Prevalence and Associated Factors of Very Early Cognitive Impairment in COVID-19 Convalescents: a Study Using Data from a Questionnaire Survey

doi:10.12114/j.issn.1007-9572.2022.0870

Chinese General Practice ›› 2023, Vol. 26 ›› Issue (10): 1234-1240.DOI: 10.12114/j.issn.1007-9572.2022.0870

Special Issue: 新型冠状病毒肺炎最新文章合辑； COVID-19疫情防控研究；脑健康最新研究合辑；疾病康复与健康最新文章合辑

• Original Research·Focus on Cognitive Impairment • Previous Articles Next Articles

Prevalence and Associated Factors of Very Early Cognitive Impairment in COVID-19 Convalescents: a Study Using Data from a Questionnaire Survey

1. The Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou 510006, China
2. Physical Examination Center, Hubei Provincial Hospital of Traditional Chinese& Western Medicine, Wuhan 430000, China
3. Department of Emergency, the Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510120, China
4. Guangdong Provincial Key Laboratory of Research on Emergency in TCM, Guangzhou 510120, China

Received:2022-12-16 Revised:2023-02-06 Published:2023-04-05 Online:2023-02-09
Contact: ZHANG Zhongde
About author:
HUA Q L, LIU H L, XU X H, et al. Prevalence and associated factors of very early cognitive impairment in COVID-19 convalescents: a study using data from a questionnaire survey [J]. Chinese General Practice, 2023, 26 (10): 1234-1240.

新型冠状病毒感染康复者极早期认知功能障碍及影响因素研究

1．510006　广东省广州市，广州中医药大学第二临床医学院
2．430000　湖北省武汉市，湖北省中西医结合医院体检中心
3．510120　广东省广州市，广州中医药大学第二附属医院急诊科
4．510120　广东省广州市，广东省中医急症研究重点实验室

通讯作者: 张忠德
作者简介:
华俏丽，刘慧玲，徐晓花，等.新型冠状病毒感染康复者极早期认知功能障碍及影响因素研究[J].中国全科医学，2023，26（10）：1234-1240.[www.chinagp.net]
作者贡献：华俏丽负责统计分析、文章撰写；刘慧玲、徐晓花、王前、周鑫负责随访患者，收集、录入数据；郑丹文、刘云涛负责设计研究，准备伦理审核材料，沟通协调；杨荣源、丁邦晗、郭建文、张忠德负责指导研究设计、文章写作，并负责审核、修改文章。
基金资助:
国家中医药管理局中医药创新团队及人才支持计划项目(ZYYCXTD-D-202203); 广东省中医药局科研项目(20223011); 广州中医药大学双一流与高水平大学学科协同创新团队项目(2021XK06，2021XK49)

Abstract

Abstract:

Background

COVID-19 may impair the central nervous system, but the prevalence and related factors of very early cognitive impairment in discharged COVID-19 convalescents are still unclear.

Objective

To assess the prevalence of very early cognitive impairment in discharged COVID-19 convalescents, and to identify its influencing factors.

Methods

This study included 574 COVID-19 convalescents from August 28 to September 30, 2020, including individuals who were discharged from designated hospitals for treating COVID-19 in Wuhan from December 2019 to April 2020 randomly selected from the hospital information system, and those with informed consent recruited through news media. According to the Eight-item Informant Interview to Differentiate Aging and Dementia (AD8) score, the subjects were divided into a very early cognitive impairment group (AD8≥2) and a non-very early cognitive impairment group (AD8<2). A questionnaire survey was conducted with the subjects by four investigators at Hubei Provincial Hospital of Traditional Chinese& Western Medicine, using the General Information Questionnaire to collect demographic information and past disease history of the patients (including gender, age, underlying disease, classification of COVID-19 on admission, interval between discharge and the current survey, and various symptoms present at the time of follow-up), using the Generalized Anxiety Disorder-7 (GAD-7), the PTSD Check List–Civilian Version (PCL-C), and the Short Form 36 Health Survey Questionnaire (SF-36) to assess patients' anxiety, post-traumatic stress disorder, and quality of life, respectively. Three hundred and eleven cases finally completed the cognitive function screening. Multiple Logistic regression was used to evaluate the effects of gender, age, underlying disease and admission classification of COVID-19 on very early cognitive impairment. A restricted cubic spline model was used to assess the quantitative relationship between anxiety level and very early cognitive impairment.

Results

311 (54.18%) who effectively responded to the survey was finally enrolled, including 170 (54.7%) with very early cognitive impairment and 141 (45.3%) without. 230 (23.9%) had residual symptoms after discharge. Comparisons of gender, age, insomnia, fatigue, chest tightness, shortness of breath, loss of appetite, generalized anxiety disorder, PTSD positive, and the score of each SF-36 entry among COVID-19 convalescents with and without very early cognitive impairment were statistically significant (P<0.05). Multivariate Logistic regression analysis suggested that females〔OR (95%CI) =2.658 (1.528, 4.625) 〕, advanced age〔OR (95%CI) =3.736 (1.083, 12.890) 〕, and having generalised anxiety disorder〔OR (95%CI) =5.081 (1.229, 21.008) 〕were influential factors in increasing very early cognitive impairment (P<0.05). Restricted cubic spline models indicated a linear quantitative relationship between anxiety level and very early cognitive impairment, with higher levels of anxiety associated with a greater likelihood of very early cognitive impairment (P for non-linear test =0.132) .

Conclusion

The incidence of very early cognitive impairment is high in COVID-19 convalescents, and it may be higher in those who are older, female, or have generalized anxiety symptoms. Timely interventions for psychiatric problems and alleviation of anxiety symptoms in COVID-19 convalescents, especially in older women, may help to improve their cognitive function and Alzheimer's disease.

Key words: COVID-19, Sequelae, Early cognitive dysfunction, MicroCog, Anxiety, Preventive health programs

摘要：

背景

新型冠状病毒感染（简称新冠感染）可引起中枢神经系统损伤，然而感染者出院后是否存在极早期认知功能障碍及其影响因素尚不明确。

目的

对新冠感染出院患者进行极早期认知功能筛查，并分析其影响因素。

方法

于2020-08-20至2020-09-30，随机抽取武汉市新冠感染定点医院病历管理系统中2019年12月至2020年4月的成年新冠感染出院康复者，同时通过新闻媒体招募同意调查的康复者，共计纳入新冠感染康复者574例。依据8条目痴呆筛查问卷（AD8）评分，将纳入者分为存在极早期认知功能障碍组（AD8≥2分）、无极早期认知功能障碍组（AD8<2分）。由4名调查人员在湖北省中西医结合医院展开问卷调查，采用一般信息调查表采集患者人口学信息及既往疾病史，包括性别、年龄、基础疾病、入院新冠感染分型、出院至本次调查的间隔时间、随访时存在的各类症状，采用广泛性焦虑量表（GAD-7）、创伤后应激障碍检查表（PCL-C）、健康状况调查简表（SF-36）评估患者焦虑、创伤后应激障碍（PTSD）状况、生活质量，最终完成认知功能筛查的康复者311例。采用多元Logistic回归评价性别、年龄、基础疾病、入院新冠感染分型等变量对极早期认知功能障碍的影响，以限制性立方样条函数模型评估焦虑水平和极早期认知功能障碍的量效关系。

结果

311例新冠感染康复者中，170例（54.7%）存在极早期认知功能障碍，141例（45.3%）不存在极早期认知功能障碍；230例（23.9%）存在出院后遗留症状。是否存在极早期认知功能障碍者的性别、年龄、失眠、疲倦乏力、胸闷、气短、食欲减退、广泛性焦虑症、PTSD阳性、SF-36各项条目得分比较，差异有统计学意义（P<0.05）。多元Logistic回归分析显示，女性〔OR（95%CI）=2.658（1.528，4.625）〕、高龄〔OR（95%CI）=3.736（1.083，12.890）〕、有广泛性焦虑症〔OR（95%CI）=5.081（1.229，21.008）〕是新冠感染康复者发生极早期认知功能障碍的影响因素（P<0.05）。限制性立方样条函数模型显示，焦虑程度和极早期认知功能障碍存在线性量效关系，即焦虑水平越高，极早期认知功能障碍的可能性越大（非线性检验P=0.13）。

结论

新冠感染康复者的极早期认知功能障碍发生率较高，高龄、女性、有广泛性焦虑症状可能更易发生极早期认知功能障碍。应及时干预新冠感染康复者，尤其是老年女性的精神心理问题，缓解其焦虑症状，可能有助于改善康复者认知功能，预防阿尔茨海默病。

关键词: 新型冠状病毒感染, 后遗症, 极早期认知功能障碍, 认知功能评估, 焦虑, 预防保健计划

HUA Qiaoli,LIU Huiling,XU Xiaohua, et al. Prevalence and Associated Factors of Very Early Cognitive Impairment in COVID-19 Convalescents: a Study Using Data from a Questionnaire Survey[J]. Chinese General Practice, 2023, 26(10): 1234-1240. DOI: 10.12114/j.issn.1007-9572.2022.0870.
华俏丽,刘慧玲,徐晓花等. 新型冠状病毒感染康复者极早期认知功能障碍及影响因素研究[J]. 中国全科医学, 2023, 26(10): 1234-1240. DOI: 10.12114/j.issn.1007-9572.2022.0870.

Figures/Tables 5

References 28

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组别	例数	性别〔n（%）〕		年龄（±s，岁）	基础疾病〔n（%）〕					入院新冠感染分型〔n（%）〕		出院至本次调查的间隔时间（±s，d）
组别	例数	男	女	年龄（±s，岁）	呼吸系统疾病	高血压	糖尿病	冠心病	脑血管病	非重症	重症	出院至本次调查的间隔时间（±s，d）
存在极早期认知功能障碍	170	44（25.9）	126（74.1）	57.5±10.2	5（2.9）	38（22.3）	19（11.2）	12（7.0）	5（2.9）	134（78.8）	36（21.2）	193.1±17.1
不存在极早期认知功能障碍	141	71（50.4）	70（49.6）	54.5±12.4	7（5.0）	33（23.4）	14（9.9）	5（3.5）	4（2.8）	115（81.6）	26（18.4）	194.4±17.2
χ²（t）值		19.807		5.368^a	0.851	0.048	0.126	1.840	<0.001	0.362		0.451^a
P值		<0.01		0.02	0.36	0.83	0.72	0.18	0.99	0.55		0.50

组别	例数	性别〔n（%）〕		年龄（±s，岁）	基础疾病〔n（%）〕					入院新冠感染分型〔n（%）〕		出院至本次调查的间隔时间（±s，d）
组别	例数	男	女	年龄（±s，岁）	呼吸系统疾病	高血压	糖尿病	冠心病	脑血管病	非重症	重症	出院至本次调查的间隔时间（±s，d）
存在极早期认知功能障碍	170	44（25.9）	126（74.1）	57.5±10.2	5（2.9）	38（22.3）	19（11.2）	12（7.0）	5（2.9）	134（78.8）	36（21.2）	193.1±17.1
不存在极早期认知功能障碍	141	71（50.4）	70（49.6）	54.5±12.4	7（5.0）	33（23.4）	14（9.9）	5（3.5）	4（2.8）	115（81.6）	26（18.4）	194.4±17.2
χ²（t）值		19.807		5.368^a	0.851	0.048	0.126	1.840	<0.001	0.362		0.451^a
P值		<0.01		0.02	0.36	0.83	0.72	0.18	0.99	0.55		0.50

组别	例数	失眠	疲倦乏力	咳嗽	胸闷	胸痛	气短	心慌心悸	食欲减退
存在极早期认知功能障碍	170	64（37.6）	107（62.9）	21（12.3）	72（42.3）	19（11.2）	68（40.0）	5（2.9）	18（10.6）
不存在极早期认知功能障碍	141	30（21.3）	45（31.9）	13（9.2）	30（21.3）	9（6.4）	29（20.6）	3（2.1）	3（2.1）
χ²值		9.794	29.693	0.777	15.534	2.162	13.561	0.008	8.762
P值		<0.01	<0.01	0.38	<0.01	0.14	<0.01	0.93	0.03

组别	例数	失眠	疲倦乏力	咳嗽	胸闷	胸痛	气短	心慌心悸	食欲减退
存在极早期认知功能障碍	170	64（37.6）	107（62.9）	21（12.3）	72（42.3）	19（11.2）	68（40.0）	5（2.9）	18（10.6）
不存在极早期认知功能障碍	141	30（21.3）	45（31.9）	13（9.2）	30（21.3）	9（6.4）	29（20.6）	3（2.1）	3（2.1）
χ²值		9.794	29.693	0.777	15.534	2.162	13.561	0.008	8.762
P值		<0.01	<0.01	0.38	<0.01	0.14	<0.01	0.93	0.03

组别	例数	广泛性焦虑症〔n（%）〕	PTSD阳性〔n（%）〕	SF-36（分）
组别	例数	广泛性焦虑症〔n（%）〕	PTSD阳性〔n（%）〕	生理功能（±s）	生理职能〔M（P₂₅，P₇₅）〕	躯体疼痛（±s）	一般健康状况（±s）	精力（±s）
存在极早期认知功能障碍	170	24（14.1）	23（13.5）	83.7±13.1	0（0，100.0）	83.5±25.2	51.0±19.6	56.9±20.1
不存在极早期认知功能障碍	141	3（2.1）	2（1.4）	92.4±10.7	100.0（0，100.0）	90.9±18.9	70.8±18.6	72.8±18.9
检验统计量值		12.505^a	13.698^a	39.720^b	30.831^c	8.280^b	82.856^b	50.739^b
P值		<0.01	<0.01	<0.01	<0.01	<0.01	<0.01	<0.001
组别	SF-36（分）			PCS		MCS
组别	精神健康（±s）	社会功能〔M（P₂₅，P₇₅）〕	情感职能〔M（P₂₅，P₇₅）〕	得分（±s）	PCS<50分〔n（%）〕	得分（±s）	MCS<50分〔n（%）〕
存在极早期认知功能障碍	52.4±17.4	50.0（25.0，100.0）	0（0，100.0）	48.7±7.6	94（55.3）	35.8±10.9	148（87.0）
不存在极早期认知功能障碍	63.0±15.3	100.0（50.0，100.0）	100.0（66.7，100.0）	53.9±7.2	38（26.9）	45.0±8.9	96（68.1）
检验统计量值	32.308^b	29.497^c	37.507^c	37.432^b	24.199^a	65.299^b	15.313^a
P值	<0.001	<0.01	<0.01	<0.01	<0.01	<0.01	<0.01

Prevalence and Associated Factors of Very Early Cognitive Impairment in COVID-19 Convalescents: a Study Using Data from a Questionnaire Survey

新型冠状病毒感染康复者极早期认知功能障碍及影响因素研究

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自变量		b	SE	Wald χ²值	OR（95%CI）	P值
性别（以男为参照）
	女	0.978	0.283	11.971	2.658（1.528，4.625）	0.01
年龄（岁，以实际值纳入）		1.318	0.632	4.352	3.736（1.083，12.890）	0.04
出院后遗留症状（以无相应症状为参照）
	失眠	0.346	0.295	1.373	1.413（0.792，2.520）	0.24
	疲倦乏力	0.540	0.288	3.514	1.716（0.976，3.020）	0.06
	胸闷	0.281	0.347	0.656	1.324（0.671，2.612）	0.42
	气短	0.170	0.372	0.208	1.185（0.572，2.456）	0.65
	食欲减退	1.141	0.704	2.629	3.129（0.788，12.424）	0.11
广泛性焦虑症（以无为参照）
	有	1.625	0.724	5.037	5.081（1.229，21.008）	0.03
PTSD阳性（以否为参照）
	是	0.924	0.842	1.206	2.520（0.484，13.125）	0.27
PCS（分，以≥50为参照）
	<50	0.459	0.298	2.362	1.616（0.839，3.113）	0.12
MCS（分，以≥50为参照）
	<50	0.408	0.334	2.061	1.582（0.881，2.839）	0.15

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