Associations between subjective cognitive difficulties, cognitive test performance, psychiatric symptoms, and QOL in pediatric LC, 2026, Davis et al.

[Chandelier]

Associations between subjective cognitive difficulties, cognitive test performance, psychiatric symptoms, and quality of life in pediatric long COVID

Spoiler: Authors

Davis, Audrey; Vargas, Gray; Parker, Kathleen; Malone, Laura A.; Nadendla, Kavita D.; Ng, Rowena

Abstract​

Objective: This retrospective study examined the associations between subjective cognitive difficulties, performance scores on standardized cognitive tests, and quality of life (QoL) among pediatric patients with long COVID.

Method: This study included 82 pediatric patients with long COVID referred for a neuropsychological evaluation by a specialty pediatric Post-COVID clinic (50 F, Mage = 14.52 years, SD = 3.04, range = 6–19). Patients completed standardized neuropsychological assessments of intellectual functioning, learning/memory, working memory, auditory attention, processing speed, executive function, and performance validity, as well as the Pediatric Quality of Life Inventory (PedsQLTM).

Other outcomes of interest included subjective cognitive impairment and psychiatric symptoms. Relationships between subjective cognitive difficulties and cognitive performance on QoL were analyzed using hierarchical multiple linear regressions, with COVID course factors and psychiatric symptoms as covariates.

Results: Our pediatric cohort reported very low overall QoL (M = 52.41, SD = 16.95), with the average score surpassing the published clinical cutoff for children with major chronic health conditions. Subjective cognitive difficulties significantly predicted lower QoL, even after controlling for psychiatric symptoms. Cognitive test performance on any domain did not significantly determine QoL.

Conclusions: These findings offer initial support that subjective cognitive difficulties, but not cognitive test performance, significantly correlate with lower QoL in pediatric patients with long COVID.

The results highlight the importance of screening for perceived subjective cognitive impairment beyond mental health screening in youth with long COVID. Treatment and school planning for children with long COVID should consider self-reported cognitive difficulties and psychological health and how these impact their daily functioning across home, school, and social settings.


Web | DOI | PDF | The Clinical Neuropsychologist | Paywall

 

[SNT Gatchaman]

From discussion with added line breaks —

Subjective cognitive functioning was a much better predictor of QoL than objective cognitive functioning. Therefore, it is important to integrate both patient and family-reported and performance-based cognitive metrics in clinical assessments of youth with long COVID. Neurocognitive measures have a moderate level of ecological validity, or ability to generalize an individual’s performance on an objective measure to their real-world functioning.

It is possible that the structured, one-to-one testing environment with reduced distractors maximizes children’s focus and sustained attention. In contrast, patients with long COVID may struggle to apply cognitive skills in daily life and in less structured environments with more distractions. Clinicians also often utilize numerous behavioral strategies, such as encouragement, praise, redirections, prompts, repetitions, and breaks, that are designed to support children’s engagement and persistence throughout the evaluation.

Notably, our patients may not experience the full impact of physical symptoms on their cognitive functioning during the neuropsychological assessment as compared to daily life. For example, children with chronic fatigue or malaise may not experience the full brunt of their symptoms during an evaluation that only lasts 2 to 3 hours, in contrast to an evening after a full day of school and other extracurricular activities, when they are trying to complete homework.

In brief, the complexity of day-to-day cognitive functioning may not be fully captured with solely objective measures—given that neuropsychological assessments are a snapshot of the child’s cognitive skills under relatively well-controlled test conditions.

Which is reasonable enough, but then they continue with —

It is important to highlight that subjective reports of daily functioning may have their own limitations. Patient and informant observations are susceptible to other forms of bias, such as negative response bias or “overreporting.” Consistent with the “good old days bias” found in patients with concussion, patients and caregivers in this population may also underestimate pre-COVID cognitive difficulties, and in turn, perceive current cognitive functioning as markedly worse. And similar to symptoms after concussion, patients and families might tend to misattribute current cognitive difficulties to the medical event, particularly given media attention describing negative effects of both conditions.

despite having previously stated —

While over 90% of our participants reported the presence of subjective cognitive difficulties, most participants performed broadly within or above age expectations on neuropsychological measures.

and

Our main study findings highlight the value of subjective reports of cognition in rehabilitative care and treatment/academic programming, even if objective measures alone do not suggest cognitive impairment.

So I'm not sure how it follows that there can be no objective evidence of cognitive impairment, while at the same time they "underestimate pre-COVID cognitive difficulties".

 

[Turtle]

2 to 3 hours of testing doesn't show much, are the researchers doing the right tests?

 

[Peter T]

2 to 3 hours of testing doesn't show much, are the researchers doing the right tests?

Yes, it is a possibility that the cognitive tests used are not the right ones to measure the cognitive impacts of Long Covid.