COVID-19 and Cognitive Change in a Community-Based Cohort

Ryan T. Demmer, Division of Epidemiology, Department of Quantitative Health Sciences, College of Medicine and Science, Mayo Clinic, Rochester, Minnesota.
Talea Cornelius, Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, New York.
Zarina Kraal, Department of Neurology, Columbia University Vagelos College of Physicians and Surgeons, New York, New York.
James R. Pike, Department of Medicine, New York University Grossman School of Medicine, New York, New York.
Yifei Sun, Department of Biostatistics, Columbia University Mailman School of Public Health, New York, New York.
Pallavi Balte, Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, New York.
Chaoqi Wu, Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, New York.
Norrina B. Allen, Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
Mary Cushman, Department of Medicine, Larner College of Medicine at the University of Vermont, Burlington.
Astrid M. Suchy-Dicey, Huntington Medical Research Institutes, Pasadena, California.
Mitchell S. Elkind, Department of Neurology, Columbia University Vagelos College of Physicians and Surgeons, New York, New York.
Virginia Howard, Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham.
Anna Kucharska-Newton, Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill.
Deb Levine, Department of Medicine, University of Michigan, Ann Arbor.
Pamela L. Lutsey, Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis.
Jennifer Manly, Department of Neurology, Columbia University Vagelos College of Physicians and Surgeons, New York, New York.
Thomas H. Mosley, The Memory Impairment and Neurodegenerative Dementia (MIND) Center, University of Mississippi Medical Center, Jackson.
Priya Palta, Department of Neurology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill.
Melinda C. Power, Department of Epidemiology, Milken Institute School of Public Health, George Washington University, Washington, DC.
Sudha Seshadri, Glenn Biggs Institute for Alzheimer's and Neurodegenerative Diseases, Graduate School of Biomedical Sciences, University of Texas Health San Antonio, San Antonio.
Russell P. Tracy, Department of Pathology and Laboratory Medicine, Larner College of Medicine at the University of Vermont, Burlington.
Keenan Walker, Laboratory of Behavioral Neuroscience, National Institute on Aging, Baltimore, Maryland.
Josef Coresh, Division of Epidemiology, Department of Population Health, New York University Grossman School of Medicine, New York.
Elizabeth C. Oelsner, Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, New York.

Document Type

Journal Article

Publication Date

6-2-2025

Journal

JAMA network open

Volume

8

Issue

6

DOI

10.1001/jamanetworkopen.2025.18648

Abstract

IMPORTANCE: SARS-CoV-2 infection has been linked to neurotoxic effects and cognitive deficits. OBJECTIVE: To determine whether decreases in cognitive function were accelerated after SARS-CoV-2 infection compared with individuals not infected. DESIGN, SETTING, AND PARTICIPANTS: Multicenter, prospective cohort study from 2016 to 2022 among 3525 participants alive on March 1, 2020, and enrolled in The Atherosclerosis Risk in Communities (ARIC) study and the Collaborative Cohort of Cohorts for COVID-19 Research study who completed a prepandemic cognitive assessment and a pandemic-era assessment of SARS-CoV-2 infection. Final analyses performed in November 2024. EXPOSURE: SARS-CoV-2 infection determined via self-report of a positive SARS-CoV-2 test or health care professional diagnosis of COVID-19, a positive SARS-CoV-2 antinucleocapsid antibody response, or presence of an administrative code for COVID-19 on medical records. MAIN OUTCOMES AND MEASURES: A neuropsychological battery assessed multiple cognitive domains, and a cocalibrated confirmatory factor analysis generated factor scores for global cognitive function. The primary outcome was the rate of excess change in cognitive function. RESULTS: The 3525 eligible participants had a mean (SD) age of 80.8 (4.7) years, 2085 (59.1%) were female, 752 (21.4%) were Black, and 2773 (78.6%) were White. SARS-CoV-2 infection was detected among 307 participants (8.7%), 103 of whom (33.6%) were hospitalized. Among uninfected participants, the mean annualized change in cognitive function was -0.09 (95% CI, -0.13 to -0.04). Compared with this rate, change was faster (β = -0.06; 95% CI, -0.09 to -0.02) among participants hospitalized for infection, but not different from participants who were infected but not hospitalized (β = 0.00; 95% CI, -0.02 to 0.03). The association among participants hospitalized for infection was evident in the cognitive domains of memory and executive function, but not language. CONCLUSIONS AND RELEVANCE: This cohort study of older participants found accelerated decreases in cognition among individuals hospitalized for SARS-CoV-2 infection, but not nonhospitalized infection, in comparison with individuals not yet infected.

Department

Epidemiology

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