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The influence of physical fatigue on telephone-based neuropsychological test performance in COVID-19 survivors

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Abstract

Fatigue has been characterized as a post COVID-19 condition known to persist months after SARS-CoV-2 infection. COVID-19 has been reported to be associated with impaired cognitive function, including disorders in attention, memory, information processing, and executive functions. The objective of this study was to determine if post-COVID fatigue, manifested as tiredness while performing low-intensity physical activity, has a detrimental effect on neuropsychological performance, to achieve this, we randomly selected 20 participants with post-COVID fatigue and 20 SARS-CoV-2 negative age-matched controls from a database of 360 residents of Tijuana, Baja California in a cross-sectional study design. All 40 participants responded to a health survey, along with a neuropsychological assessment test via telephone call. Statistical analysis was performed using a multiple linear regression model including the following independent variables: study condition (post-COVID fatigue or negative control), sex, age, years of education, hypertension, asthma, administration of supplemental oxygen during COVID-19 recovery, and the hour at which the evaluation started. Significant regression analysis was obtained for all global parameters of the assessment, including BANFE-2 score (p = 0.021, R2 Adj. = 0.263), NEUROPSI score (p = 0.008, R2 Adj. = 0.319), and total errors (p = 0.021, R2 Adj. = 0.263), with significant regression coefficients for study condition on two global parameters, BANFE-2 score (p = 0.028, β = − 0.371) and NEUROPSI score (p = 0.010, β = −0.428). These findings suggest that the presence of post-COVID fatigue is a factor associated with a decrease in neuropsychological performance.

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Data availability

Supplementary data associated with this article can be found at the Mendeley Data repository [53], https://doi.org/10.17632/9ftc6z8znd.1.

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Acknowledgements

The COVID-19 Diagnostic Center at UABC is financially supported by federal and state resources as well as UABC's own earnings. COMC would like to thank SPSU UABC (grant No. 096/2022-1) and FICSAC Universidad Iberoamericana (grant No. OG.P21.7) for their tuition scholarship. IRSH acknowledges support from F-PROMEP-38/Rev-04. MSA acknowledges support from F-PROMEP-20/Rev-08. The authors thank all the participants involved in the study.

Funding

The funding source did not play a role in the study design, the collection, analysis, or interpretation of data, or in the writing of the manuscript and publication of the paper.

Author information

Authors and Affiliations

  1. Centro de Diagnóstico COVID-19, Facultad de Medicina y Psicología, Calzada Tecnológico y Universidad S/N Delegación Mesa de Otay, 22390, Tijuana, BC, Mexico

    Cristian O. Mancilla-Corona, Manuel Sanchez-Alavez, Gisela Pineda-García, Julieta Y. Islas-Limon, Jonathan V. Lopez-Baena, Jesús I. Rodríguez-Vásquez & Idanya R. Serafin-Higuera

  2. Molecular Medicine, Scripps Research, 10550 North Torrey Pines Road, La Jolla, CA, 92037, USA

    Manuel Sanchez-Alavez

  3. Baja California Ministry of Health, Pioneros No. 1005 Centro, 21000, Mexicali, BC, Mexico

    Oscar E. Zazueta

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  1. Cristian O. Mancilla-Corona
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  2. Manuel Sanchez-Alavez
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  8. Idanya R. Serafin-Higuera
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Contributions

COM-C: Conceptualization, methodology, investigation, formal analysis, visualization, writing—original draft. MS-A: Conceptualization, methodology, writing—review and editing, supervision. GP-G: methodology, visualization, writing—review and editing. JYI-L: writing—review and editing. OEZ: Methodology, writing—review and editing. JVL-B: Investigation. JIR-V: Investigation. IRS-H: Conceptualization, methodology, investigation, writing—review and editing, supervision.

Corresponding authors

Correspondence to Cristian O. Mancilla-Corona or Idanya R. Serafin-Higuera.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethics approval

This study involving human participants was reviewed and approved by the Faculty of Medicine and Psychology Ethics Review Board (Archive D275) at Autonomous University of Baja California and meets the ethical principles promulgated in the Declaration of Helsinki.

Consent to participate

All individual participants included in the study provided their informed consent.

Appendices

Appendix

Complete set of verbal tasks used for neuropsychological assessment.

  1. 1.

    Brief Neuropsychological Assessment (NEUROPSI):

    1. (a)

      Digit span task (backwards): participants were asked to repeat a series of 2 to 6 numbers in the reverse order, 2 different series were provided for each number of digits, the task was terminated after 2 consecutive errors of the same series, the examiner registered the maximum number of digits repeated correctly. This task is sensitive to the evaluation of working memory.

    2. (b)

      Consecutive subtraction (20–3): participants performed a consecutive subtraction 3 by 3 starting at 20 (e.g., 20–3 = 17, 17–3 = 14…), the task ended after 5 subtractions. This task evaluates simple math abilities.

    3. (c)

      Spontaneous memory curve: participants were asked to repeat a list of 6 words, this procedure was repeated two more times with the same words in a different order. The examiner determined the average number of words repeated correctly in all 3 trials. This task evaluates short-term verbal memory.

    4. (d)

      Semantic fluency: participants were asked to name as many different animals (e.g., cow, dog, rabbit, etc.) as they could in one minute. This task evaluates cognitive flexibility and lexical access fluency.

    5. (e)

      Phonological fluency: participants were asked to name as many words as possible beginning with the letter “f” (e.g., food, fresh, flat, etc.) in one minute. This task evaluates cognitive flexibility and lexical access fluency.

    6. (f)

      Math: this task evaluates arithmetic abilities and reasoning, participants were asked to solve 3 simple math problems:

      1. 1.

        How much is 13 + 15?

      2. 2.

        John had $12, he received $9 and then spent $14, how much money did the end up with?

      3. 3.

        How many oranges are there in two and a half dozen?

  2. 2.

    Neuropsychological Battery of Executive Functions and Frontal Lobes (BANFE-2):

    1. (a)

      Alphabetical arrangement (Lists 1 and 2): participants were asked to alphabetize two lists of 5 and 6 words respectively, the examiner registered the number of trials participants required to repeat each list of words in the correct order. These tasks require to actively sort a list of words according to a rule, they evaluate working memory.

    2. (b)

      Consecutive subtraction (A: 40 − 3 and B: 100 − 7): participants performed a consecutive subtraction 3 by 3 and 7 by 7 starting at the indicated number (e.g., 100 − 7 = 93, 93 − 7 = 86…). These tasks evaluate simple math abilities and working memory, while the analysis of completion times allows for the assessment of processing speed.

    3. (c)

      Consecutive addition (1 + 5): participants performed a consecutive 5 by 5 addition starting at 1 (e.g., 1 + 5 = 6, 6 + 5 = 11…), the task ended after 20 consecutive sums. These tasks evaluate simple math abilities and working memory, while the analysis of completion times allows for the assessment of processing speed.

    4. (d)

      Verbal fluency: participants were asked to name as many verbs (e.g., running, speaking, eating, etc.) as they could in one minute. This task evaluates cognitive flexibility and lexical access fluency.

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Mancilla-Corona, C.O., Sanchez-Alavez, M., Pineda-García, G. et al. The influence of physical fatigue on telephone-based neuropsychological test performance in COVID-19 survivors. Eur Arch Psychiatry Clin Neurosci (2023). https://doi.org/10.1007/s00406-023-01638-2

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