key: cord-0706011-4uin89zn
authors: Patel, R.; Savrides, I.; Cahalan, C.; Doulatani, G.; O'Dell, M. W.; Toglia, J.; Jaywant, A.
title: COVID-19 and Cognitive Impairment: Severity, Evolution, and Functional Impact during Inpatient Rehabilitation
date: 2021-03-17
journal: nan
DOI: 10.1101/2021.03.15.21253637
sha: 63de86e05851315044548283eb6379286d83a837
doc_id: 706011
cord_uid: 4uin89zn

Objective: To determine the frequency, magnitude, and change in cognitive impairment in patients with COVID-19 undergoing acute inpatient rehabilitation. We secondarily evaluated correlates of cognitive impairment and the relationship between cognition and functional gain. Design: Cross-sectional observational study with assessments at admission and discharge Setting: Acute inpatient rehabilitation unit within a large, urban academic medical center Participants: 77 patients hospitalized for COVID-19 and subsequently admitted to an inpatient rehabilitation unit between March-August 2020, 45 of whom were re-assessed at discharge. Interventions: N/A Main Outcome Measures: Montreal Cognitive Assessment (MoCA) scores on admission and discharge (when available) and Quality Indicator for Self-Care (QI-SC) scores on admission and discharge. Results: 62/77 (80.5%) of patients demonstrated cognitive deficits on the MoCA at admission: 39/77 (50.6%) were mildly impaired, 20/77 (26%) moderately impaired, and 3/77 (3.9%) severely impaired. Cognitive impairment was associated with a prior history of delirium, but not age or length of acute care hospitalization. 32/45 (71.1%) patients with discharge scores improved and met the MoCA minimally clinically important difference (MCID); however, 35/45 (77.8%) continued to score in the impaired range. Patients who met the MoCA MCID demonstrated significantly greater QI-SC score gains than those that did not meet the MCID (p=.02). Conclusion: Cognitive impairment is common among hospitalized COVID-19 patients requiring acute inpatient rehabilitation. Cognitive impairment improves over the course of inpatient rehabilitation, and is associated with functional gain. Nonetheless, cognitive deficits frequently remain present at discharge, indicating the need for systematic assessment and follow-up, especially given the association with functional outcome.

correlates of cognitive impairment and the relationship between cognition and functional gain. CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) prompting the need for assessing and treating cognitive dysfunction to optimize function. Total score ranges from 7, indicating total assistance, to 42, indicating independence 9 . The QI-88 SC is reliable and discriminates between the quality of care among rehabilitation facilities 9 . OTs 89 assigned admission and discharge QI-SC scores to all participants.

. CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. 

Normal Mild Impairment Moderate Impairment Severe Impairment . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review)

The copyright holder for this preprint this version posted March 17, 2021. ; https://doi.org/10.1101/2021.03.15.21253637 doi: medRxiv preprint

Association between acute care and critical illness 164 hospitalization and cognitive function in older adults

Cognitive 167 dysfunction in ICU patients: risk factors, predictors, and rehabilitation interventions

Cognitive impairment as predictor of functional dependence in an elderly sample

Cognitive 174 decline among individuals with history of mild symptomatic SARS-CoV-2 infection: A 175 longitudinal prospective study nested to a population cohort

International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity

Frequency and profile of objective cognitive deficits in hospitalized patients recovering from 179

Epub ahead of print

COVID-19 cognitive deficits after 183 respiratory assistance in the subacute phase: A COVID-rehabilitation unit experience

Responsiveness, minimal clinically 187 important difference, and validity of the MoCA in stroke rehabilitation

Measuring inpatient 191 rehabilitation facility quality of care: Discharge self-care functional status quality measure

PMID: 196 the author/funder, who has granted medRxiv a license to display the preprint in perpetuity

The authors received no funding to complete this study. All authors have 156 no conflicts or competing interests to declare. AJ is funded through a Career Development

CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

The copyright holder for this preprint this version posted March 17, 2021. ; https://doi.org/10.1101/2021.03.15.21253637 doi: medRxiv preprint