Neuropsychological functioning after COVID-19: minor differences between individuals with and without persistent complaints 2024 Verveen, Knoop et al

Full title: Neuropsychological functioning after COVID-19: minor differences between individuals with and without persistent complaints after SARS-CoV-2 infection

Objective: It is unclear how self-reported severe fatigue and difficulty concentrating after SARS-CoV-2 infection relate to objective neuropsychological functioning. The study aimed to compare neuropsychological functioning between individuals with and without these persistent subjective complaints.

Method: Individuals with and without persistent severe fatigue (Checklist Individual Strength (CIS) fatigue ≥ 35) and difficulty concentrating (CIS concentration ≥ 18) at least 3 months after SARS-CoV-2 infection were included. Neuropsychological assessment was performed on overall cognitive functioning, attention, processing speed, executive functioning, memory, visuo-construction, and language (18 tests). T-scores −1.5 SD below population normative data (T ≤ 35) were classified as “impaired”.

Results: 230 participants were included in the study, of whom 22 were excluded from the analysis due to invalid performance. Of the participants included in the analysis, 111 reported persistent complaints of severe fatigue and difficulty concentrating and 97 did not. Median age was 54 years, 59% (n = 126) were female, and participants were assessed a median of 23 months after first infection (IQR: 16–28). With bivariate logistic regression, individuals with persistent complaints had an increased likelihood of slower information processing speed performance on the Stroop word reading (OR = 2.45, 95%CI = 1.02–5.84) compared to those without persistent complaints. Demographic or clinical covariates (e.g. hospitalization) did not influence this association. With linear regression techniques, persistent complaints were associated with lower t-scores on the D2 CP, TMT B, and TMT B|A. There were no differences in performance on the other neuropsychological tests.

Conclusions: Individuals with subjective severe fatigue and difficulty concentrating after COVID-19 do not typically demonstrate cognitive impairment on extensive neuropsychological testing.

Paywall, https://www.tandfonline.com/doi/full/10.1080/13854046.2024.2379508

 

Nath uses the same terminology and it really erks me.

 

Minor differences when the testing methods probably have a really large random noise factor? Should psychology studies be placed in the fiction section of a library?

Does that translate as "their results would have disproven our desired conclusions"? Maybe they needed to edit those out to achieve the desired p-value?

 

I think, at least in American English, "medical complaint" is not a pejorative--it's not accusing the person of "complaining." It's really just medical-ese or doctor-ese for "medical concern" or "medical problem." So while I understand it might come across as offensive and have a framing impact, I don't think it should be interpreted as necessarily being used intentionally in that way. I mean, it might be--but it might just be an unfortunate turn of phrase that is meant to be benign.

 

Counterpoint though: I don't think you would write in medicalese that a person with, say rheumatoid arthritis, has "persistent complaints" of joint pain and deformity. You would write that their (established/accepted) symptoms are better, worse or stable. So I think there is an element of this being pejorative. The word "complaint" is usually preceded with the word "presenting" eg "history of presenting complaint" is the story the patient gives when first being seen, but wouldn't usually be revisited at follow-up appointments. The implication is "patient keeps repeating same presenting complaint (but I can find or think there's nothing wrong)".

 

In answer to the question above there is no mention of post-exertional malaise.

I have only been able to have a very brief skim but here are a few random initial thoughts:

Participants with "persistent complaints" had OR 2.45 (95% CI: 1.02–5.84) for slower processing speed on the Stroop word-reading test compared to those without "persistent complaints". This is minor but I would not have put in the abstract that they "do not typically demonstrate cognitive impairment on extensive neuropsychological testing". I do wonder about the generalisability - e.g. the authors report that 3/4rs of participants had a "high level" of education. Also I wonder if they have accounted adequately for all the possible confounders - I note that those with "persistent complaints" had lower vaccination rates, for instance, than those with.

It is also inconsistent with a number of other studies that have demonstrated cognitive deficits in this population. One particular curiosity is their use of TOMM to exclude 21/230 (9.1%) of participants. A brief search shows that there are some concerning reports about the use of this metric in the literature, e.g. this study which found high TOMM failure rates in those with Alzheimer's. The fact that the excluded participants were more often non-Dutch than Dutch (32% / 13%) is also curious and raises questions for me about the validity of the TOMM in these groups. Hope that someone familiar with neuropsychological testing can weigh in.

There have been a number of recent BPS-angled/associated papers recently that have raised potential red flags for me when skimming through that would benefit from a more thorough look, such as this one and - far more so - the recent app-based therapy one in the Lancet. Hope someone with more bandwidth & no/less severe ME takes a hard look at them.