Just as a boat captain assesses damage to their vessel after a storm, scientists are exploring the cognitive deficits that can occur in patients recovering from SARS-CoV-2. By reviewing published studies, they aim to identify the most common cognitive alterations and the best tools for assessing cognition in this population. The majority of studies used first-level tests like the Montreal Cognitive Assessment (MoCA) and Mini-Mental State Examination (MMSE), which can detect mild to moderate/severe deficits respectively. Attention and executive function tests were also found to be highly represented among second-level tests. Interestingly, remotely-delivered tests resulted in lower rates of cognitive impairment. Overall, impairments were often observed in executive functions, attention, and memory. While these findings are valuable, further research with larger sample sizes is needed to explore the clinical utility of second-level tools. This work emphasizes the importance of early detection and intervention for emerging cognitive deficits in post-infective SARS-CoV-2 patients.

BackgroundPatients with post-infective severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) often show both short- and long-term cognitive deficits within the dysexecutive/inattentive spectrum. However, little is known about which cognitive alterations are commonly found in patients recovered from SARS-CoV-2, and which psychometric tools clinicians should consider when assessing cognition in this population. The present work reviewed published studies to provide a critical narrative of neuropsychological (NPs) deficits commonly observed after SARS-CoV-2 infection and the tests most suited for detecting such cognitive sequelae depending on illness severity.MethodsThis review followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines and was pre-registered on Prospective Register of Systematic Reviews (PROSPERO) (CRD42021253079). Observational studies quantitatively assessing cognition in patients with post-infective SARS-CoV-2 were considered. From 711 retrieved articles, 19 studies conducted on patients with SARS-CoV-2 without medical comorbidities were included and stratified by disease severity.ResultsThe majority of studies (N = 13) adopted first-level tests. The most frequently administered screeners were the Montreal Cognitive Assessment (MoCA) and the Mini-Mental State Examination (MMSE)—with the former more likely to detect mild, and the latter moderate/severe deficits. Among second-level tests, those assessing attention and executive functions (EFs) were highly represented. Remotely-delivered tests yielded lower percentages of cognitive impairment. Overall, cognitive domains often found to be impaired were EFs, attention, and memory.ConclusionCognitive sequelae in patients with post-infective SARS-CoV-2 can be detected with NPs testing. Depending on the psychometric test features, the likelihood of observing cognitive deficits can vary. Further studies on larger sample sizes are needed to investigate the clinical usefulness of second-level tools. The primary goal of preventative health services should be the early detection and intervention of emerging cognitive deficits.

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