Emerging research suggests that a sizeable portion of individuals hospitalized due to COVID-19 develop cognitive and psychological sequelae. In our conversation with Dr. Chaya Fridman, a board-certified neuropsychologist at Cornell, we discuss the ways that SARS-CoV-2 (the virus that causes COVID-19) may lead to neurocognitive impairment, including both direct effects of the virus and secondary factors (e.g., respiratory distress and treatments used in the Intensive Care Unit). We review how the virus gains access to the central nervous system and the potential underlying mechanisms by which it causes an increased risk of stroke and other neurological issues. We also examine the long-term effects of prior coronaviruses (SARS-CoV and MERS-CoV) to attempt to forecast the long-term effects of COVID-19, with a focus on how neuropsychological practice (both inpatient and outpatient) might be affected.
- Important terms and concepts related to COVID-19
- Basic physiological and neurological mechanisms by which SARS-CoV-2 may cause psychiatric and neurological symptoms
- Prevalence of neurological symptoms related to SARS-CoV-2 infection
- Most common neurological symptoms resulting from SARS-CoV-2 infection
- The relationship of SARS-CoV-2 infection to ischemic stroke and proposed mechanisms
- How SARS-CoV-2 may enter the body through the olfactory system
- Acute and long-term effects of SARS-CoV and MERS-CoV and how generalizable these findings are to SARS-CoV-2
- Comorbidity of COVID-19 and post-traumatic stress disorder
- How severity of COVID-19 illness is associated with cognitive and emotional symptoms
- Previous SARS-CoV-2 infection and its potential relationship with later neurological or neurodegenerative conditions
- Impact of COVID-19 infection on neurological and psychiatric symptoms in pediatric populations
- Demographic moderators of severity of neurological, psychiatric, and behavioral symptoms in individuals with COVID-19 infection
- The relationship of ICU admissions with negative cognitive functioning
- Mechanical ventilation and its effect on cognitive functioning
- Prevalence of delirium in individuals hospitalized and in long-term care facilities with COVID-19 infection
- Long-term psychiatric health of ICU survivors
- Inpatient neuropsychological evaluations of hospitalized individuals with COVID-19 infection
- Teleneuropsychology procedures for neuropsychological evaluations of hospitalized individuals with COVID-19 infection and encountered challenges
- Usefulness of behavioral observations and collateral report in understanding subtle cognitive and emotional manifestations in individuals with COVID-19 infection
- Contribution of neuropsychologists to psychological care
- Consideration of past history of COVID-19 infection in future neuropsychological evaluations
Chaya B. (Gopin) Fridman, Ph.D., ABPP-CN, is Director of Neuropsychology at the Weill Cornell Specialty Center. She is a board certified subspecialist in pediatric neuropsychology and an Associated Professor at NYP/Weill-Cornell Medical College. Her clinical work and research interests include ADHD, affective disorders, movement disorders, epilepsy, and other conditions affecting cognition. She was the co-author of a recent TCN article entitled Neuropsychological functioning in severe acute respiratory disorders caused by the coronavirus: implications for the current COVID-19 pandemic (see full reference below).
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