Approaching Post-COVID Cognitive Changes, Milder Cognitive Disorders: Joanna Hellmuth, MD, MS


The cognitive neurologist at the University of California, San Francisco discussed the complexities in characterizing milder cognitive disorders and the need for more tailored assessments for these patients. [WATCH TIME: 8 minutes]

WATCH TIME: 8 minutes

"This [MMSE & MoCA] was developed to have thresholds for dementia. We need to think, how would a younger person with a milder executive functioning disorder perform on an MMSE or McCA compared to a 72-year-old who is worried about Alzheimer disease? When you think about it that way, you realize that maybe these aren’t the best tools."

It has been frequently reported that following COVID-19 infection, some patients may experience cognitive post-acute sequelae (PASC), or what some refer to as “COVID fog.” The clinical community is still trying to understand more about the pathogenesis of the virus, including its long-term effects on other neurodegenerative disorders, such as Alzheimer disease (AD). While the changes observed certainly are not to the extent of AD, the cognitive state itself needs more recognition and validation by the clinical community, according to Joanna Hellmuth, MD, MS.

Hellmuth, cognitive neurologist, University of California, San Francisco, recently published a paper with her colleagues that focused on the clinical features associated with cognitive PASC in post-COVID-19 patients. The results showed that those who had more cognitive risk factors, including learning disabilities, ADHD, and cerebrovascular factors, were more likely to develop COVID-associated cognitive changes. Additionally, a secondary analysis showed these patients had more abnormal cerebrospinal volumes than controls. Although it’s not actionable information, Hellmuth noted, it may help clarify the landscape of the brain prior to COVID-19 infection.

In an interview with NeurologyLive®, Hellmuth discussed the need individualize examinations with patients who’ve contracted COVID-19 to assess their risk of cognitive PASC. She provided a thorough explanation of how to get the best clinical characterization of patients, and whether changes may be from other underlying disorders. Additionally, the expert detailed why AD-related assessments such as the Mini-Mental State Examination and the Montreal Cognitive Assessment are not useful in these milder cognitive disorders.

1. Apple AC, Oddi A, Peluso MJ, et al. Risk factors and abnormal cerebrospinal fluid associate with cognitive symptoms after mild COVID-19. Ann Clin Transl Neurol. Published online January 19, 2022. doi:10.1002/can3.51498
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