A hypoarousal model of neurological post-COVID syndrome: the relation between mental fatigue, the level of central nervous activation and cognitive processing speed
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Background: Knowledge on the nature of post-COVID neurological sequelae often manifesting as cognitive dysfunction and fatigue is still unsatisfactory. Objectives: We assumed that cognitive dysfunction and fatigue in post-COVID syndrome are critically linked via hypoarousal of the brain. Thus, we assessed whether tonic alertness as a neurocognitive index of arousal is reduced in these patients and how this relates to the level of central nervous activation and subjective mental fatigue as further indices of arousal. Methods: 40 post-COVID patients with subjective cognitive dysfunction and 40 matched healthy controls underwent a whole-report paradigm of briefly presented letter arrays. Based on report performance and computational modelling according to the theory of visual attention, the parameter visual processing speed (VPS) was quantified as a proxy of tonic alertness. Pupillary unrest was assessed as a measure of central nervous activation. The Fatigue Assessment Scale was applied to assess subjective mental fatigue using the corresponding subscale. Results: VPS was reduced in post-COVID patients compared to controls (p = 0.005). In these patients, pupillary unrest (p = 0.029) and mental fatigue (p = 0.001) predicted VPS, explaining 34% of the variance and yielding a large effect with f 2 = 0.51. Conclusion: In post-COVID patients with subjective cognitive dysfunction, hypoarousal of the brain is reflected in decreased processing speed which is explained by a reduced level of central nervous activation and a higher level of mental fatigue. In turn, reduced processing speed objectifies mental fatigue as a core subjective clinical complaint in post-COVID patients.
Originalsprog | Engelsk |
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Tidsskrift | Journal of Neurology |
Vol/bind | 270 |
Sider (fra-til) | 4647-4660 |
ISSN | 0340-5354 |
DOI | |
Status | Udgivet - okt. 2023 |
Bibliografisk note
Funding Information:
This work was supported by a Ph.D. scholarship “Landesgraduiertenstipendium” of Friedrich-Schiller-University Jena to EM, by the German Forschungsgemeinschaft [DFG, FI 1424/2-1] and the Horizon 2020 Framework Programme of the European Union (ITN SmartAge, H2020-MSCA-ITN-2019-859890) to KF and by the Thüringer Aufbaubank (2021 FGI 0060) to PAR and AS.
Publisher Copyright:
© 2023, The Author(s).
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