key: cord-0950288-ewetmjp2 authors: Lahiri, D.; Dubey, S.; Ardila, A. title: Impact of COVID-19 related lockdown on cognition and emotion: A pilot study date: 2020-07-01 journal: nan DOI: 10.1101/2020.06.30.20138446 sha: f1ae97ddf75822038cf1895401c322e4d28c4d9e doc_id: 950288 cord_uid: ewetmjp2 COVID-19 pandemic has posed an unprecedented challenge in front of the world contributed mostly by social distancing and lockdown. Among several other effects this pandemic has wreaked havoc on the psychology and cognition of people across the globe. In this paper we attempted to find out the impact of lockdown and social isolation on the cognition and emotion of young healthy adults with high education (n=43) by means of a questionnaire sent through email. We found that more than 50% of the participants had some kind of emotional or cognitive (dysexecutive) symptoms, as calculated through emotional symptom index (ESI) and cognitive symptom index (CSI). The correlation between cognitive and emotional symptoms was also found to be moderately strong (0.59). Although it is a pilot study and larger samples are required to draw firm conclusion, the results argue in favor of a negative impact on the cognition and emotion of healthy educated young people caused by the COVID-19 related lockdown. It can be conjectured that, if taking an older sample with a lower education, emotional and cognitive changes would be more evident. The pandemic of COVID-19 has posed an unprecedented challenge in front of the world. While several studies are devoted towards examining the clinical effects of SARS-CoV-2 infection, few published so far have investigated the psychological consequences of such a rare global health emergency (e.g., Dai et al, 2020; Wang et al, 2020) . It can be anticipated, however, that toward a near future, a myriad of studies dealing with this topic will become available.Our experience from previous pandemics of MERS and SARS shows that during times of such large-scale emergency the non-infected population may suffer from several psychological adverse effects. Among these ill-effects on mental health, post-traumatic stress disorder (PTSD) is the forerunner followed closely by depression, anxiety, and other behavioral &psychological disorders (Jung et al, 2020; Park&Park, 2020; Wu, Chan &Ma, 2005) . Psychological symptoms are known to affect cognitive functioning particularly in the domain of attention and executive function. In this context two large meta-analyses may be referred to. Zakzanis, Leach & Kaplan (1998) found that specific components of executive functioning, namely verbal fluency and inhibition, are vulnerable in depression. By the same token, Snyder's (2013) meta-analysis found, major depressive disorders associatedwith significant impairments on all measures of executive function. A recent paper highlighting the neurobiological consequences of social isolation points out that remaining socially isolated can have deleterious effect on memory and executive dysfunction in the long run (Bzdok& Dunbar, 2020). It is understood that different sections of the population have different demands of executive function and hence the effects on this cognitive attribute will also vary. To our knowledge, no study thus far has analyzed the cognitive effects on general population consequent to the ongoing pandemic as well as the unprecedented measures to curb it, for instance social distancing and prolonged lockdown. Education is known to be associated with increased cognitive reserve (Cammano-Isoma, 2006; Meng& D'Arcy, 2012) . Prospective studies have shown that this association is valid in terms of level of cognitive functioning rather than the rate of cognitive decline (Wilson et al, 2009; Winnock et al, 2002) . In other words, higher educated persons are not immune to the usual age-related cognitive decline (Van Dijk et al, 2008) . In addition, higher cognitive reserve is thought to alter the clinical trajectories of dementia onset by delaying the symptom onset. In sum, there is evidence to believe that higher educated persons have better cognitive reserve and therefore may be better capable of coping with emergency situations such as the present one that puts the cognitive system under stress owing to the psychological effects of isolation. Similarly, young people are thought to have better cognitive reserve given the several mechanisms that influence cognitive decline with increasing age (Harada et al, 2013) . Considering the aforementioned arguments, we believe that studying the cognitive effects of isolation on young and middle age educated individuals may be more sensitive as a screening investigation in this context. In this background, we set out to explore the emotional and cognitive effects of isolation on adults with high level of formal education. The objective of the present study was to find out the prevalence of emotional and cognitive symptoms in the backdrop of COVID-19 lockdown among the educated persons. Besides, we also aimed to have a basic measure of the psychological symptoms prevalent in the same population. Here we report the preliminary findings of the pilot study that we conducted over last couple of months. We intend to take the present study forward with larger sample so as to have a deeper understanding of the problem. Self-reported questionnaire was developed focusing on symptoms related to executive dysfunction and emotional symptoms such as low mood and anxiety along with duration of the respective symptoms. The questionnaire is included in the Appendix. The questionnaire was administered in English language. Institutional ethics committee waived off supervision for this online survey. Participants were young and middle age adults in the age range of 25 to 40 years with high education and without any pre-existing psychiatric or cognitive illness. Any person known to have been infected with SARS-CoV-2 or exposed to it was excluded from the tally. Potential participants fulfilling the inclusion criteria were requested through email to fill up the questionnaire. Among the respondents consecutive 43 were included in the study of which 39 responses were finally analyzed. Basic statistical analysis was carried out calculating the percentage of different selfreported symptoms in the aforementioned domains. Indexation was applied taking into account All rights reserved. No reuse allowed without permission. was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint (which this version posted July 1, 2020. . https://doi.org/10.1101/2020.06.30.20138446 doi: medRxiv preprint the self-reported symptoms. Emotional symptom index (ESI) was computed based on the indices of the 3 questions related to low mood, anxiety, and sleep duration, while cognitive symptom index (CSI) was computed based on the symptoms related to apparent executive dysfunction, namely losing track of conversation, losing track of day and date, misplacing common objects of daily use, and increase in retrieval or processing time of information. Correlation co-efficient between the two composite indices, ESI and CSI was calculated to establish their interrelationship. We have analyzed a sample of 39 respondents through ESI and CSI. Our parameter selection was normally distributed. Each single parameter is unique, mutually exclusive and distinct. Therefore an indexation technique was used to homogenize the entire classification. It consists of two simultaneous stages-(1) Indexation: by using the statistical technique of normalization (Actual-Minimum/ Maximum-Minimum, value ranges from 0 to 1) ; (2) Weightage: by assigning equal weightage for all the indices. Hence ESI = 1/3( Low mood index+ Anxiety index+ Sleep index) and CSI = ΒΌ ( Losing track of conversation index+ Losing track of day and date index+ Object misplacement index+ Index of processing/ retrieval). By correlating ESI and CSI we get a dimension of directional measure ( r xy = Cov (X,Y)/ SD x , SD y ). A total of 43 responses were gathered from the online survey conducted for this study. Of these, 4 responses were excluded because they were incomplete and therefore 39 were included in the final analysis. Table 1 presents the characteristics of the sample. Eight participants reported preexisting co-morbidities of which 5 had hypothyroidism (on replacement) and 4 reported hypertension (on medication). None of the participants reported any pre-existing psychiatric illness or symptoms related to cognitive difficulty. Low mood index was found to be 0.52; that means, 52% in average presented emotional changes; while anxiety index was 0.33 and sleep index was 0.70. The composite index of these 3 indices, termed as ESI, was 0.52. Similarly, indices for conversational track, date and day track, All rights reserved. No reuse allowed without permission. was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint (which this version posted July 1, 2020. . https://doi.org/10.1101/2020.06.30.20138446 doi: medRxiv preprint object misplacement and retrieval/processing of information were observed to be 0.70, 0.56, 0.72, 0.57 respectively and the composite index, termed as CSI , was found to be 0.33. When correlation between ESI and CSI were computed, the value came out to be 0.597, suggestive of a moderately strongcorrelation between the two signifying that ESI and CSI can be co-operative through proper measure. Although this is a pilot study with a limited sample and a small amount of questions, it is evident that an important percentage of the participants reported some emotional and cognitive changes associated with the lockdown situation that they are living in. About 50% of the participants are feeling as having some emotional and cognitive changes, but without any specific quantification of their magnitude. Our participants presented two important demographic characteristics: they were young or middle age adults on one hand, and they had a high level of education on the other. It can be conjectured that, if taking an older sample with a lower education, emotional and cognitive changes would be more evident. There is a significant association between the sensitivity to stressful situations and age; and also coping strategies in stressful situations are associated with age (De Minzi&Sacchi, 2005) . Education, on the other hand, is considered critical in cognitive performance, not only in young adults, but even in elders (e.g., .Nonetheless, within the current conditions, about 50% of the participants reported emotional and cognitive changes associated with the lockdown situation currently existing in a significant number of countries world-wide. At this point it is impossible to know if these changes are going to have long-lasting consequences, once the lockdown is over (Greenberg, Carr& Summers, 2002) but it is known that there are individual differences in the vulnerability to stress (Kessler, 1979) . Thus, not everyone responds in the same way to the stress associated with the lockdown and probably, long-term consequences may be different. Cognition and emotion are thought to affect each other. Together they form the basic building blocks of metacognition (Akturk & Sahin, 2011) and play significant role in orchestrating theory of mind (Airenti, 2015) . Cognition, emotion, motivation, planning, organization, prudence and related executive abilities together with psyche also form the basis of stress coping. COVID-19 pandemic has unraveled difficulties in stress coping with its All rights reserved. No reuse allowed without permission. was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint (which this version posted July 1, 2020. . https://doi.org/10.1101/2020.06.30.20138446 doi: medRxiv preprint psychiatric manifestations. Stress is known to have direct association with dysfunctional prefrontal network of cognitive circuit (Selemon, Young, Cruz & Williamson, 2019; Soares et al, 2013 ) without completely defying the contributory effect of depression and low mood. The present study revealed attention deficit and dysexecution related to lockdown. There is a diversity of limitation is this study related not only to the questionnaire that was used, the characteristics of the sample, and the limited number of participants, but also with the specific city and country where the sample was collected. The severity of the COVID-19 pandemic and social response to it, has been highly variable across regions and countries (Hopman, Allegranzi&Mehtar, 2020 was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint (which this version posted July 1, 2020. was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. 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