Discussion
COVID-19 suffered deficits, SARS-COV-2 infection, critically ill, anxiety, ’ cognitive status, ’, cognitive impairment, cognitive dysfunction, PTSD, non-critically ill, COVID-19 critically ill, depression, cognitive deficit, deficit or neurological diagnosis
SEQUELAE, CRITICALLY ILL, DYSFUNCTION
In the current study, one out of three critically ill patients with COVID-19 suffered deficits in OC one year after ICU discharge. Moreover, about 30% of the sample also showed clinically significant difficulties in SC. However, a worse perception of cognitive status, self-assessed by the patient (SC) using the PDQ, did not necessarily correspond with worse outcomes in OC assessed by a professional using an extensive neuropsychological battery. Female gender and symptoms of PTSD were the factors most strongly related to the perception of cognitive deficit, while cognitive reserve emerged as a protective factor against objective cognitive deficit.The results regarding the prevalence of cognitive dysfunction in non-COVID-19 ICU survivors in previous literature are heterogenous. While Brück et al. [On the other hand, 27.5% of our sample manifested clinically significant deficits on the SC questionnaires. Similar results were found by Brück et al. [Interestingly, we did not observe significant differences in SC between patients with and without OC impairment. Previous studies on critically ill patients with and without COVID-19 have suggested that OC may not necessarily be related to SC [Regarding emotional state, 22.5% of COVID-19 ICU survivors reported mild to severe symptoms of anxiety, 26.3% depression, and 27.5% PTSD one year after discharge. Prior reviews reported similar [Finally, when comparing groups with and without dysfunction in OC, we observed that high cognitive reserve was a predictor of not developing objective cognitive deficit. In previous studies of post-ICU survivors, cognitive reserve has also been identified as a protective factor for patients’ cognitive status [One of the limitations of the present study, also common in most research in critically ill survivors, is the absence of a baseline neuropsychological examination of patients' cognitive functioning before ICU admission. However, we excluded participants with a diagnosis of dementia/cognitive deficit or neurological diagnosis, and we tried to estimate participants’ prior cognitive state using the Short-IQCODE questionnaire. In addition, we were unable to carry out a baseline cognitive assessment at ICU discharge due to the pandemic context. Another limitation is the lack of a control group of non-critically ill patients with SARS-COV-2 infection and a control group of non-COVID-19 post-ICU patients to assess whether the observed alteration is different in these patient groups. Finally, as the sample size is relatively small, the results of this study should be interpreted with caution.Future studies should continue to explore the long-term cognitive and emotional sequelae of COVID-19 critically ill patients, observing their evolution over time and detecting possible risk and protective factors. They should use extensive neuropsychological batteries to better characterize their cognitive impairment, in order to provide the best possible intervention in ICU survivors and to prevent these alterations from becoming chronic. Inquiring the long-term functional impact that the perception of cognitive deficit has on critically ill patients may also be of interest.