Omar et al.

Middle East Current Psychiatry (2022) 29:79 Middle East Current

https://doi.org/10.1186/s43045-022-00245-6
Psychiatry

RESEARCH Open Access

Cognitive impairment in health care

workers recovering from COVID‑19 infection:
a cross‑sectional comparative study
Ahmed Khaled Abd‑Elrazzak Omar1, Salwa M. A. Dahesh2, Doha El‑Sayed Ellakwa3, Mohamed Kamal Gomaa4,
Basma Abdulsamad5, Rana Hanafy5, Hanan G. Al Metwally6, Ruqia Nour Edin Mohammad Mohammad5,
Samar Saleh Badawy5, Rabab M. El Saleh5, Mohammed E. Abdelhafiz5, Abdalla Mohamed Gouda5,
Showikar Adel Saleh Seada5, Marwa M. Amr5, Yomna Asar7,8 and Roa Gamal Alamrawy7*   

Abstract
Background: The COVID-19 outbreak has infected people all over the world where many clinics are being con‑
structed to diagnose and treat lingering symptoms or long COVID. Neurological and long-term cognitive conse‑
quences are very worrisome. Many of COVID-19’s neurological symptoms are likely the result of the body’s extensive
immunological response to infection rather than the virus attacking the brain or nervous system directly. At the same
time, the extent and type of COVID-19’s cognitive consequences are unknown. The goal of this study was to assess
the cognitive functions of healthcare workers 2 weeks to 3 months after COVID-19 infection. Ninety-two healthcare
workers participated in the study; 32 were post-COVID-19 cases, and 60 were healthy people (the comparison group).
The cognitive functions of the participants were assessed using the Addenbrooke’s Cognitive Examination (ACE-III)
test, which evaluated attention, memory, language, and visuospatial skills, as well as the Arabic version of the Patient
Health Questionnaire Anxiety GAD-7 and Depression Assessments PHQ-9.
Results: The study revealed that there was a highly significant direct correlation between post-infection with COVID-
19 and scores of both anxiety and depression and an inverse correlation in the case of attention and memory. On the
other hand, there is no statistical effect of post-COVID-19 on verbal fluency, language scores, and visio-spatial abilities.
Using multiple linear regression, there was a powerful significant decrease effect of post-COVID-19 on memory scores
controlling both anxiety and depression degrees (Beta = − 0.745, P < 0.001). Also, there was a strong negative
correlation post-COVID-19 on attention scores controlling both anxiety and depression degrees (Beta = − 0.745,
P < 0.001).
Conclusions: The study showed a strong negative effect of post-COVID-19 on the attention and memory of patients.
Furthermore, both anxiety and depression scores increased significantly among the post-COVID-19 patients.
Keywords: COVID-19, Long-term symptoms, Persistent symptoms, Cognitive impairment, Cognitive function,
Neuropsychology

Background
The World Health Organization (WHO) declared cor-
*Correspondence: [email protected] onavirus disease 2019 (COVID-19) an international
7
Mamoura Psychiatric Hospital, General Secretariat of Mental Health public health emergency on January 30, 2020 [1]. SARS-
and Addiction Treatment, Ministry of Health and Population, Alexandria, CoV-2 coronavirus, a positive-sense RNA virus belong-
Egypt
Full list of author information is available at the end of the article
ing to the Coronaviridae family, causes COVID-19, a

© The Author(s) 2022. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which
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Omar et al. Middle East Current Psychiatry (2022) 29:79 Page 2 of 12

highly contagious respiratory infection (Malik et al. Methods

2020). As of July 2022, WHO reported over 535 million Study design and study population
confirmed cases of COVID-19 including more than 6 The study design was an observational cross-sectional
million deaths [1]. comparative study, with a convenience sampling method
Although the respiratory tract represents the primary used. Demographic and clinical features in a cohort of
affected organ in COVID-19 patients, other organs and HCWs recovered from COVID-19 were investigated and
systems had been involved and reported including cardi- compared with a comparative group of HCWs during
ovascular, renal, and neurological systems [2]. Neuropsy- the outbreak period (from June to October 2021). Inclu-
chiatric complications of COVID-19 have been reported sion criteria were the medical staff (physicians, dentists,
progressively by multiple case reports and case series. pharmacists, nurses, and medical technicians) aged more
Delirium, confusion, and neurocognitive abnormalities than 18 years old and able to complete the test content
were some of the most common documented neurologi- independently. The study included the post-COVID-19
cal problems in COVID-19 patients [3]. Depression, anx- cases that have recovered from 2 weeks to 3 months dur-
iety, post-traumatic stress disorder (PTSD), and insomnia ing the study. The included patients have previously been
were the common psychiatric disorders among COVID- diagnosed as COVID-19 cases and confirmed by poly-
19 patients [4–7]. By dissecting the molecular pathogene- merase chain reaction (PCR-for-COVID), a computed
sis of SARS-CoV-2, different neuro-invasive mechanisms tomography scan (CT-chest), and routine tests battery
have been proposed [8]. Coronavirus infection of the besides symptoms like fever, cough, GIT symptoms, loss
central nervous system (CNS) could occur via olfactory of smell or taste, and fatigue according to the COVID-19
mucosa, peripheral leukocytes adhering to endothelial protocol of the Ministry of Health and Population, Egypt.
cells of the blood-cerebrospinal fluid (CSF) barrier, or The participated HCWs worked at Hospitals of the Egyp-
oxidative stress generated by brain-lung-heart interac- tian Ministry of Health and Population (Dekernes Hospi-
tion. These associated mechanisms result in the overpro- tal, Ras Sedr Hospital, El Hamool Hospital, Seidy Salem
duction of pro-inflammatory cytokines leading to final Hospital, Mansoura Oncology Center). The exclusion cri-
demyelination and inflammation of neurons [4]. teria were the HCWs with a history of mental disorders
Since healthcare workers (HCWs) represent the front and current treatment for mental illnesses, such as taking
line of defense in this crisis, neuropsychiatric complica- antipsychotics, antidepressants, mood stabilizers, anti-
tions of COVID-19 among them represent a highly sig- epileptics, benzodiazepines, and other drugs that may
nificant research topic. An increased risk of infection is interfere with the assessment. Also, HCWs had severe
expected among HCWs due to their close contact with physical illnesses, serious suicidal thoughts, or hearing or
infected patients, especially those with undiagnosed or visual impairments. Pregnant and lactating women were
subclinical cases [9]. According to a recently published also excluded.
meta-analysis, HCWs were reported to be exposed to a Sample size calculations were performed using SPSS
variety of long-term psychological stressors, such as anx- software version 26 [11]. After careful examination of the
iety (37%), sadness (36%), and insomnia (32%) [10]. How- literature, no references clarified the difference between
ever, studies are lacking in handling neuro-psychological the variables used in the present study. Based on this,
complications other than depression, anxiety, and insom- the sample size was calculated on the ground during the
nia. Additionally, all quantitative studies were cross-sec- study using the estimated means and standard devia-
tional studies with short follow-up periods, which did not tion (SD) of the two groups. Epi Info software [12] was
reflect COVID-19’s long-term mental health outcomes used for independent continuous groups assuming the
on HCWs. Also, the impact and severity of this epidemic mean ± SD of anxiety was equal to 9.8 ± 4.2 for the post-
vary greatly from one country to another [10]. COVID-19 group and the mean equal to 6.4 for the com-
The present study aimed to evaluate cognitive dysfunc- parative group at 0.05 alpha error and 95% power. When
tions in Egyptian HCWs post-COVID-19 infection as enrolment equals 2, the estimated sample size was deter-
attention, memory, language, and visuospatial skills in mined as 30 and 60 for the case and comparative group,
addition to anxiety and depression. Diagnosis of long- respectively.
term COVID-19 cognitive dysfunctions will enable the
implementation of diagnostic and therapeutic protocols Measurement
necessary for the treatment and rehabilitation of affected Clinical interviews were carried out for collecting socio-
HCWs. In turn, it will contribute in the reduction of demographic data and performing cognitive assess-
their medical errors that affect the lives of their patients ment by the Addenbrooke’s Cognitive Examination III
besides maintaining the health of HCWs, the first line of (ACE-III) [13], anxiety assessment by the Arabic ver-
defense, against this pandemic. sion of the Generalized Anxiety Disorder Scale (GAD-7)
Omar et al. Middle East Current Psychiatry (2022) 29:79 Page 3 of 12

[14], and depression assessment by the Arabic version of Results

the Patient Health Questionnaire (PHQ-9) [14]. Socio- The total number of participants in this study was 92
demographic data were self-reported by the participants, healthcare workers; 16 (17.4%) were males and 76 (82.6%)
including sex, age, residence, marital status, and occupa- were females. Their ages ranged from 22 to 54 years.
tion (physicians, dentist, pharmacist, chemist, nurse, or The number of post-COVID-19 cases was 32 while the
technician). comparative group was 60 healthcare workers with dif-
ACE-III is a brief cognitive battery that assesses various ferent job categories: 17 physicians, 3 dentists, 36 phar-
aspects of cognition and is one of the most widely used macists/chemists, 16 nurses, and 20 assistants. The
assessment tools in routine clinical practice. ACE-III is a results showed that there were no statistically signifi-
19-item tool that tests the five subdomains of cognition: cant differences between post-COVID-19 cases and the
attention and orientation, memory, verbal fluency, lan- comparative group according to gender, job category
guage, and visuospatial ability. ACE-III was easily applied (Table 1), mean age, verbal fluency, language scores, and
by the trained researchers who interviewed the agreed visio-spatial abilities (Table 2). Although the mean score
participants face-to-face. The test was administered in of Addenbrooke’s Cognitive Examination among post-
15–20 min, then scored and interpreted by an unbiased COVID-19 cases was lower than that of the comparative
non-specialist. The total score of the examination is 100 group, the difference was still insignificant (P = 0.069).
and the higher scores indicate better cognitive function- The mean scores of memories, attention, and were lower
ing [13]. The Arabic version of the ACE-III showed high among post-COVID-19 cases than those among the com-
sensitivity and specificity [15, 16]. For assessing anxiety parative group where the differences were highly statisti-
symptoms, the Arabic version of the Generalized Anxi- cally significant (p < 0.01). On the other hand, the mean
ety Disorder Scale (GAD-7) was used. A total score equal scores of the post-COVID-19 cases were significantly
or more than 5 was considered having anxiety [17]. The higher in the case of anxiety and depression (p < 0.05).
validity and reliability of the Arabic version of GAD-7 Concerning the degree of anxiety and depression, the
have been confirmed where Cronbach’s alpha value for lowest degrees were recorded among the comparative
the internal insistency reliability was 0.763. Also, the group while the post-COVID-19 cases group recorded
validity and reliability of the Arabic versions of PHQ-9 the highest ones. The difference between the two groups
were demonstrated where Cronbach’s alpha value for the was highly statistically significant (p < 0.01) (Table 3).
internal consistency reliability was 0.857 [14, 17]. The results revealed that there was a highly significant
direct correlation between post-infection with COVID-
19 and both scores and degrees of anxiety and depression
Statistical analysis and inverse correlation in the case of attention and mem-
Data of the two groups were collected and tabulated for ory (p < 0.001) (Tables 4, 5, 6, and 7).
statistical analysis by PC using the Epi Info and SPSS On the other hand, there was no significant statisti-
version 26 for windows software packages [11]. Both cal correlation between post-infection with COVID-19
the homogeneity test and the Leven test were used. and age, language, verbal fluency, visio-spatial abilities,
Descriptive analysis as the arithmetic mean and stand- and Addenbrooke’s Cognitive Examination (p > 0.05)
ard deviation of the age and scores of examinations of (Tables 5, 6, and 7).
the participated HCWs were calculated. Student’s t test Multiple linear regressions were used considering
was used for comparing the continuous parametric data memory score as an outcome or predicted variable while
of the two groups. Z-test and chi-square were used for post-COVID-19, depression score, and anxiety score as
in-between proportions. Correlations and multiple linear predictors. The result revealed a highly negative strong
regressions were used for estimating the relation between significant effect of post-COVID-19 on memory scores
post-COVID-19 and various cognitive scores (Rosner, controlling both anxiety and depression degrees (Beta
2015). All statistical tests were interpreted in a two-tailed = − 0.745, P < 0.001). Also, there was a strong negative
fashion at a cut-off value equal to 0.05. correlation of depression score with memory while con-
trolling for post-COVID-19 and anxiety variables (Beta =
Ethics approval and consent to participate − 0.391, P = 0.001).
The protocol of the study followed the professional eth- Another multiple linear regression was used consid-
ics of the Declaration of Helsinki and was approved by ering attention score as an outcome or predicted vari-
Egypt’s ethical committee of the Minister of Health and able while post-COVID-19, depression score, and anxiety
Population (Com. No./Dec. No. 10-2021/12). All partici- score as predictors. The result revealed a highly strong
pants agreed and signed written informed consent forms significant negative effect of post-COVID-19 on atten-
before the interviews. tion scores controlling both anxiety and depression
Omar et al. Middle East Current Psychiatry (2022) 29:79 Page 4 of 12

Table 1 Descriptive analysis of the post-COVID-19 cases and control group according to their gender and various job categories
Variables COVID-19 P value
Control Post-COVID-19 cases

Job category Physician No. 8 9 Exact

% 13.3% 28.1% Pearson chi-
square
Dentist No. 2 1 0.266
% 3.3% 3.1%
Pharmacist/chemist No. 28 8
% 46.7% 25.0%
Nurse No. 10 6
% 16.7% 18.8%
Assistant No. 12 8
% 20.0% 25.0%
Total No. 60 32
% 100.0% 100.0%
Gender Male No. 12 4 0.407
% 20.0% 12.5%
Female No. 48 28
% 80.0% 87.5%
Total No. 60 32
% 100.0% 100.0%

Table 2 A comparison between post-COVID-19 cases and a comparative group of healthcare workers according to their age and
scores of attention, memory, verbal fluency, language, visio-spatial abilities, Addenbrooke’s cognitive examination, anxiety, and
depression
Variables Comparative group Post-COVID-19 cases t P value
Mean ± SD SE Mean ± SD SE
(n = 60) (n = 32)

Age (years) 30.77 ± 6.021 0.777 32.88 ± 6.955 1.229 1.515 0.133
Attention score 17.63 ± 0.712 0.092 16.72 ± 1.708 0.302 3.612 P < 0.001**
Memory score 23.17 ± 2.101 0.271 16.72 ± 1.708 0..685 3.686 P < 0.001**
Verbal fluency score 11.43 ± 2.942 0.380 12.38 ± 2.673 0.473 1.508 0.135
Language score 24.87 ± 1.891 0.244 24.53 ± 1.606 0.284 0.852 0.396
Visio-spatial abilities 14.70 ± 1.522 0.196 14.97 ± 1.257 0.222 0.855 0.395
Addenbrooke’s Cognitive 91.800 ± 5.70103 0.736 89.468 ± 5.967 1.054 1.838 0.069
Examination
Anxiety score 6.4667 ± 4.589 0.592 9.843 ± 4.258 0.752 3.445 0.001**
Depression score 8.300 ± 4.900 0.632 10.500 ± 5.224 0.923 1.965 0.048*
*P value < 0.05 (significant)
**P value < 0.01 (highly significant)

degrees (Beta = − 0.745, P < 0.001). Also, there was a The total number of participants in this study was
strong negative correlation of depression scores with 92 healthcare workers; 16 (17.4%) were males and 76
attention while controlling for post-COVID-19 and anxi- (82.6%) were females. Their ages ranged from 22 to 54
ety variables (Beta = − 0.365, P < 0.001). On the other years. The number of post-COVID-19 cases was 32
hand, anxiety had no significant effect on both memory while the comparative group was 60 healthcare workers
and attention while controlling for post-COVID-19 and with different job categories: 17 physicians, 3 dentists,
depression score variables (P > 0.05). 36 pharmacists/chemists, 16 nurses, and 20 assistants.
The results showed that there were no statistically
Omar et al. Middle East Current Psychiatry (2022) 29:79 Page 5 of 12

Table 3 A comparison between post-COVID-19 cases and the comparative group according to anxiety degree
Anxiety degree COVID-19 Total
The comparative group Post-COVID-19 Case

Anxiety degree No anxiety No. 26a 3b 29

% 43.3% 9.4% 31.5%
Mild anxiety No. 20a 11a 31
% 33.3% 34.4% 33.7%
Moderate anxiety No. 10a 11a 21
% 16.7% 34.4% 22.8%
Severe anxiety No. 4a 7b 11
% 6.7% 21.9% 12.0%
Total No. 60 32 92
% 100.0% 100.0% 100.0%
Exact Pearson chi-square = 14.546, P = 0.002
The letter a denotes a significant difference from the b column

Table 4 A comparison between post-COVID-19 cases and the comparative group according to depression degree
Depression degree COVID-19 Total
The comparative Post-COVID-19
group cases

Depression degree No depression No. 18a 5a 23

% 30.0% 15.6% 25.0%
Mild depression No. 22a 7a 29
% 36.7% 21.9% 31.5%
Moderate depression No. 12a 11a 23
% 20.0% 34.4% 25.0%
Moderate to severe depression No. 8a 5a 13
% 13.3% 15.6% 14.1%
Severe depression No. 0a 4b 4
% 0.0% 12.5% 4.3%
Total No. 60 32 92
% 100.0% 100.0% 100.0%
Exact Pearson chi-square = 12.476, P = 0.012
The letter a denotes a significant difference from the b column

Table 5 Correlations between post-COVID-19, visio-spatial abilities, Addenbrooke’s cognitive examination, anxiety, and depression
score
Variables COVID-19 Visio-spatial abilities Addenbrooke’s Cognitive Anxiety score
Examination

Visio-spatial abilities 0.090

(P= 0.395)
Addenbrooke’s Cognitive R= − 0.190 R= 0.504**
Examination (P= 0.069) (P< 0.001)
Anxiety score R= 0.341** R= − 0.170 R= − 0.409**
(P= 0.001) (P= 0.106) (P< 0.001)
Depression score R= 0.207* R= − 0.197 R= − 0.283** R= 0.763**
(P= 0.048) (P= 0.060) (P= 0.006) (P< 0.001)
*P value < 0.05 (significant)
**P value < 0.01 (highly significant)
Omar et al. Middle East Current Psychiatry (2022) 29:79 Page 6 of 12

Table 6 Correlations between post-COVID-19 and degrees of anxiety and depression

Variables COVID-19 Anxiety degree

Spearman’s rho correlation coefficient Anxiety degree 0.397**

(P< 0.001)
Depression degree 0.279** 0.783**
(P= 0.007) (P< 0.001)
**P value < 0.01 (highly significant)

Table 7 Correlations between post-COVID-19, age, attention, memory, verbal fluency, and language scores
Variables COVID-19 Age Attention Memory Verbal fluency

Age R= 0.158 (P= 0. .133)

Attention R= − 0.356** R= 0.048
(P< 0.021) (P= 0.649)
Memory R= − 0.362** R= − 0.085 R= 0.240*
(P< 0.001) (P= 0.421) (P= 0. 021)
Verbal fluency R= − 0.157 R= − 0.255* R= 0.034 R= 0.076
(P= 0.135) (P= 0.014) (P= 0.745) (P= 0.472)
Language R= − 0.089 R= 0.043 R= 0.434** R= 0.136 R= 0.039
(P= 0.396) (P=0.681) (P< 0.001) (P= 0.195) (P= 0.709)
*P value < 0.05 (significant)
**P value < 0.01 (highly significant)

significant differences between post-COVID-19 cases significant statistical correlation between post-infection
and comparative groups according to gender and job with COVID-19 and both scores of visio-spatial abilities
category (Table 1). and Addenbrooke’s Cognitive Examination (p > 0.05)
The results showed that there were no statistically (Table 5).
significant differences between post-COVID-19 cases There was a highly significant direct correlation
and the comparative group according to mean age, ver- between post-infection with COVID-19 and both
bal fluency, language scores, and visio-spatial abilities. scores and degrees of anxiety and depression (p < 0.01)
Although the mean score of Addenbrooke’s Cognitive (Table 6).
Examination among post-COVID-19 cases was lower A highly significant inverse correlation was found
than that of the comparative group, the difference was between post-infection with COVID-19 and both scores
still insignificant (P = 0.069). The mean scores of mem- of attention and memory (p < 0.001). On the other hand,
ory and attention were lower among post-COVID-19 there was no significant statistical correlation between
cases than those among the comparative group where post-infection with COVID-19 and age, language, and
the differences were highly statistically significant (p verbal fluency (Table 7).
< 0.01). The mean scores of anxiety and depression A multiple linear regression was used considering
among post-COVID-19 cases were significantly higher memory score as an outcome or predicted variable while
than the comparative group (p = 0.048 and 0.001, post-COVID-19, depression score, and anxiety score as
respectively) (Table 2 and Figs. 1 and 2). predictors. The result revealed a highly strong negative
Concerning the degree of anxiety and depression, the significant effect of post-COVID-19 on memory scores
lowest degrees were recorded among the comparative controlling both anxiety and depression degrees (Beta
group while the post-COVID-19 cases group recorded = − 0.745, P < 0.001). Also, there was a strong negative
the highest ones. The difference between the two correlation of depression scores with memory while con-
groups was highly statistically significant (p = 0.002) trolling for post-COVID-19 and anxiety variables (Beta =
(Table 3). − 0.391, P = 0.001) (Table 8 and Fig. 3).
The results revealed that there was a highly significant Another multiple linear regression was used con-
direct correlation between post-infection with COVID- sidering attention score as an outcome or predicted
19 and both scores of anxiety and depression (p = 0.001 variable while post-COVID-19, depression score,
and 0.45, respectively). On other hand, there was no
Omar et al. Middle East Current Psychiatry (2022) 29:79 Page 7 of 12

Fig. 1 COVID result: anxiety score

Fig. 2 COVID result: depression score

Omar et al. Middle East Current Psychiatry (2022) 29:79 Page 8 of 12

and anxiety score as predictors. The result revealed a on memory or attention while controlling for post-
highly strong significant effect of post-COVID-19 on COVID-19 and depression score variables (Table 9 and
attention scores controlling both anxiety and depres- Fig. 4).
sion degrees (Beta = − 0.745, P < 0.001). Also, there
was a strong correlation of depression scores with Discussion
attention while controlling for post-COVID-19 and Starting in 2019, the world is still facing the COVID-19
anxiety variables (Beta = − 0.365, P = 0.001). On pandemic and its complications [1]. Although the infec-
the other hand, anxiety had no significant effect tion is originally known to affect the respiratory system

Table 8 Multiple linear regression considering memory variable as an outcome while predictors are post COVID-19, depression score,
and anxiety score
Predictors (variables) Standardized coefficients t P values 95% CI of the coefficient
Beta

Post-COVID-19 − 0.745 − 9.285 < 0.001 − 14.286, − 9.249

Depression score − 0.391 − 3.321 0.001 − 1.358, − 0.341
Anxiety score − 0.188 − 1.565 0.121 − 0.127, − 1.071

Fig. 3 Scatterplot shows dependent variable: memory; regression standardized residual; regression standardized predicted value

Table 9 A multiple linear regression considering attention score variable as an outcome while predictors are post-COVID-19,
depression score, and anxiety score
Predictors (variables) Standardized coefficients t P values 95% CI of the coefficient
Beta

Post-COVID-19 − 0.745 − 10.268 < 0.001 − 10.798, − 7.296,

Depression score − 0.365 − 3.433 0.001 − 0.964, − 0.257
Anxiety score − 0.146 − 1.345 0.182 − 0.698, − 0.134
Omar et al. Middle East Current Psychiatry (2022) 29:79 Page 9 of 12

Fig. 4 Scatterplot shows dependent variable: attention; regression standardized residual; regression standardized predicted value

[18], literature is rapidly evolving to expose a multi- As depressive and anxiety symptomatology is associ-
faceted disease mysteriously and collectively named ated with cognitive deficits as well, screening for anxiety
post-COVID with psychiatric [19–21] and neurological and depression symptoms were respectively assessed by
complications [6, 22, 23]. the GAD-7 and PHQ-9. The interview was devoid of
One of the commonly reported complaints is that cog- any information related to post-COVID, to avoid any
nitive functions decline after recovering from COVID- response bias that could arise, as, in a study by Winter
19 infection. This impairment was growingly reported and Braw [28], exposure to information regarding post-
in heterogeneous populations [24]. as in the elderly [25], COVID neurological symptoms increased self-reported
critically ill [26], and hospitalized [27]. Nonetheless, such symptoms of cognitive dysfunction.
decline was also reported in everyday talks of recovered To eliminate the risk of confounding and in line with
healthcare workers. One would talk about how “foggy” he the cognitive reserve hypothesis that suggests that
or she became after recovering from COVID-19. Despite higher education, regular participation in mentally
this, up to our knowledge, no previous study assessed stimulating activities, and complexity of occupation
the cognitive functions in healthcare workers post- increase an individual’s resistance to cognitive decline,
COVID-19 infection. This motivated our study to assess our study included matched cases and a comparative
cognitive functions using ACE-III in a sample of health- group from the same field [29]. Also, the same work
care workers who recovered from COVID-19 infection in conditions would balance the social isolation adverse
a duration between 2 weeks and 3 months. Our sample effects as linked to cognitive decline in the absence of
strictly included individuals between 22 to 54 years, who aging covariates [30].
were previously healthy, and they have not been admitted Among the 92 study participants, ACE-III was
either to an intensive care unit or a hospital. conducted to test the cognitive domains: attention,
Omar et al. Middle East Current Psychiatry (2022) 29:79 Page 10 of 12

memory, verbal fluency, language, and visuospatial and implement early intervention and neuropsycholog-
abilities. Although the difference in the mean score of ical rehabilitation programs.
ACE-III among post-COVID-19 cases and the com- Limitations include a cross-sectional study design
parative group was insignificant, the cases group scored to assess cognitive function post-COVID-19, although
lower. Both anxiety and depressive symptoms scores no baseline data was found before the pandemic. The
were significantly prominent in the cases group. recruited sample was a convenience sample which may
On the one hand, as regards the individual tests, the limit the generalizability of the results.
mean scores of memory and attention were highly sig- Strengths include being among the first to tackle the
nificant among cases to reveal a prominent affection. objective assessment of cognitive functions in healthcare
On the other hand, our results indicate that neurocog- workers. Another strength was the matching between the
nitive deficits after recovery from COVID-19 are inde- case and the comparative group; from the same field with
pendent of depressive and anxiety symptoms. These the elimination of age, gender, and sociodemographic
findings were reported in analyzed data from 81,337 differences.
individuals in which spatial working memory and Recommendations are in line with those of Oh, Van-
selective attention deficits were revealed, even after norsdall, and Parker [37]; the need for longer prospective
carefully controlling for premorbid IQ, pre-existing studies that include individuals from different races and
medical conditions, socio-demographic factors, and ethnicities to determine symptom timelines and whether
psychiatric symptoms. Those who received mechanical such impairment is long-lasting or temporary. More
ventilation had the greatest impairment [9]. Although research is needed to understand the underlying biologi-
Woo et al. [31] reported that short-term memory, cal mechanism of the effect of SARS-CoV-2 on the cen-
attention, and concentration were particularly affected tral nervous system
by COVID-19, their screening results did not corre-
late with hospitalization, treatment, viremia, or acute Conclusions
inflammation and were independent of depressive In our sample of healthcare workers recovering from
symptoms or fatigue. COVID-19, attention and memory were significantly
In a study by Almeria et al., cognitive profiles fol- affected. Depressive and anxiety symptoms were more
lowing COVID-19 infection included lower scores on reported among the cases group, and there is a direct
memory, attention, executive functions, and the global correlation between these symptoms and attention and
cognitive index, as well as higher scores in anxiety and memory scores. Nonetheless, attention and memory
depression, which were reported in the group with cog- affection were independent of the assessed depressive
nitive complaints following COVID-19 infection [32]. and anxiety symptomatology. Our findings shed light
Zhou et al. described cognitive dysfunction in the on the importance of neuropsychological interventions
sustained attention domain in COVID-19 patients [33]. besides the more commonly implemented psychological
While a study on 267 participants, a positive SARS- ones, in the context of care of the carers.
CoV-2 test was associated with about a 5-times greater
likelihood of reporting subjective memory problems at
a follow-up after 8 months [34]. In 58% of a cohort aged Abbreviations
ACE-III: Addenbrooke’s Cognitive Examination III; COVID-19: Coronavirus infec‑
between 22 and 71 years, a decrease in cognition was tion; GAD-7: Generalized Anxiety Disorder Scale; HCWs: Since healthcare work‑
observed as reflected by lower scores on Montreal Cog- ers; PHQ-9: Patient Health Questionnaire; WHO: World Health Organization.
nitive Assessment Scale (MoCA) [35]. In a review of
Acknowledgements
objective cognitive tests data from 12 studies, patients None.
with COVID-19 infection between a few days and 6
months have experienced global cognitive impairment. Disclosure
The data has not been previously presented orally or by poster at scientific
Moreover, some encountered memory and attention meetings.
problems and impairment in executive functions, par-
ticularly verbal fluency [36]. Authors’ contributions
The study’s design, writing, methodology, data collection, and analysis were
Being in the frontline, being responsible for saving all contributed to by all the authors. The authors read and approved the final
lives, and having long shifts, the ambiance of the cri- manuscript.
sis would exert an extra burden on the already affected
Funding
individual. Hence, our result shed light on subjects who This study has not received any funds.
recovered from COVID-19; they should undergo long-
term monitoring for evaluation of cognitive functions Availability of data and materials
The data used to support the findings of this study can be found in the
manuscript.
Omar et al. Middle East Current Psychiatry (2022) 29:79 Page 11 of 12

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Approval from the Ethics Committee was approved by the ethical commit‑ professionals. Centre for Disease Control and Prevention, Atlanta.
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