Neuropsychological Sequelae in Survivors of Severe COVID-19: A Research Proposal

Accumulating data confirms that coronaviruses are not restricted to the respiratory system and that they are able to invade the central nervous system leading to neurological disorders. Nonetheless, studies to date of COVID-19 have primarily focussed on morbidity and/or pulmonary function, but within the literature neurologic signs have been recorded in some patients and include headache, vomiting, hyposmia, impaired consciousness, stroke and encephalopathy. It is likely that as a result of the current pandemic, many COVID-19 patients will sustain brain injury through hypoxia or other poorly established mechanisms. Despite these observations, the neuropsychological and neuropsychiatric sequelae of the COVID-19 pandemic remains unchartered but is likely to be significant and burdensome. Permanent or enduring neuropsychological symptoms as a result of damage to the central nervous system need to be appropriately identified early on in order to manage patients and mitigate any further burden of the disease on individuals and society. This is an especially pressing matter given the high prevalence of infection rate in health workers and other key public workers whose personal lives and fundamental work for communities would be greatly compromised by cognitive impairment. We propose to investigate the neuropsychological status of COVID-19 patients who survive hospitalisation and assess the extent of long-term cognitive impairment using standardized test batteries. We aim to ascertain whether or not the deficit profile is in keeping with brain damage due to hypoxia or suggestive of damage via other mechanisms. Our analysis will include premorbid risk factors, variables that moderate treatment-seeking and factors that mediate perceptions of and attitudes towards coronavirus to mediate health-precaution behaviours. Our inquiry will also take account of the psychological ramifications of severe COVID-19, with a particular focus on psychiatric morbidity, stigmatisation, changes in standards of daily living, occupational repercussions and effects on the family. Finally, we will use our data to develop brief screening tools that primary care physicians and community clinic staff will be able to administer in order to flag potential patients that may be experiencing neuropsychological effects of their COVID-19 illness.