Objectives: Determine the prevalence of various stress-related factors among a sample of the US adult population in order to ascertain the potential impact upon cognitive functioning during the COVID-19 pandemic.
Methods: A US census, age-balanced sample of adults was recruited through an online survey platform in June 2020. Participants, blinded to the survey sponsor, completed a 20-question survey regarding activity participation as well as experiences and perceptions prior to and since the onset of the pandemic.
Results: A total of 693 respondents were included, of which 23% (n=159/693) were ≥60 years of age. Most (93.2%; n=646/693) reported experiencing one or more stressors. The prevalence of lifestyle-related stressors was high, with 47.2% and 63.1% reporting poor diet and poor sleep, respectively; and a substantially greater proportion indicated a worsening of diet, sleep, and financial stress since the pandemic began. The overall prevalence of health-related stressors was also high, with 63.5% reporting anxious symptoms—of which 26.6% were new onset, and 51.7% reporting depressive symptoms—of which 21.1% were new onset. Overall, 20.8% (n=144/693) described a worsening of their cognitive health since the pandemic began, with a greater likelihood of such among those who also experienced worsening of a health-related issue.
Conclusions: The prevalence of stressors known to affect cognitive functioning has increased during the pandemic, underscoring the necessity of proactively establishing routine neurocognitive assessment in clinical practice in order to better mitigate the impending mental health crisis.
Cognitive Test, Cognition, Stress, COVID-19, Brain Fog
The pandemic resulting from COVID-19, the disease caused by the highly transmissible severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has profoundly affected nearly every aspect of society. Information on COVID-19 continues to evolve rapidly, however many facets of the current and ongoing research effort have already yielded useful evidence that may be beneficial to multiple groups—patients with severe COVID-19, asymptomatic patients, healthcare professionals, or the general public. While the current pandemic context is tragic in every sense, an opportunity to more effectively manage one of the most common lingering effects of this disease nevertheless presents itself.
Cognitive impairment is a frequent and persistent issue among patients recovering from critical illness. It is associated with the post-surgical recovery period, ICU stay, specific procedures and conditions such as coronary artery bypass grafting (CABG) and acute respiratory distress syndrome (ARDS), as well as previous pandemics (SARS-1, Middle East respiratory syndrome [MERS]) [1-4], and now, COVID-19 [5,6]. Cognitive function is also a key determinant of functional recovery in a post-ICU setting, as such, failing to detect cognitive impairment at discharge can result in missed therapeutic opportunities for those who would otherwise benefit from targeted cognitive intervention .
Patients recovering from critical illness frequently experience other mental health and medical issues. Many of these issues are, in-turn, associated with cognitive impairment. Major depressive disorder (MDD), anxiety disorders, and post-traumatic stress disorder (PTSD) are common comorbidities among this patient population [1,8, and 9]. In addition, studies during the COVID-19 pandemic [10,11], as well as previous studies during the SARS and MERS pandemics [11-14], demonstrate the psychological impact of these infections on not only patients, but also clinicians, caregivers, family members, and the general public. In fact, psychological distress after natural disasters and health crises is common and often persistent [13,15]. There are many psychosocial factors at play during the pandemic which have the potential to cause psychiatric injury (Table 1) . Public health crises such as the COVID-19 pandemic are also associated with the exacerbation of existing as well as recurrence of remitted mental health issues (eg, substance use disorders [SUDs]) . These psychiatric disorders have been associated with a wide range of negative effects including increased somatic illnesses and impaired cognitive function [18,19].