Simple Screening Tool Assesses Cognitive Impairment Post-COVID

Deborah L. Ungerleider, MD, for Medscape

June 01, 2022

Editor's note: Find the latest COVID-19 news and guidance in Medscape's Coronavirus Resource Center.

The study covered in this summary was published on as a preprint and has not yet been peer reviewed.

Key Takeaway

  • Patients with post-COVID syndrome have long-term cognitive impairment that can last for more than 3 months and can be identified with the Oxford Cognitive Screen-Plus assessment, which is cost-effective, mobile, and easily used.

Why This Matters

  • Having a cost-effective, mobile way of assessing cognitive impairment in patients with post-COVID syndrome can provide important information that can help with predicting outcomes and making decisions regarding treatment. This can be especially helpful for patients living in rural, medically underserved areas and for other patients without needing a referral to a specialized medical facility.

Study Design

  • Patients with post-COVID syndrome, aged 18-65 years who were seen at the post-COVID clinic at Jena University Hospital between August 2020 and March 2022, were studied. The control group was comprised of healthy individuals who were sociodemographically matched. Patients with prior neurologic disorders were excluded.

  • Data were collected on patients' medical histories, sociodemographic information, and subjective cognitive complaints.

  • The participants were assessed by the depression section of the Patient Health Questionnaire-9, the Fatigue Assessment Scale, the Brief Fatigue Inventory, and the Oxford Cognitive Screen-Plus.

  • The Oxford Cognitive Screen-Plus assessment, a tablet-based screening tool, was used to assess orientation, memory, attention, and executive function; scores were calculated for these areas.

  • The relationships between these dysfunctions and clinical and patient-reported outcomes were investigated.

  • Statistical analyses using t-tests with Welch correction, chi-squared tests with Yates' continuity correction, Wilcoxon rank sum tests, and multiple linear regression were performed.

Key Results

  • During the initial interviews, 69.9% of patients complained of having attentional issues, 58.9% complained of having memory problems, and 55.7% of patients complained of both.

  • In assessing fatigue and depression, with the Brief Fatigue Inventory and the Patient Health Questionnaire-9, respectively, the patients had significantly worse scores for both than the controls (P < .0001 for both).

  • Patients had lower scores than the healthy controls on Encoding 2 (for memory encoding) (P = .034), Delayed Recall accuracy (for delayed memory) (P = .013), Figure Copy accuracy (for praxis) (P = .037), Cancellation false positives (P = .03), and Invisible Cancellation accuracy (P = .018) (both for attention).

  • Patients also had significantly lower scores than healthy controls for Delayed Memory (P < .01), Executive Functioning (P = .033), and Attention (P = .027).

  • For Memory encoding, 10.7% of patients scored below the cutoff vs 3.85% of healthy controls.

  • For Delayed Memory, 21.15% of patients scored below the cutoff vs 6% of healthy controls.

  • For Executive Functioning, 19.27% of patients scored below the cutoff vs 8% of healthy controls.

  • For Attention, 14.91% of patients scored below the cut-off vs 2% of healthy controls.

  • Taking all domain scores into account, 53.7% of patients were impaired on at least 1 domain score vs 25% of controls; 18.68% of patients scored below the cutoff on at least 2 domains vs 5% of controls; and 3.89% of patients scored below the cutoff on at least 3 domains vs 0% of controls.

  • The Delayed Memory scores were lower in patients with subjective cognitive complaints compared to those without (P = .024).

  • Both hospitalization and age were predictors of poorer Delayed Memory scores (P < .01 and P = .005, respectively).

  • For attentional performance, hospitalization was a significant predictor (P < .01) but age was not (P = .089).

  • For executive function, neither age nor hospitalization were predictors (P = .242).


  • Although the authors excluded patients with known neurologic disorders, they still could not tell whether the deficits that were identified existed prior to the patient's COVID-19 infection.

  • Selection bias might limit the generalization to all patients with post-COVID syndrome, as the patients in this study all had symptoms severe enough to be seen in a specialized clinic.


  • The post-COVID Center was supported by the Thüringer Aufbaubank (2021 FGI 0060).

  • The authors have no conflicts of interest regarding the content of the manuscript.

This is a summary of a preprint research study, "Assessment of Subtle Cognitive Impairments in Patients With Post-COVID Syndrome With the Tablet-based Oxford Cognitive Screen-Plus (OCS-Plus)," written by Valeska Kozik, MSc, from the Department of Neurology, Jena University Hospital/Friedrich-Schiller-University, Jena, Germany, and colleagues on MedRxiv, provided to you by Medscape. This study has not yet been peer reviewed. The full text of the study can be found on

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