Fatigue and Cognitive Impairment in Post-COVID-19 Syndrome: A Systematic Review and Meta-Analysis, 2021, Ceban et al

Fatigue and Cognitive Impairment in Post-COVID-19 Syndrome: A Systematic Review and Meta-Analysis

Felicia Ceban, Susan Ling, Leanna M.W. Lui, Yena Lee, Hartej Gill, Kayla M. Teopiz, Nelson B. Rodrigues, Mehala Subramaniapillai, Joshua D. Di Vincenzo, Bing Cao, Kangguang Lin, Rodrigo B. Mansurah, Roger C. Ho, Joshua D. Rosenblat, Kamilla W. Miskowiak, Maj Vinberg, Vladimir Maletic, Roger S. McIntyre

Abstract

Importance

COVID-19 is associated with clinically significant symptoms despite resolution of the acute infection (i.e., post-COVID-19 syndrome). Fatigue and cognitive impairment are amongst the most common and debilitating symptoms of post-COVID-19 syndrome.

Objective
To quantify the proportion of individuals experiencing fatigue and cognitive impairment 12 or more weeks following COVID-19 diagnosis, and to characterize the inflammatory correlates and functional consequences of post-COVID-19 syndrome.

Data Sources
Systematic searches were conducted without language restrictions from database inception to June 8, 2021 on PubMed/MEDLINE, The Cochrane Library, PsycInfo, Embase, Web of Science, Google/Google Scholar, and select reference lists.

Study Selection
Primary research articles which evaluated individuals at least 12 weeks after confirmed COVID-19 diagnosis and specifically reported on fatigue, cognitive impairment, inflammatory parameters, and/or functional outcomes were selected.

Data Extraction & Synthesis
Two reviewers independently extracted published summary data and assessed methodological quality and risk of bias. A meta-analysis of proportions was conducted to pool Freeman-Turkey double arcsine transformed proportions using the random-effects restricted maximum-likelihood model.

Main Outcomes & Measures
The co-primary outcomes were the proportions of individuals reporting fatigue and cognitive impairment, respectively, 12 or more weeks after COVID-19 infection. The secondary outcomes were inflammatory correlates and functional consequences of post-COVID-19 syndrome.

Results
The literature search yielded 10,979 studies, and 81 studies were selected for inclusion. The fatigue meta-analysis comprised 68 studies, the cognitive impairment meta-analysis comprised 43 studies, and 48 studies were included in the narrative synthesis. Meta-analysis revealed that the proportion of individuals experiencing fatigue 12 or more weeks following COVID-19 diagnosis was 0.32 (95% CI, 0.27, 0.37; p < 0.001; n = 25,268; I2=99.1%). The proportion of individuals exhibiting cognitive impairment was 0.22 (95% CI, 0.17, 0.28; p < 0.001; n = 13,232; I2=98.0). Moreover, narrative synthesis revealed elevations in proinflammatory markers and considerable functional impairment in a subset of individuals.

Conclusions & Relevance
A significant proportion of individuals experience persistent fatigue and/or cognitive impairment following resolution of acute COVID-19. The frequency and debilitating nature of the foregoing symptoms provides the impetus to characterize the underlying neurobiological substrates and how to best treat these phenomena.


https://www.sciencedirect.com/science/article/pii/S0889159121006516

 

There has been, understandably, quite a bit of variance in 'long covid' publications, so it makes sense that we're going to start seeing some reviews. I could only skim this, but there wasn't a lot that stood out one way or another. At least, given that it seems kind of broad, but then I'm going to be on the lookout for certain types of specifics, obviously related to ME/CFS. I will say that the list of the authors' affiliated institutions is not exactly inspiring:

Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada
Brain and Cognition Discovery Foundation, Toronto, ON, Canada
Braxia Health, Mississauga, ON, Canada
Department of Pharmacology, University of Toronto, Toronto, ON, Canada
Key Laboratory of Cognition and Personality, Faculty of Psychology, Ministry of Education, Southwest University, Chongqing, 400715, P. R. China
Department of Affective Disorders, the Affiliated Brain Hospital of Guangzhou Medical University, (Guangzhou Huiai Hospital), Guangzhou Medical University, Guangzhou, China
Laboratory of Emotion and Cognition, the Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou Medical University, Guangzhou, China
Department of Psychiatry, University of Toronto, Toronto, ON, Canada
Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
Institute for Health Innovation and Technology (iHealthtech), National University of Singapore, Singapore
Department of Psychology, University of Copenhagen, Copenhagen, Denmark
Mental Health services, Capital Region of Denmark, Copenhagen University Hospital, Copenhagen, Denmark
Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
Psychiatric Research Unit, Psychiatric Centre North Zealand, Hillerød, Denmark
Department of Psychiatry, University of South Carolina, Greenville, SC, USA

Taking that into consideration, perhaps it's not quite as bad as one might expect. Or maybe it is & I'm too bleary-eyed to see the red flags.

Those affiliations did make me wonder a bit about the journal, so I took a look. There have been several dozen papers on ME/CFS published in it. It is a mixed bag, as there have been papers by Suzanne Vernon, Nancy Klimas, Carmen Scheibenbogen, Lenny Jason, & Fluge & Mella, among others; but also CDC (Unger & Reeves), Carmine Pariante, Peter White, and--this stands out--half a dozen papers by Vegard Bruun Wyller. If it's one of his favorite journals to publish in, that would be somewhat concerning, but judging the journal and particularly this paper would be a bit harsh.

Far more important would be seeing reviews that deal with often-seen criticisms of the idea of Long Covid, i.e. self-report, no confirmed Covid test/diagnosis, etc. There is plenty of self-reported data on the papers they looked at, but info they deem 'objective' as well, via both testing & 'validated' questionnaires. They set a parameter of 12 weeks post-acute, in accordance with the NICE criteria for LC/PASC. Overall...very 'fatigue' heavy, no mention of post-exertional malaise or CPET testing. So, strikes me as typical of so much useless, vague ME/CFS research, even if it doesn't necessarily seem as ideologically driven as the specifically noxious garbage generated by our good friends in the BPS cult.