Hospitalized Older Adults With COVID-19 Face Accelerated Cognitive Decline

Older adults with SARS-CoV-2 infection who were hospitalized due to COVID-19 experience faster and larger decreases in cognitive function compared with nonhospitalized patients and persons without prior SARS-CoV-2, according to the results of a diverse, multicenter cohort study published by investigators in the Journal of the American Medical Association.¹

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Research Suggests Cognitive Impacts With COVID-19

COVID-19 causes a variety of symptoms that can vary from patient to patient. Beyond the most common respirator symptoms, countless patients have reported persistent cognitive difficulties following infection with SARS-CoV-2. One cross-sectional study of thousands with a prior positive COVID-19 test found that about 45% of patients self-reported brain fog, poor memory, or reduced executive function following infection. Some experienced these symptoms for up to 2 months.²

Accordingly, a series of investigations have confirmed the potential for cognitive deficits after COVID-19, though they contain critical limitations that put their validity into question and warrant further research into the topic. The current investigators sought to ameliorate these concerns through an analysis of a diverse US community-based sample of older adults to examine the association between short-term cognitive change and COVID-19 infection history.^1,3

They hypothesized that, when accounting for prepandemic cognitive status and other factors, SARS-CoV-2 infection would be connected to accelerated cognitive change.¹

Hospitalized Patients Face Higher Risks of Cognitive Decline

Using a sample of alive patients from the Atherosclerosis Risk in Communities (ARIC) Study, which was originally conducted between 1987 and 1989, the investigators assessed patients for a history of SARS-CoV-2 infection and their cognitive function. The authors used a linear mixed effects model that included time between cognitive assessments, infection status, and an interaction between infection and time to estimate the association between SARS-CoV-2 infection and cognitive score change.^1,4

A total of 3525 eligible participants were included in the analysis. Demographic reporting found a mean age of 80.8 years among the cohort, with a majority of participants being White. In this cohort, 8.7% of individuals developed an infection, and 33.6% of these individuals were hospitalized.¹

The investigators first measured the annualized rate of change in global cognitive function. For uninfected participants, this measure was –0.09 (95% CI, –0.13 to –0.04) for uninfected participants and –0.10 (95% CI, –0.5 to 0.05) for infected individuals. According to infection severity, individuals hospitalized for SARS-CoV-2 infection had a faster rate of annualized change (excess change: –0.06 [95% CI, –0.09 to –0.02]), yet individuals with nonhospitalized infections did not have such a change (excess change: 0.00 [95% CI, –0.02 to 0.03]).¹

Concurrently, only patients with hospitalized infection experienced related changes in domain-specific cognitive scores. For executive function and memory, the annualized rate of change for uninfected patients was −0.04 (95% CI, −0.08 to 0.01) and −0.02 (95% CI, −0.07 to 0.04), respectively, and −0.07 (95% CI, −0.13 to −0.02) and −0.07 (95% CI, −0.14 to −0.00) for hospitalized infected patients, respectively.¹

Observations Showcase Need for Cognitive Function Considerations Post-COVID-19

These observations coincide with previous reports from the US that have detailed cognitive decline deficits following a bout with COVID-19. One such investigation, conducted by Groff et al, found that over half of COVID-19 survivors experienced symptoms of postacute sequelae of COVID-19, most often in the form of functional mobility impairments and mental health complications. The results garnered from these authors support these conclusions, but particularly among hospitalized patients.^1,3

Despite these observations indicating a significant association between COVID-19 specifically and cognitive decline, the authors note in their discussion that a wide range of infectious and noninfectious causes of hospitalization have been associated with incident dementia and cognitive decline. Importantly, it remains unclear whether SARS-CoV-2 infection initiates specific processes that contribute to accelerated cognitive decline that varies from other causes of hospitalization.¹

Regardless of the exact cause, the incidence of cognitive decline following COVID-19 infection is clear. Pharmacists should monitor patients who report a SARS-CoV-2 infection for changes in cognition or daily activities, especially older adults and those who are hospitalized due to their infection. While in the hospital, pharmacists are pivotal to counseling patients on their treatment plan and providing them comfort to ensure their illness is properly managed.¹

REFERENCES

1. Demmer RT, Cornelius T, Kraal Z, et al. COVID-19 and Cognitive Change in a Community-Based Cohort. JAMA Netw Open. 2025;8(6):e2518648. doi:10.1001/jamanetworkopen.2025.18648

2. Perlis RH, Santillana M, Ognyanova K, et al. Prevalence and Correlates of Long COVID Symptoms Among US Adults. JAMA Netw Open. 2022;5(10):e2238804. doi:10.1001/jamanetworkopen.2022.38804

3. Groff D, Sun A, Ssentongo AE, et al. Short-term and Long-term Rates of Postacute Sequelae of SARS-CoV-2 Infection: A Systematic Review. JAMA Netw Open. 2021;4(10):e2128568. doi:10.1001/jamanetworkopen.2021.28568

4. The ARIC Investigators. The Atherosclerosis Risk in Communities (ARIC) Study: Design and objectives. Amer Journ Epidem. 1989;129(4):687-702. doi:10.1093/oxfordjournals.aje.a115184