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3 Two Dominant Post-COVID Subtypes in Patients Seeking Treatment for “Brain Fog” Through a Post-COVID Treatment Clinic
- Kristine Lokken, Jamie Hansel Robinson, Richard Kennedy, David E Vance, Ronald M Lazar, Roy C Martin, Melissa J Greenfield, Pariya F Wheeler, Adam Gerstenecker
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 876-877
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- Article
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Objective:
To examine patterns of cognitive function among a clinical sample of patients seeking treatment for Post-Acute Sequelae of COVID-19 (PASC).
Participants and Methods:One hundred nineteen patients each completed a baseline neuropsychological evaluation, including clinical diagnostic interview, cognitive assessments, and a comprehensive battery of self-report questionnaires. Patients had a mean age of 50 years (range:18 to 74, SD=10.1) and a mean of 15.5 years (SD=2.54) of formal education. Patients were primarily female (74%) and of White/Caucasian race (75%). Hierarchical agglomerative clustering was used to partition the data into groups based on cognitive performance. Euclidean distance was used as the similarity measure for the continuous variables and within-cluster variance was minimized using Ward’s method. The optimal number of clusters was determined empirically by fitting models with 1 to 15 clusters, with the best number of clusters selected using the silhouette index. All analyses were conducted using the NbClust package, an R package for determining the relevant number of clusters in a data set.
Results:Clustering yielded two distinct clusters of cognitive performance. Group 1 (n=57) performed worse than Group 2 (n=62) on most cognitive variables (including a brief cognitive screener and tests of attention/working memory, executive function, processing speed, learning and delayed recall). Of note, there were no significant differences between groups on an infection severity scale, hospitalizations/ICU admissions, initial or current COVID-19 symptoms, or prior comorbidities. Groups did not differ in age or gender, but Group 1 had a lower education level than Group 2 (M=14.7, SD=2.45 vs. M=16.2, SD=2.42; p=.001). Group 1 also had significantly more minorities than Group 2 (40% vs. 8%; p<.001). No other demographic differences (income, living arrangement, or marital status) were observed. In comparison to Group 2 patients, Group 1 patients self-reported significantly higher levels of anxiety and depression and functional impairment (Functional Activities Questionnaire: M=11.3, SD=8.33 vs. M=7.65, SD=7.97), perceived stress (Perceived Stress Scale: M=24.7, SD=7.90 vs. M=20.3, SD=7.89), insomnia (Insomnia Severity Index: M=16.0, SD=6.50 vs. M=13.1, SD=6.76), and subjective cognitive functioning (Cognitive Failures Questionnaire: M=58.8, SD=16.9 vs. M=50.3, SD=18.6; p’s<.05).
Conclusions:Findings indicate two predominant subtypes of patients seeking treatment for PASC, with one group presenting as more cognitively impaired and reporting greater levels of anxiety, depression, insomnia, perceived stress, functional limitations, and subjective cognitive impairment. Future directions include follow-up assessments with these patients to determine cognitive trajectories over time and tailoring treatment adjuncts to address mood symptoms, insomnia, functional ability, and lifestyle variables. Understanding mechanisms of differences in cognitive and affective symptoms is needed in future work. Limitations to the study were that patients were referred for evaluation based on the complaint of “brain fog” and the sample was a homogenous, highly educated, younger group of individuals who experienced generally mild COVID-19 course.
Relationship Between Depressive Symptoms and Cognition in Older, Non-demented African Americans
- Jamie L. Hamilton, Adam M. Brickman, Rosalyn Lang, Goldie S. Byrd, Jonathan L. Haines, Margaret A. Pericak-Vance, Jennifer J. Manly
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- Journal:
- Journal of the International Neuropsychological Society / Volume 20 / Issue 7 / August 2014
- Published online by Cambridge University Press:
- 19 May 2014, pp. 756-763
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Knowledge of the relationship between depressive symptoms and cognition in older adults has primarily come from studies of clinically depressed, functionally impaired or cognitively impaired individuals, and in predominately White samples. Limited minority representation in depression research exposes the need to examine these associations in more ethnic/racially diverse populations. We sought to examine the relationship between depressive symptoms and cognition in a sample of non-demented older African Americans recruited from surrounding U.S. cities of New York, Greensboro, Miami, and Nashville (N=944). Depressive symptoms were evaluated with the Geriatric Depression Scale (GDS). Cognition was evaluated with a comprehensive neuropsychological battery. Test scores were summarized into attention, executive function, memory, language, and processing speed composites. Controlling for age, education, reading level, and sex, African American older adults who endorsed more symptoms obtained significantly lower scores on measures of memory, language, processing speed, and executive functioning. Further investigation of the causal pathway underlying this association, as well as potential mediators of the relationship between depressive symptoms and cognitive test performance among older African Americans, such as cardiovascular and cerebrovascular disease, may offer potential avenues for intervention. (JINS, 2014, 20, 1–8)
Contributors
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- By Lee R. Berger, Fred L. Bookstein, Günter Bräuer, Michel Brunet, Steven E. Churchill, Ronald J. Clarke, M. Christopher Dean, Michelle S. M. Drapeau, Sarah Elton, Dean Falk, Andrew Gallagher, John A. J. Gowlett, Colin Groves, Philipp Gunz, Adam Hartstone-Rose, Jason Hemingway, Ralph L. Holloway, Vance T. Hutchinson, William L. Jungers, Ivor Janković, Kevin L. Kuykendall, Sang-Hee Lee, Julia Lee-Thorp, Paul R. Manger, Emma Mbua, Henry M. McHenry, Philipp Mitteroecker, Simon Neubauer, Osbjorn M. Pearson, Travis R. Pickering, Martin Pickford, Sally C. Reynolds, Brian G. Richmond, Avraham Ronen, Darryl J. de Ruiter, Brigitte Senut, Fred H. Smith, Muhammad A. Spocter, Matt Sponheimer, J. Francis Thackeray, Phillip V. Tobias, Peter S. Ungar, Lyn Wadley, Gerhard W. Weber, Milford H. Wolpoff, B. Headman Zondo
- Edited by Sally C. Reynolds, University of the Witwatersrand, Johannesburg, Andrew Gallagher, University of Johannesburg
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- Book:
- African Genesis
- Published online:
- 05 April 2012
- Print publication:
- 29 March 2012, pp viii-xii
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Contributors
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- By Basem Abdelmalak, Joseph Abdelmalak, Alaa A. Abd-Elsayed, David L. Adams, Eric E. Adelman, Maged Argalious, Endrit Bala, Gene H. Barnett, Sheron Beltran, Andrew Bielaczyc, William Bingaman, James M. Blum, Alina Bodas, Vera Borzova, Richard Bowers, Adam Brown, Chad M. Brummett, Alexandra S. Bullough, James F. Burke, Juan P. Cata, Neeraj Chaudhary, Michael J. Claybon, Miguel Cruz, Milind Deogaonkar, Vikram Dhawan, Thomas Didier, D. John Doyle, Zeyd Ebrahim, Hesham Elsharkawy, Wael Ali Sakr Esa, Ehab Farag, Ryen D. Fons, Joseph J. Gemmete, Matt Giles, Phil Gillen, Goodarz Golmirzaie, Marcos Gomes, Lisa Grilly, Maged Guirguis, David W. Healy, Heather Hervey-Jumper, Shawn L. Hervey-Jumper, Paul E. Hilliard, Samuel A. Irefin, George K. Istaphanous, Teresa L. Jacobs, Ellen Janke, Greta Jo, James W. Jones, Rami Karroum, Allen Keebler, Stephen J. Kimatian, Colleen G. Koch, Robert Scott Kriss, Andrea Kurz, Jia Lin, Michael D. Maile, Negmeldeen F. Mamoun, Mariel Manlapaz, Edward Manno, Donn Marciniak, Piyush Mathur, Nicholas F. Marko, Matthew Martin, George A. Mashour, Marco Maurtua, Scott T. McCardle, Julie McClelland, Uma Menon, Paul S. Moor, Laurel E. Moore, Ruairi Moulding, Dileep R. Nair, Todd Nelson, Julie Niezgoda, Edward Noguera, Jerome O’Hara, Aditya S. Pandey, Mauricio Perilla, Paul Picton, Marc J. Popovich, J. Javier Provencio, Venkatakrishna Rajajee, Mohit Rastogi, Stacy Ritzman, Lauryn R. Rochlen, Leif Saager, Vivek Sabharwal, Oren Sagher, Kenneth Saliba, Milad Sharifpour, Lesli E. Skolarus, Paul Smythe, Wolf H. Stapelfeldt, William R. Stetler, Peter Stiles, Vijay Tarnal, Khoi D. Than, B. Gregory Thompson, Alparslan Turan, Christopher R. Turner, Justin Upp, Sumeet Vadera, Jennifer Vance, Anthony C. Wang, Robert J. Weil, Marnie B. Welch, Karen K. Wilkins, Erin S. Williams, George N. Youssef, Asma Zakaria, Sherif S. Zaky, Andrew Zura
- Edited by George A. Mashour, Ehab Farag
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- Book:
- Case Studies in Neuroanesthesia and Neurocritical Care
- Published online:
- 03 May 2011
- Print publication:
- 03 February 2011, pp x-xvi
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Exploration of the Scaling Limits of 3D Integration
- Scott Pozder, Robert Jones, Vance Adams, Hui-Feng Li, Michael Canonico, Stefan Zollner, Sang Hwui Lee, Ronald J. Gutmann, Jian-Qiang Lu
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- Journal:
- MRS Online Proceedings Library Archive / Volume 970 / 2006
- Published online by Cambridge University Press:
- 26 February 2011, 0970-Y02-01
- Print publication:
- 2006
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Three dimensional (3D) wafer bonding is an emerging technology that may be used to increase transistor densities by stacking devices over devices. The alignment of the wafers and the devices on them is a function of the mechanical capability of the wafer to wafer alignment tool and the thermal conditions of each wafer when bonded. However, as bonded wafers are thinned to 1% or less of their starting thickness the processes of bonding and thinning as well as previous process history affect wafer planarity and silicon stress. The drive to vertically interconnect circuit blocks at the sub-micron scale requires a high density of vertical interconnects and thinning a wafer to less than 5 μm enables through wafer via processing at a scale found in the first layers of the interconnect stack. In this paper the measurement of wafer to wafer alignment was done by comparing a metal pattern on a face down bonded silicon on insulator (SOI) wafer to a complementary metal pattern on the bulk wafer to which it was bonded. The effect of aggressive thinning is evaluated using thinned back to face bonded SOI wafers with functional devices and face down bonded non-patterned SOI wafers thinned after bonding. The face up bonded SOI wafers with functional devices were temporarily bonded face down to a Si-wafer I, thinned to the buried oxide (BOX), face up bonded with benzocyclobutene (BCB) on a Si-wafer II, followed by release of the temporary bond and electrical test. Raman and XRD stress measurements of the non-patterned SOI wafer silicon 70 nm and 110 nm thick SOI Si were taken before and after thinning, and the radius of curvature of the SOI wafers and the bulk wafer substrates was monitored. Thermo-mechanical models of SOI Si stress and bonded wafer curvature are compared to the measured results.