Woolston, Dixie J.

AbstractINTRODUCTIONWe previously demonstrated that single‐domain amnestic mild cognitive impairment (SDAm‐MCI) detected through longitudinal neuropsychological testing in our research cohort is less severe than in clinically incident symptomatic individuals. This study aims to replicate and expand this work using a National Alzheimer's Coordinating Center dataset.METHODSParticipants were classified into two groups: those enrolled with normal cognition (Normal Enrollees) and those enrolled with SDAm‐MCI (Amnestic Enrollees). Groups were compared at the time of diagnosis and on rates of cognitive decline post‐diagnosis.RESULTSAt SDAm‐MCI diagnosis, Normal Enrollees were 17% to 39% less impaired on memory tasks, after which the slope of change over time steepened compared to their pre‐symptomatic change and was steeper than in Amnestic Enrollees.DISCUSSIONIncident MCI detected through longitudinal neuropsychological testing is initially milder but may progress more steeply than in clinically established MCI. Sensitive assessment of cognitive decline is essential for capturing early changes that are more likely to be amenable to therapeutic treatment.Highlights Longitudinal cognitive evaluation detects symptomatic Alzheimer's disease earlier than mental status exams. At the time of diagnosis, converters were less impaired compared to initially symptomatic patients. Converters’ cognition declined more steeply than initially symptomatic patients. Sensitive cognitive tests are essential to capture early changes, given new disease‐modifying therapies.

Abstract Background and purpose Cognitive complaints are common in patients recovering from Coronavirus Disease 2019 (COVID-19), yet their etiology is often unclear. We assess factors that contribute to cognitive impairment in ambulatory versus hospitalized patients during the sub-acute stage of recovery. Methods Participants were prospectively recruited from a hospital-wide registry. All patients tested positive for SARS-CoV-2 infection using a real-time reverse transcriptase polymerasechain-reaction assay. Patients ≤ 18 years-of-age and those with a pre-existing major neurocognitive disorder were excluded. Participants completed an extensive neuropsychological questionnaire and a computerized cognitive screen via remote telemedicine platform. Rates of subjective and objective neuropsychological impairment were compared between the ambulatory and hospitalized groups. Factors associated with impairment were explored separately within each group. Results A total of 102 patients (76 ambulatory, 26 hospitalized) completed the symptom inventory and neurocognitive tests 24 ± 22 days following laboratory confirmation of SARSCoV-2 infection. Hospitalized and ambulatory patients self-reported high rates of cognitive impairment (27-40%), without differences between the groups. However, hospitalized patients showed higher rates of objective impairment in visual memory (30% vs. 4%; p=0.001) and psychomotor speed (41% vs. 15%; p=0.008). Objective cognitive test performance was associated with anxiety, depression, fatigue, and pain in the ambulatory but not the hospitalized group. Conclusions Focal cognitive deficits are more common in hospitalized than ambulatory patients. Cognitive performance is associated with neuropsychiatric symptoms in ambulatory but not hospitalized patients. Objective neurocognitive measures can provide essential information to inform neurologic triage and should be included as endpoints in clinical trials.