TY - JOUR
T1 - A Biopsychosocial Approach to Persistent Post-COVID-19 Fatigue and Cognitive Complaints
T2 - Results of the Prospective Multicenter NeNeSCo Study
AU - Klinkhammer, Simona
AU - Duits, Annelien A.
AU - Deckers, Kay
AU - Horn, Janneke
AU - Slooter, Arjen J.C.
AU - Verwijk, Esmée
AU - van Heugten, Caroline M.
AU - Visser-Meily, Johanna M.A.
AU - Aries, Marcel J.H.
AU - van Bussel, Bas C.T.
AU - Jansen, Jacobus F.A.
AU - Janssen, Marcus L.F.
AU - Santen, Susanne van
AU - Magdelijns, Fabienne J.H.
AU - Posthuma, Rein
AU - Linden, David E.J.
AU - van der Woude, Margaretha C.E.
AU - Dormans, Tom
AU - Otten, Amy
AU - Postma, Alida A.
AU - Karakus, Attila
AU - Bronsveld, Inez
AU - Kaasjager, Karin A.H.
AU - Galenkamp, Niek
AU - Geurtsen, Gert J.
AU - Brouwer, Matthijs C.
AU - Brinkman, Kees
AU - Kylstra, Wytske A.
AU - Koch, Dook W.
AU - Beudel, Martijn
N1 - Publisher Copyright:
© 2024
PY - 2024/5
Y1 - 2024/5
N2 - Objective: To evaluate whether psychological and social factors complement biomedical factors in understanding post-COVID-19 fatigue and cognitive complaints. Additionally, to incorporate objective (neuro-cognitive) and subjective (patient-reported) variables in identifying factors related to post-COVID-19 fatigue and cognitive complaints. Design: Prospective, multicenter cohort study. Setting: Six Dutch hospitals. Participants: 205 initially hospitalized (March-June 2020), confirmed patients with SARS-CoV-2, aged ≥18 years, physically able to visit the hospital, without prior cognitive deficit, magnetic resonance imaging (MRI) contraindication, or severe neurologic damage post-hospital discharge (N=205). Interventions: Not applicable. Main Outcome Measures: Nine months post-hospital discharge, a 3T MRI scan and cognitive testing were performed and patients completed questionnaires. Medical data were retrieved from medical dossiers. Hierarchical regression analyses were performed on fatigue severity (Fatigue Severity Scale; FSS) and cognitive complaints (Cognitive Consequences after Intensive Care Admission; CLC-IC; dichotomized into CLC-high/low). Variable blocks: (1) Demographic and premorbid factors (sex, age, education, comorbidities), (2) Illness severity (ICU/general ward, PROMIS physical functioning [PROMIS-PF]), (3) Neuro-cognitive factors (self-reported neurological symptoms, MRI abnormalities, cognitive performance), (4) Psychological and social factors (Hospital Anxiety and Depression Scale [HADS], Utrecht Coping List, Social Support List), and (5) Fatigue or cognitive complaints. Results: The final models explained 60% (FSS) and 48% (CLC-IC) variance, with most blocks (except neuro-cognitive factors for FSS) significantly contributing. Psychological and social factors accounted for 5% (FSS) and 11% (CLC-IC) unique variance. Higher FSS scores were associated with younger age (P=.01), lower PROMIS-PF (P<.001), higher HADS-Depression (P=.03), and CLC-high (P=.04). Greater odds of CLC-high were observed in individuals perceiving more social support (OR=1.07, P<.05). Conclusions: Results show that psychological and social factors add to biomedical factors in explaining persistent post-COVID-19 fatigue and cognitive complaints. Objective neuro-cognitive factors were not associated with symptoms. Findings highlight the importance of multidomain treatment, including psychosocial care, which may not target biologically-rooted symptoms directly but may reduce associated distress.
AB - Objective: To evaluate whether psychological and social factors complement biomedical factors in understanding post-COVID-19 fatigue and cognitive complaints. Additionally, to incorporate objective (neuro-cognitive) and subjective (patient-reported) variables in identifying factors related to post-COVID-19 fatigue and cognitive complaints. Design: Prospective, multicenter cohort study. Setting: Six Dutch hospitals. Participants: 205 initially hospitalized (March-June 2020), confirmed patients with SARS-CoV-2, aged ≥18 years, physically able to visit the hospital, without prior cognitive deficit, magnetic resonance imaging (MRI) contraindication, or severe neurologic damage post-hospital discharge (N=205). Interventions: Not applicable. Main Outcome Measures: Nine months post-hospital discharge, a 3T MRI scan and cognitive testing were performed and patients completed questionnaires. Medical data were retrieved from medical dossiers. Hierarchical regression analyses were performed on fatigue severity (Fatigue Severity Scale; FSS) and cognitive complaints (Cognitive Consequences after Intensive Care Admission; CLC-IC; dichotomized into CLC-high/low). Variable blocks: (1) Demographic and premorbid factors (sex, age, education, comorbidities), (2) Illness severity (ICU/general ward, PROMIS physical functioning [PROMIS-PF]), (3) Neuro-cognitive factors (self-reported neurological symptoms, MRI abnormalities, cognitive performance), (4) Psychological and social factors (Hospital Anxiety and Depression Scale [HADS], Utrecht Coping List, Social Support List), and (5) Fatigue or cognitive complaints. Results: The final models explained 60% (FSS) and 48% (CLC-IC) variance, with most blocks (except neuro-cognitive factors for FSS) significantly contributing. Psychological and social factors accounted for 5% (FSS) and 11% (CLC-IC) unique variance. Higher FSS scores were associated with younger age (P=.01), lower PROMIS-PF (P<.001), higher HADS-Depression (P=.03), and CLC-high (P=.04). Greater odds of CLC-high were observed in individuals perceiving more social support (OR=1.07, P<.05). Conclusions: Results show that psychological and social factors add to biomedical factors in explaining persistent post-COVID-19 fatigue and cognitive complaints. Objective neuro-cognitive factors were not associated with symptoms. Findings highlight the importance of multidomain treatment, including psychosocial care, which may not target biologically-rooted symptoms directly but may reduce associated distress.
KW - Cognitive complaints
KW - Fatigue
KW - Infection
KW - Long COVID
KW - Post-COVID
KW - Rehabilitation
KW - SARS-CoV-2
UR - http://www.scopus.com/inward/record.url?scp=85184780761&partnerID=8YFLogxK
U2 - 10.1016/j.apmr.2023.12.014
DO - 10.1016/j.apmr.2023.12.014
M3 - Article
C2 - 38228250
SN - 0003-9993
VL - 105
SP - 826
EP - 834
JO - Archives of Physical Medicine and Rehabilitation
JF - Archives of Physical Medicine and Rehabilitation
IS - 5
ER -