group means were within 1 SD of normative expectations. Clinically elevated fatigue was associated with reduced processing speed performance.