![]() This pattern is consistent with early reports describing a dysexecutive syndrome after COVID-19 4 and has considerable implications for occupational, psychological, and functional outcomes. The relative sparing of memory recognition in the context of impaired encoding and recall suggests an executive pattern. Impairments in executive functioning, processing speed, category fluency, memory encoding, and recall were predominant among hospitalized patients. In this study, we found a relatively high frequency of cognitive impairment several months after patients contracted COVID-19. No significant differences in impairments in other domains were observed between groups. Patients treated in the ED were more likely to have impaired category fluency (OR: 1.8 95% CI: 1.1-3.1) and memory encoding (OR: 1.7 95% CI: 1.0-3.0) than those treated in the outpatient setting. In adjusted analyses, hospitalized patients were more likely to have impairments in attention (odds ratio : 2.8 95% CI: 1.3-5.9), executive functioning (OR: 1.8 95% CI: 1.0-3.4), category fluency (OR: 3.0 95% CI: 1.7-5.2), memory encoding (OR: 2.3 95% CI: 1.3-4.1), and memory recall (OR: 2.2 95% CI: 1.3-3.8) than those in the outpatient group. Participants self-identified as Black (15%), Hispanic (20%), or White (54%) or selected multiracial or other race and ethnicity (11% other race included Asian and those who selected “other” as race). The mean (IQR) age of 740 participants was 49 (38-59) years, 63% (n = 464) were women, and the mean (SD) time from COVID-19 diagnosis was 7.6 (2.7) months ( Table 1). Analyses were performed using SAS, version 9.4 (SAS Institute). The threshold for statistical significance was α = .05, and the tests were 2-tailed. 2, 3 Logistic regression assessed the association between cognitive impairment and COVID-19 care site (outpatient, ED, or hospital), adjusting for race and ethnicity, smoking, body mass index, comorbidities, and depression. We calculated the frequency of impairment on each measure, defined as a z score of less than or equal to 1.5 SDs below measure-specific age-, educational level–, and sex-adjusted norms. The study followed the Strengthening the Reporting of Observational Studies in Epidemiology ( STROBE) reporting guideline. The Mount Sinai Health System Institutional Review Board approved this study, and informed consent was obtained from study participants. Cognitive functioning was assessed using well-validated neuropsychological measures: Number Span forward (attention) and backward (working memory), Trail Making Test Part A and Part B (processing speed and executive functioning, respectively), phonemic and category fluency (language), and the Hopkins Verbal Learning Test–Revised (memory encoding, recall, and recognition). ![]() Participant demographic characteristics (eg, age, race, and ethnicity) were collected via self-report. Study participants were 18 years or older, spoke English or Spanish, tested positive for SARS-CoV-2 or had serum antibody positivity, and had no history of dementia. ![]() We analyzed data in this cross-sectional study from April 2020 through May 2021 from a cohort of patients with COVID-19 followed up through a Mount Sinai Health System registry.
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