Thread by @gkwood3

Do cognitive deficits persist after COVID-19 and, if so, what is their biological basis?

Our NEW pre-print under review in @NaturePortfolio

We report one-year cognitive, serum biomarker, and neuroimaging findings in 351 patients

A thread 1/n dx.doi.org/10.21203/rs.3.…

N.B. this is @covidcns pre-print therefore it has not yet completed peer review, the findings are provisional and conclusions may change 2/n

At one year, in those who had required hospitalisation, cognitive deficits were global and equivalent in magnitude to 20 years of ageing. Scores are compared to 2,927 matched normative community volunteers 3/n

Cognitive deficits were associated with elevated brain injury biomarkers and reduced grey matter volume. The half-lives of the brain injury markers mean that this is objective evidence of *ongoing* brain injury one year after COVID-19. 4/n

Deficits were correlated with symptoms of depression and the anterior cingulate cortex volume, which has functional roles in connecting cognition, attention, and emotion 5/n

The severity of the initial infection, infection early in the pandemic, post-acute psychiatric symptoms and a history of encephalopathy were associated with greatest deficits. Importantly this means our findings don't generalised to COVID-19 today or mild respiratory disease 6/n

Treatment with corticosteroids during the acute phase appeared *protective* against post-acute cognitive deficits 7/n

Despite some improvement at the first follow-up, by the second there was plateau in the cognitive recovery trajectory 8/n

There is growing biochemical evidence that neurological complications in COVID-19, including cognitive impairment, are immune-mediated which is corroborated here by clinical demonstration of the protective effect of acute treatment with corticosteroids 9/n

Mechanisms underpinning this potentially immune-mediated construct of depression, cognition and brain injury need to be further elucidated, to allow the development of targeted therapeutic interventions 10/n

Thank you very much to the national @covidcns Consortium for the hard work to get to this point - thank you to our study funders @The_MRC @UKRI_News and to @NIHRresearch for funding my ACF

Research made possible by @_brendan95 @psychgenomics @ProfHampshire @AlanCarson15 @ProfTonyDavid @Frosty_Immunity @Frankongho @Menon_Cambridge @edbullmore @bettyonthebrain @topherhuebel @RunningMadProf and many more!

@_brendan95 @psychgenomics @ProfHampshire @AlanCarson15 @ProfTonyDavid @Frosty_Immunity @Frankongho @Menon_Cambridge @edbullmore @bettyonthebrain @topherhuebel @RunningMadProf @matthewrbroome @John_PaulTaylor @Tim_R_Nicholson @MasudHusain @MatthewHotopf @Cunningham_Colm @delirious_dr @tompollak @rai_bethlehem @valegiunca @RachelUTG @fmrib_steve @fmrib_karla @BrainImagingLiv

Thank you to our PPIE Panel including the brilliant @encephalitis with @encephalitisava @NeuroAlliance @StrokeAssocNews and @MQmentalhealth. We worked together on study design, ongoing review and reporting of findings