Objective:

To evaluate the impact of community education levels on cognitive outcomes post-COVID-19.

Background:

Brain fog post-COVID-19 is common, yet community factors that impact cognitive outcome are not well described.

Design/Methods:

We conducted a prospective, observational study of adult COVID-19 patients with no pre-COVID history of cognitive impairment. Publicly available community data were matched to patient-level data by zip code including regional rates of school absenteeism, rates of high school graduation, and average math and English standardized test scores for grades 3-8. Cognitive testing (Telephone Montreal Cognitive Assessment [tMoCA]) was performed at 6-, 12- and 36-month post-COVID.  Associations of abnormal tMoCA scores (≤18), and improvement in tMoCA (≥1 point between 6-36 months) with community and patient-level education variables were assessed using logistic regression analyses.

Results:

tMoCA data were available for 219 patients (N=137 at 6-months, N=109 at 12-months, N=62 at 36-months, and N=81 had repeated measures of tMOCA between 6-36 months). The median age was 63 years (IQR 51-72), 22% of the cohort did not complete high school, and 76% had ≥13 years of education. In univariate models, patient-level education≥college, higher community rates of on-time high school graduation, higher grade-school math and English test scores, and lower rates of school absenteeism and high-school drop-out were associated with significantly better odds of normal tMOCA scores (all P<0.05).  In backwards, stepwise, multivariable logistic regression models, higher community grade school English tests scores were associated with normal tMOCA scores at 6-months (aOR 0.90, 95%CI 0.83-0.97, P=0.004), and patient-level education≥college was associated with normal tMOCA scores at 12-months (aOR 0.33, 95%CI 0.12-0.95, P=0.040). In patients with repeated tMOCA assessments, only patient-level education≥college was associated with improvements in tMOCA between 6-36 months (OR 2.72, 95% CI 1.08-6.86, P=0.034). 

Conclusions:

Higher community and patient-level education status was associated with better cognitive outcomes post-COVID.