medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/2079-701X-2022-16-11-102-107medsovet-6962Research ArticleПРАКТИКАPRACTICEОпыт лечения постковидных когнитивных нарушений (клиническое наблюдение)Treatment experience of post-COVID cognitive impairment (clinical observation)https://orcid.org/0000-0002-9851-4362ЖитковаЮ. В.ZhitkovaYu. V.

Житкова Юлия Владимировна, доктор медицинских наук, руководитель кабинета нарушения памяти, врач-невролог поликлинического отделения

420101, Казань, ул. Карбышева, д. 12, лит. А

Yuliya V. Zhitkova, Dr. Sci. (Med.), Head of the Memory Disorders Cabinet, Neurologist of the Polyclinic Department

12, letter A, Karbyshev St., Kazan, 420101

zhitkova@mail.ruhttps://orcid.org/0000-0002-8825-2346ХасановаД. Р.KhasanovaD. R.

Хасанова Дина Рустемовна, доктор медицинских наук , врач-невролог, главный внештатный ангионевролог Министерства здравоохранения Республики Татарстан, руководитель неврологического направления, Межрегиональный клинико-диагностический центр; профессор кафедры неврологии и нейрохирургии факультет повышения квалификации и профессиональной переподготовки специалистов, Казанский государственный медицинский университет

420101, Казань, ул. Карбышева, д. 12, лит. А,

420012, Казань, ул. Бутлерова, д. 49

Dina R. Khasanova, Dr. Sci. (Med.), Neurologist, Chief Supplementary Staff Member Angio-neurologist of the Ministry of Health of the Republic of Tatarstan, Head of the Neurological Department, Interregional clinical-diagnostic center; Professor, Department of Neurology and Neurosurgery, Faculty of Advanced Training and Professional Retraining of Specialists, Kazan State Medical University

12, letter A, Karbyshev St., Kazan, 420101,

49, Butlerov St., Kazan, 420012

dhasanova@mail.ruМежрегиональный клинико-диагностический центрРоссияInterregional clinical-diagnostic centerRussian FederationМежрегиональный клинико-диагностический центр; Казанский государственный медицинский университетРоссияInterregional clinical-diagnostic center; Kazan State Medical UniversityRussian Federation202206072022011102107Copyright © Житкова Ю.В., Хасанова Д.Р., 20222022Житкова Ю.В., Хасанова Д.Р.Zhitkova Y.V., Khasanova D.R.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/6962

Постковидные когнитивные нарушения, в т. ч. у молодого населения, представляют актуальную медико-социальную проблему. Известно, что COVID-19 даже при отсутствии прямого повреждения мозга, связанного с COVID-19-ассоциированным инсультом или энцефалитом, и независимо от тяжести течения инфекции острого периода и возраста пациентов, может вызывать продолжительное и дезадаптирующее когнитивное расстройство. Патогенез этих нарушений сложен, на сегодняшний день до конца не ясен и продолжает активно изучаться. Отсутствуют также стандартизированные диагностические и  лечебные подходы к  ведению пациентов с  постковидными когнитивными нарушениями. Приведенное клиническое наблюдение демонстрирует опыт лечения когнитивных нарушений после COVID-19 у молодого пациента с использованием имеющихся знаний о патогенезе. Проведен обзор современных публикаций по проблеме постковидных когнитивных нарушений. На  основании имеющихся литературных данных обсуждена роль различных патогенетических факторов развития постковидных когнитивных нарушений у представленного пациента. На конкретном клиническом примере дано обоснование выбора лечебных стратегий и необходимости проведения дальнейших исследований в области постковидного синдрома и  его патогенеза, диагностики и  лечения постковидных когнитивных нарушений, что позволит создать доказательную базу для разработки клинических рекомендаций.

 

Post-Cognitive Impairment, including in  the young population, is an urgent medical and social problem. It is known that COVID-19, even in the absence of direct brain damage associated with covid-associated stroke or encephalitis, regardless of the severity of the infection during the acute period and the age of patients, can cause long-term and maladaptive cognitive impairment. The pathogenesis of these disorders is complex, and it is not completely clear today and continues to be actively studied. There is also no standardized diagnostic and therapeutic approach in the management of patients with post-COVID cognitive impairment. The presented clinical observation demonstrates the experience of treating cognitive impairment after COVID-19 in a young patient using the available knowledge of pathogenesis. A review of modern publications on the problem of post-COVID cognitive impairment was carried out. Based on the available literature data, the role of various pathogenetic factors in the development of post-covid cognitive impairment in the presented patient is discussed. Based on a specific clinical example, the rationale for the choice of treatment strategies and the need to further increase knowledge about the postCOVID syndrome, conduct future research in  the field of  pathogenesis, diagnosis and treatment of  post-COVID cognitive impairment, which will create an evidence base for the development of clinical recommendations, is given.

долгосрочные последствия COVID-19когнитивные нарушенияпостковидный синдромкогнитивные нарушения после COVID-19лечение когнитивных нарушенийlong-term effects of COVID-19cognitive impairmentpost-COVID syndromepost-COVID-19 cognitive impairmenttreatment of cognitive impairmentReferencesAlemanno F., Houdayer E., Parma A., Spina A., Del Forno A., Scatolini A. et al. COVID-19 cognitive deficits after respiratory assistance in the subacute phase: A COVID-rehabilitation unit experience. PLoS ONE. 2021;16(2):e0246590. https://doi.org/10.1371/journal.pone.0246590.Alemanno F., Houdayer E., Parma A., Spina A., Del Forno A., Scatolini A. et al. COVID-19 cognitive deficits after respiratory assistance in the subacute phase: A COVID-rehabilitation unit experience. PLoS ONE. 2021;16(2):e0246590. https://doi.org/10.1371/journal.pone.0246590.Daroische R., Hemminghyth M.S., Eilertsen T.H., Breitve M.H., Chwiszczuk L.J. Cognitive Impairment After COVID-19 – A Review on Objective Test Data. Front Neurol. 2021:12:699582. https://doi.org/10.3389/fneur.2021.699582.Daroische R., Hemminghyth M.S., Eilertsen T.H., Breitve M.H., Chwiszczuk L.J. Cognitive Impairment After COVID-19 – A Review on Objective Test Data. Front Neurol. 2021:12:699582. https://doi.org/10.3389/fneur.2021.699582.Altuna M., Sánchez-Saudinós M.B., Lleó A. Cognitive symptoms after COVID-19. Neurol Perspect. 2021:1(Suppl_1):S16–S24. https://doi.org/10.1016/j.neurop.2021.10.005.Altuna M., Sánchez-Saudinós M.B., Lleó A. Cognitive symptoms after COVID-19. Neurol Perspect. 2021:1(Suppl_1):S16–S24. https://doi.org/10.1016/j.neurop.2021.10.005.Henneghan A.M., Lewis K.A., Gill E., Kesler S.R. Cognitive Impairment in Non-critical, Mild-to-Moderate COVID-19 Survivors. Front Psychol. 2022:13:770459. https://doi.org/10.3389/fpsyg.2022.770459.Henneghan A.M., Lewis K.A., Gill E., Kesler S.R. Cognitive Impairment in Non-critical, Mild-to-Moderate COVID-19 Survivors. Front Psychol. 2022:13:770459. https://doi.org/10.3389/fpsyg.2022.770459.Hampshire A., Trendera W., Chamberlain S.R., Jollya A.E., Grant J.E., Patricke F. et al. Cognitive deficits in people who have recovered from COVID-19. EClinicalMedicine. 2021:39:101044. https://doi.org/10.1016/j.eclinm.2021.101044.Hampshire A., Trendera W., Chamberlain S.R., Jollya A.E., Grant J.E., Patricke F. et al. Cognitive deficits in people who have recovered from COVID-19. EClinicalMedicine. 2021:39:101044. https://doi.org/10.1016/j.eclinm.2021.101044.Heneka M.T., Golenbock D., Latz E., Morgan D., Brown R. Immediate and long-term consequences of COVID-19 infections for the development of neurological disease. Alzheimers Res Ther. 2020:12(1):69. https://doi.org/10.1186/s13195-020-00640-3.Heneka M.T., Golenbock D., Latz E., Morgan D., Brown R. Immediate and long-term consequences of COVID-19 infections for the development of neurological disease. Alzheimers Res Ther. 2020:12(1):69. https://doi.org/10.1186/s13195-020-00640-3.Miskowiak K.W., Johnsen S., Sattler S.M., Nielsen S., Kunalanc K., Rungby J. et al. Cognitive impairments four months after COVID-19 hospital discharge: Pattern, severity and association with illness variables. European Neuropsychopharmacology. 2021:46:39–48. https://doi.org/10.1016/j.euroneuro.2021.03.019.Miskowiak K.W., Johnsen S., Sattler S.M., Nielsen S., Kunalanc K., Rungby J. et al. Cognitive impairments four months after COVID-19 hospital discharge: Pattern, severity and association with illness variables. European Neuropsychopharmacology. 2021:46:39–48. https://doi.org/10.1016/j.euroneuro.2021.03.019.Jaywant A., Vanderlind W.M., Alexopoulos G.S., Fridman C.B., Perlis R.H., Gunning F.M. Frequency and profile of objective cognitive deficits in hospitalized patients recovering from COVID-19. Neuropsychopharmacology. 2021:46(13):2235–2240. https://doi.org/10.1038/s41386-021-00978-8.Jaywant A., Vanderlind W.M., Alexopoulos G.S., Fridman C.B., Perlis R.H., Gunning F.M. Frequency and profile of objective cognitive deficits in hospitalized patients recovering from COVID-19. Neuropsychopharmacology. 2021:46(13):2235–2240. https://doi.org/10.1038/s41386-021-00978-8.Politi L.S., Salsano E., Grimaldi M. Magnetic Resonance Imaging Alteration of the Brain in a Patient With Coronavirus Disease 2019 (COVID-19) and Anosmia. JAMA Neurol. 2020;77(8):1028–1029. https://doi.org/10.1001/jamaneurol.2020.2125.Politi L.S., Salsano E., Grimaldi M. Magnetic Resonance Imaging Alteration of the Brain in a Patient With Coronavirus Disease 2019 (COVID-19) and Anosmia. JAMA Neurol. 2020;77(8):1028–1029. https://doi.org/10.1001/jamaneurol.2020.2125.Moein S.T., Hashemian S.M.R., Mansourafshar B., Khorram-Tousi A., Tabarsi P., Doty R.L. Smell dysfunction: a biomarker for COVID-19. Int Forum of Allergy Rhinol. 2020:10(8):944–950. https://doi.org/10.1002/alr.22587.Moein S.T., Hashemian S.M.R., Mansourafshar B., Khorram-Tousi A., Tabarsi P., Doty R.L. Smell dysfunction: a biomarker for COVID-19. Int Forum of Allergy Rhinol. 2020:10(8):944–950. https://doi.org/10.1002/alr.22587.Lechien J.R., Chiesa-Estomba C.M., De Siati D.R., Horoi M., Le Bon S.D., Rodriguez A. et al. Olfactory and gustatory dysfunctions as a clinical presentation of mild-to-moderate forms of the coronavirus disease (COVID-19): a multicenter European study. Eur Arch Otorhinolaryngol. 2020:277(8):2251–2261. https://doi.org/10.1007/s00405-020-05965-1.Lechien J.R., Chiesa-Estomba C.M., De Siati D.R., Horoi M., Le Bon S.D., Rodriguez A. et al. Olfactory and gustatory dysfunctions as a clinical presentation of mild-to-moderate forms of the coronavirus disease (COVID-19): a multicenter European study. Eur Arch Otorhinolaryngol. 2020:277(8):2251–2261. https://doi.org/10.1007/s00405-020-05965-1.Bagheri S.H.R., Asghari A.M., Farhadi M., Shamshiri A.R., Kabir A., Kamrva S.K. et al. Coincidence of COVID-19 epidemic and olfactory dysfunction outbreak in Iran. Med J Islam Repub Iran. 2020:34:62. Available at: https://pubmed.ncbi.nlm.nih.gov/32974228/.Bagheri S.H.R., Asghari A.M., Farhadi M., Shamshiri A.R., Kabir A., Kamrva S.K. et al. Coincidence of COVID-19 epidemic and olfactory dysfunction outbreak in Iran. Med J Islam Repub Iran. 2020:34:62. Available at: https://pubmed.ncbi.nlm.nih.gov/32974228/.Suzuki M., Saito K., Min W.-P., Vladau C., Toida K., Itoh H., Murakami S. Identification of viruses in patients with postviral olfactory dysfunction. Laryngoscope. 2007:117(2):272–277. https://doi.org/10.1097/01.mlg.0000249922.37381.1e.Suzuki M., Saito K., Min W.-P., Vladau C., Toida K., Itoh H., Murakami S. Identification of viruses in patients with postviral olfactory dysfunction. Laryngoscope. 2007:117(2):272–277. https://doi.org/10.1097/01.mlg.0000249922.37381.1e.Gane S.B., Kelly C., Hopkins C. Isolated sudden onset anosmia in COVID-19 infection. A novel syndrome? Rhinology. 2020:1:58(3):299–301. https://doi.org/10.4193/Rhin20.114.Gane S.B., Kelly C., Hopkins C. Isolated sudden onset anosmia in COVID-19 infection. A novel syndrome? Rhinology. 2020:1:58(3):299–301. https://doi.org/10.4193/Rhin20.114.Rocke J., Hopkins C., Philpott C., Kumar B.N. Is loss of sense of smell as a diagnostic marker in COVID-19: A Systematic Review and Meta-analysis. Clin Otolaryngol. 2020;45(6):914–922. https://doi.org/10.22541/au.158757120.03114031.Rocke J., Hopkins C., Philpott C., Kumar B.N. Is loss of sense of smell as a diagnostic marker in COVID-19: A Systematic Review and Meta-analysis. Clin Otolaryngol. 2020;45(6):914–922. https://doi.org/10.22541/au.158757120.03114031.van Riel D., Verdijk R., Kuiken T. The olfactory nerve: a shortcut for influenza and other viral diseases into the central nervous system. J Pathol. 2015:235(2):277–287. https://doi.org/10.1002/path.4461.van Riel D., Verdijk R., Kuiken T. The olfactory nerve: a shortcut for influenza and other viral diseases into the central nervous system. J Pathol. 2015:235(2):277–287. https://doi.org/10.1002/path.4461.Vaira L.A., Salzano G., Deiana G., De Riu G. Anosmia and ageusia: common findings in COVID-19 patients. Laryngoscope. 2020:130(7):1787–1787. https://doi.org/10.1002/lary.28692.Vaira L.A., Salzano G., Deiana G., De Riu G. Anosmia and ageusia: common findings in COVID-19 patients. Laryngoscope. 2020:130(7):1787–1787. https://doi.org/10.1002/lary.28692.Крюков А.И., Казакова А.А., Гехт А.Б. Нарушение обоняния у больных COVID-19: механизмы и клиническое значение. Вестник оториноларингологии. 2020:85(5):93–97. https://doi.org/10.17116/otorino20208505193.КKryukov A.I., Kazakova A.A., Guekht A.B. Smell impairment in COVID-19 patients: mechanisms and clinical significance. Vestnik Oto-Rino-Laringologii. 2020:85(5):93–97. (In Russ.) https://doi.org/10.17116/otorino20208505193.Сhurnin I., Qazi J., Fermin C.R., Wilson J.H., Payne S.C., Mattos J.L. Association between olfactory and gustatory dysfunction and cognition in older adults. Am J Rhinol Allergy. 2019:33(2):170–177. https://doi.org/10.1177/1945892418824451.Сhurnin I., Qazi J., Fermin C.R., Wilson J.H., Payne S.C., Mattos J.L. Association between olfactory and gustatory dysfunction and cognition in older adults. Am J Rhinol Allergy. 2019:33(2):170–177. https://doi.org/10.1177/1945892418824451.Dintica C.S., Marseglia A., Rizzuto D., Wang R., Seubert J., Arfanakis K. et al. Impaired olfaction is associated with cognitive decline and neurodegeneration in the brain. Neurology. 2019:92(7):e700–e709. https://doi.org/10.1212/WNL.0000000000006919.Dintica C.S., Marseglia A., Rizzuto D., Wang R., Seubert J., Arfanakis K. et al. Impaired olfaction is associated with cognitive decline and neurodegeneration in the brain. Neurology. 2019:92(7):e700–e709. https://doi.org/10.1212/WNL.0000000000006919.Pirker-Keesa A., Platho-Elwischgera K., Hafnera S., Redlichc K., Baumgartnera C. Hyposmia Is Associated with Reduced Cognitive Function in COVID-19: First Preliminary Results. Dement Geriatr Cogn Disord. 2021:50(1):68–73. https://doi.org/10.1159/000515575.Pirker-Keesa A., Platho-Elwischgera K., Hafnera S., Redlichc K., Baumgartnera C. Hyposmia Is Associated with Reduced Cognitive Function in COVID-19: First Preliminary Results. Dement Geriatr Cogn Disord. 2021:50(1):68–73. https://doi.org/10.1159/000515575.Lavi E., Cong L. Type I astrocytes and microglia induce a cytokine response in an encephalitic murine coronavirus infection. Exp Mol Pathol. 2020:115:104474. https://doi.org/10.1016/j.yexmp.2020.104474.Lavi E., Cong L. Type I astrocytes and microglia induce a cytokine response in an encephalitic murine coronavirus infection. Exp Mol Pathol. 2020:115:104474. https://doi.org/10.1016/j.yexmp.2020.104474.Zhou H., Lu S., Chen J., Wei N., Wang D., Lyu H. et al. The landscape of cognitive function in recovered COVID-19 patients. J Psychiatr Res. 2020:129:98–102. https://doi.org/10.1016/j.jpsychires.2020.06.022.Zhou H., Lu S., Chen J., Wei N., Wang D., Lyu H. et al. The landscape of cognitive function in recovered COVID-19 patients. J Psychiatr Res. 2020:129:98–102. https://doi.org/10.1016/j.jpsychires.2020.06.022.Herrmann J., Mori V., Bates J.H.T., Suki B. Modeling lung perfusion abnormalities to explain early COVID-19 hypoxemia. Nat Commun. 2020:11(1):4883. https://doi.org/10.1038/s41467-020-18672-6.Herrmann J., Mori V., Bates J.H.T., Suki B. Modeling lung perfusion abnormalities to explain early COVID-19 hypoxemia. Nat Commun. 2020:11(1):4883. https://doi.org/10.1038/s41467-020-18672-6.Akoumianaki E., Vaporidi K., Bolaki M., Georgopoulos D. Happy or Silent Hypoxia in COVID-19-A Misnomer Born in the Pandemic Era. Front Physiol. 2021:12:745634. https://doi.org/10.3389/fphys.2021.745634.Akoumianaki E., Vaporidi K., Bolaki M., Georgopoulos D. Happy or Silent Hypoxia in COVID-19-A Misnomer Born in the Pandemic Era. Front Physiol. 2021:12:745634. https://doi.org/10.3389/fphys.2021.745634.Nation D.A., Sweeney M.D., Montagne A., Sagare A.P., D’Orazio L.M., Pachicano M. et al. Blood-brain barrier breakdown is an early biomarker of human cognitive dysfunction. Nat Med. 2019:25(2):270–276. https://doi.org/10.1038/s41591-018-0297-y.Nation D.A., Sweeney M.D., Montagne A., Sagare A.P., D’Orazio L.M., Pachicano M. et al. Blood-brain barrier breakdown is an early biomarker of human cognitive dysfunction. Nat Med. 2019:25(2):270–276. https://doi.org/10.1038/s41591-018-0297-y.Zetterberg H., Schott J.M. Biomarkers for Alzheimer’s disease beyond amyloid and tau. Nat Med. 2019:25(2):201–203. https://doi.org/10.1038/s41591-019-0348-z.Zetterberg H., Schott J.M. Biomarkers for Alzheimer’s disease beyond amyloid and tau. Nat Med. 2019:25(2):201–203. https://doi.org/10.1038/s41591-019-0348-z.Montagne A., Nation D.A., Sagare A.P., Barisano G., Sweeney M.D., Chakhoyan A. et al. APOE4 leads to blood-brain barrier dysfunction predicting cognitive decline. Nature. 2020:581(7806):71–76. https://doi.org/10.1038/s41586-020-2247-3.Montagne A., Nation D.A., Sagare A.P., Barisano G., Sweeney M.D., Chakhoyan A. et al. APOE4 leads to blood-brain barrier dysfunction predicting cognitive decline. Nature. 2020:581(7806):71–76. https://doi.org/10.1038/s41586-020-2247-3.Zhang L., Zhou L., Bao L., Liu J., Zhu H., Lv Q. et al. SARS-CoV-2 crosses the blood–brain barrier accompanied with basement membrane disruption without tight junctions alteration. Signal Transduct Target Ther. 2021:6(1):337. https://doi.org/10.1038/s41392-021-00719-9.Zhang L., Zhou L., Bao L., Liu J., Zhu H., Lv Q. et al. SARS-CoV-2 crosses the blood–brain barrier accompanied with basement membrane disruption without tight junctions alteration. Signal Transduct Target Ther. 2021:6(1):337. https://doi.org/10.1038/s41392-021-00719-9.Krasemann S., Haferkamp U., Pfefferle S., Woo M.S., Heinrich F., Schweizer M. et al. The blood-brain barrier is dysregulated in COVID-19 and serves as a CNS entry route for SARS-CoV-2. Stem Cell Reports. 2022:17(2):307–320. https://doi.org/10.1016/j.stemcr.2021.12.011.Krasemann S., Haferkamp U., Pfefferle S., Woo M.S., Heinrich F., Schweizer M. et al. The blood-brain barrier is dysregulated in COVID-19 and serves as a CNS entry route for SARS-CoV-2. Stem Cell Reports. 2022:17(2):307–320. https://doi.org/10.1016/j.stemcr.2021.12.011.Sweeney M.D., Montagne A., Sagare A.P., Nation D.A., Schneider L.S., Chui H.C. et al. Vascular dysfunction – The disregarded partner of Alzheimer’s disease. Alzheimers Dement. 2019:15(1):158–167. https://doi.org/10.1016/j.jalz.2018.07.222.Sweeney M.D., Montagne A., Sagare A.P., Nation D.A., Schneider L.S., Chui H.C. et al. Vascular dysfunction – The disregarded partner of Alzheimer’s disease. Alzheimers Dement. 2019:15(1):158–167. https://doi.org/10.1016/j.jalz.2018.07.222.Blazhenets G., Schröter N., Bormann T., Thurow J., Wagner D., Frings L. et al. Slow but evident recovery from neocortical dysfunction and cognitive impairment in a series of chronic COVID-19 patients. J Nucl Med. 2021:62(7):910–915. https://doi.org/10.2967/jnumed.121.262128.Blazhenets G., Schröter N., Bormann T., Thurow J., Wagner D., Frings L. et al. Slow but evident recovery from neocortical dysfunction and cognitive impairment in a series of chronic COVID-19 patients. J Nucl Med. 2021:62(7):910–915. https://doi.org/10.2967/jnumed.121.262128.Hosp J.A., Dressing A., Blazhenets G., Bormann T., Rau A., Schwabenland M. et al. Cognitive impairment and altered cerebral glucose metabolism in the subacute stage of COVID-19. Brain. 2021:144(4):1263–1276. https://doi.org/10.1093/brain/awab009.Hosp J.A., Dressing A., Blazhenets G., Bormann T., Rau A., Schwabenland M. et al. Cognitive impairment and altered cerebral glucose metabolism in the subacute stage of COVID-19. Brain. 2021:144(4):1263–1276. https://doi.org/10.1093/brain/awab009.Dressing A., Bormann T., Blazhenets G., Schroeter N., Walter L.I., Thurow J. et al. Neuropsychological profiles and cerebral glucose metabolism in neurocognitive Long COVID-syndrome. J Nucl Med. 2021:63(5):121.262677. https://doi.org/10.2967/jnumed.121.262677.Dressing A., Bormann T., Blazhenets G., Schroeter N., Walter L.I., Thurow J. et al. Neuropsychological profiles and cerebral glucose metabolism in neurocognitive Long COVID-syndrome. J Nucl Med. 2021:63(5):121.262677. https://doi.org/10.2967/jnumed.121.262677.Ceban F., Ling S., Lui L.M.W., Lee Y., Gill H., Teopiz K.M. et al. Fatigue and cognitive impairment in Post-COVID-19 Syndrome: A systematic review and meta-analysis. Brain Behav Immun. 2022:101:93–135. https://doi.org/10.1016/j.bbi.2021.12.020.Ceban F., Ling S., Lui L.M.W., Lee Y., Gill H., Teopiz K.M. et al. Fatigue and cognitive impairment in Post-COVID-19 Syndrome: A systematic review and meta-analysis. Brain Behav Immun. 2022:101:93–135. https://doi.org/10.1016/j.bbi.2021.12.020.

The authors declare that there are no conflicts of interest present.