MCI patients with COVID-19 Have Increased Progression to Dementia at 18 months
Angelia Kirkpatrick1, Claire Delpirou Nouh2, Farhat Husain6, Chao Xu3, Andrea Vincent7, Andriy Yabluchanskiy4, Anna Csiszar4, Zoltan Ungvari4, Jim Scott5, Calin Prodan2
1Medicine, 2Neurology, 3Biostatistics and Epidemiology, 4Neurosurgery, 5Psychiatry, University of Oklahoma Health Sciences Center, 6Neurology, Department of Veterans Affairs, 7Cognitive Research Center, University of Oklahoma, Norman
Objective:

To evaluate the impact of SARS-CoV-2 infection on the rate of progression to dementia in patients diagnosed with MCI prior to the COVID-19 pandemic.

Background:

Older age and vascular risk factors are associated with increased risk for developing more severe forms of COVID-19 and with increased rates of progression to dementia from MCI.  We sought to determine if SARS-CoV-2 infection affects the rate of progression to dementia in a cohort of MCI patients diagnosed prior to the COVID-19 pandemic.

Design/Methods:

Consecutive MCI patients between June 30, 2019 and February 28, 2020 were identified by chart review in a large academic memory loss clinic. Patients were followed at regular intervals using telehealth and in-person visits. Progression to dementia was confirmed through neuropsychological testing and repeat imaging studies were completed. The impact of COVID-19, demographics and vascular risk factors on the rate progression to dementia was determined using logistic regression and Receiver Operator Characteristic (ROC) analyses. Significance was set at p < 0.05.

Results:

There were 118 patients diagnosed with MCI (mean age 75 years, average of 2.8 vascular risk factors). Thirty-three (28%) progressed to dementia over an average follow-up of 18 months. SARS-CoV-2 infection was confirmed by PCR in 18 patients (15.3%), with mild or moderate symptoms in most cases. Progression to dementia was noted in 10/18 (55.6%) patients with versus 23/100 (23%) patients without COVID-19 (p = 0.011). Age and SARS-CoV-2 infection were significantly associated with cognitive decline (AUC 0.724, 95% CI 0.623-0.825, p = 0.0002). On multiple logistic regression, COVID-19 was associated with a 4.39 (95% CI 1.48-13.04) increased odds of progression to dementia after adjusting for age (p = 0.008).

Conclusions:

These results indicate that Sars-CoV-2 infection in MCI patients with multiple vascular risk factors increases the risk for progression to dementia at 18 months.

10.1212/WNL.0000000000203381