Journal of Patient Safety & Quality Improvement

Journal of Patient Safety & Quality Improvement

Comparison of Working Memory, Cognitive Flexibility, and Sustained Attention in People with Previous COVID-19 Infection Who Have Recovered with Non-Infected Counterparts

Document Type : Original Article

Authors
Faezeh Sarabadan 1
Somayeh Pour Mohammadi 2
1 MSc, Department of Psychology, South Tehran Branch, Islamic Azad University, Tehran, Iran.
2 PhD in General Psychology, Department of Psychology, Science and Research Branch, Islamic Azad University, Tehran, Iran.
10.22038/psj.2025.87302.1467
Abstract
Introduction:
Many people experience persistent cognitive problems after COVID-19, with no current targeted treatments. This study compared working memory, cognitive flexibility, and attention in recovered COVID-19 patients versus non-infected peers to better understand these deficits.
Materials and Methods:
The study utilized a case-control and causal-comparative research design to explore cognitive differences related to COVID-19 severity. The participants were residents of Tehran divided into two groups: individuals who had not been affected by COVID-19 or experienced only mild cases, and those who had suffered from severe COVID-19 in 2023. The total sample consisted of 60 participants, with equal groups of 30 each, selected through convenience sampling. The methodology involved administering various memory assessments, including the N-Back, Wisconsin, and continuous performance tests, to evaluate cognitive function. For data analysis, an independent samples T-test was conducted in SPSS version 26 to compare cognitive performance between groups.
 Results:
The recovered COVID-19 group had an average age of 40.57, while controls averaged 36.57. They scored lower in working memory (30.21 vs. 32.56, p=0.038) and cognitive flexibility (4.03 vs. 5.03, p=0.031). No significant differences were found in sustained attention, indicating it may remain unaffected post-recovery.
Conclusion:
COVID-19 recovery is linked to declines in working memory and flexibility. Interventions targeting these areas could aid recovery and improve quality of life. These differences were observed through measures of performance levels and survival rates. Based on these findings, it is recommended that interventions aimed at improving working memory and cognitive flexibility be implemented in hospitals and mental health centers.
Keywords
Working memory
Cognitive flexibility
Sustained attention
Coronavirus
Subjects
  1. Islam A, Ahmed A, Naqvi IH, Parveen S. Emergence of deadly severe acute respiratory syndrome coronavirus-2 during 2019–2020. Virus disease. 2020;31(2):128-36.
  2. Wu F, Zhao S, Yu B, Chen YM, Wang W, Song ZG, Hu Y, Tao ZW, Tian JH, Pei YY, Yuan ML, Zhang YL, Dai FH, Liu Y, Wang QM, Zheng JJ, Xu L, Holmes EC, Zhang YZ. A new coronavirus associated with human respiratory disease in China. Nature. 2020;579(7798):265-269.
  3. Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, Zhang L, Fan G, Xu J, Gu X, Cheng Z, Yu T, Xia J, Wei Y, Wu W, Xie X, Yin W, Li H, Liu M, Xiao Y, Gao H, Guo L, Xie J, Wang G, Jiang R, Gao Z, Jin Q, Wang J, Cao B. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395(10223):497-506.
  4. Soriano JB, Murthy S, Marshall JC, Relan P, Diaz JV; WHO Clinical Case Definition Working Group on Post-COVID-19 Condition. A clinical case definition of post-COVID-19 condition by a Delphi consensus. Lancet Infect Dis. 2022;22(4): e102-e107.
  5. Varatharaj A, Thomas N, Ellul MA, Davies NWS, Pollak TA, Tenorio EL, Sultan M, Easton A, Breen G, Zandi M, Coles JP, Manji H, Al-Shahi Salman R, Menon DK, Nicholson TR, Benjamin LA, Carson A, Smith C, Turner MR, Solomon T, Kneen R, Pett SL, Galea I, Thomas RH, Michael BD; CoroNerve Study Group. Neurological and neuropsychiatric complications of COVID-19 in 153 patients: a UK-wide surveillance study. Erratum in: Lancet Psychiatry. 2020;7(10): e64.
  6. Chen T, Wu D, Chen H, Yan W, Yang D, Chen G, Ma K, Xu D, Yu H, Wang H, Wang T, Guo W, Chen J, Ding C, Zhang X, Huang J, Han M, Li S, Luo X, Zhao J, Ning Q. Clinical characteristics of 113 deceased patients with coronavirus disease 2019: retrospective study. BMJ. 2020;368:m1091.
  7. Helms J, Kremer S, Merdji H, Clere-Jehl R, Schenck M, Kummerlen C, Collange O, Boulay C, Fafi-Kremer S, Ohana M, Anheim M, Meziani F. Neurologic Features in Severe SARS-CoV-2 Infection. N Engl J Med. 2020;382(23):2268-2270.
  8. Lovell N, Maddocks M, Etkind SN, Taylor K, Carey I, Vora V, Marsh L, Higginson IJ, Prentice W, Edmonds P, Sleeman KE. Characteristics, Symptom Management, and Outcomes of 101 Patients with COVID-19 Referred for Hospital Palliative Care. J Pain Symptom Manage. 2020; 60(1): e77-e81.
  9. Mao L, Jin H, Wang M, Hu Y, Chen S, He Q, Chang J, Hong C, Zhou Y, Wang D, Miao X, Li Y, Hu B. Neurologic Manifestations of Hospitalized Patients with Coronavirus Disease 2019 in Wuhan, China. JAMA Neurol. 2020;77(6):683-690.
  10. Goldstein S, Naglieri JA, Princiotta D, & Otero TM. Introduction: A History of Executive Functioning as a Theoretical and Clinical Construct. In S. Goldstein & J. A. Naglieri (Eds.), Handbook of Executive Functioning 2014; (pp. 3-12). New York, NY: Springer New York.
  11. Songco A, Patel SD, Dawes K, Rodrigues E, O'Leary C, Hitchcock C, Dalgleish T, Schweizer S. Affective working memory in depression. Emotion. 2023;23(6):1802-1807.
  12. Herrera E, Pérez-Sánchez MDC, San Miguel-Abella R, Barrenechea A, Blanco C, Solares L, González L, Iza C, Castro I, Nicolás E, Sierra D, Suárez P, González-Nosti M. Cognitive impairment in young adults with post COVID-19 syndrome. Sci Rep. 2023;13(1):6378.
  13. Toussaint LL, Bratty AJ. Amygdala and Insula Retraining (AIR) Significantly Reduces Fatigue and Increases Energy in People with Long COVID. Evid Based Complement Alternat Med. 2023; 2023:7068326.
  14. Cristillo V, Pilotto A, Cotti Piccinelli S, Bonzi G, Canale A, Gipponi S, Bezzi M, Leonardi M, Padovani A; Neuro Covid Next Study group. Premorbid vulnerability and disease severity impact on Long-COVID cognitive impairment. Aging Clin Exp Res. 2022;34(1):257-260.
  15. Bertuccelli M, Ciringione L, Rubega M, Bisiacchi P, Masiero S, Del Felice A. Cognitive impairment in people with previous COVID-19 infection: A scoping review. Cortex. 2022; 154:212-230.
  16. Badenoch JB, Rengasamy ER, Watson C, Jansen K, Chakraborty S, Sundaram RD, Hafeez D, Burchill E, Saini A, Thomas L, Cross B, Hunt CK, Conti I, Ralovska S, Hussain Z, Butler M, Pollak TA, Koychev I, Michael BD, Holling H, Nicholson TR, Rogers JP, Rooney AG. Persistent neuropsychiatric symptoms after COVID-19: a systematic review and meta-analysis. Brain Commun. 2021;4(1): fcab297.
  17. Alemanno F, Houdayer E, Parma A, Spina A, Del Forno A, Scatolini A, Angelone S, Brugliera L, Tettamanti A, Beretta L, Iannaccone S. COVID-19 cognitive deficits after respiratory assistance in the subacute phase: A COVID-rehabilitation unit experience. PLoS One. 2021 Feb 8;16(2): e0246590.
  18. Zhou H, Lu S, Chen J, Wei N, Wang D, Lyu H, Shi C, Hu S. The landscape of cognitive function in recovered COVID-19 patients. J Psychiatr Res. 2020; 129:98-102.
  19. Frolli A, Ricci MC, Di Carmine F, Lombardi A, Bosco A, Saviano E, Franzese L. The Impact of COVID-19 on Cognitive Development and Executive Functioning in Adolescents: A First Exploratory Investigation. Brain Sci. 2021;11(9): 1222.
  20. Gubler DA, Makowski LM, Troche SJ, Schlegel K. Loneliness and Well-Being During the Covid-19 Pandemic: Associations with Personality and Emotion Regulation. J Happiness Stud. 2021;22(5):2323-2342.
  21. Öztürk ŞB, Akbayır SB. The Mediator Role of Psychological Resilience in the Relationship of Cognitive Flexibility and Fear of COVID-19. Journal of Family Counseling and Education.2020; 8(1):41-56.
  22. Jun J, Toh YN, Sisk CA, Remington RW, Lee VG. Do concerns about COVID-19 impair sustained attention? Cogn Res Princ Implic. 2021;6(1):41.
  23. Arbula S, Pisanu E, Bellavita G, Menichelli A, Lunardelli A, Furlanis G, Manganotti P, Cappa S, Rumiati R. Insights into attention and memory difficulties in post-COVID syndrome using standardized neuropsychological tests and experimental cognitive tasks. Sci Rep. 2024;14(1):4405.
  24. Jaeggi SM, Buschkuehl M, Perrig WJ, Meier B. The concurrent validity of the N-back task as a working memory measure. Memory. 2010; 18(4): 394-412.
  25. Miri Ashtiani SN, Daliri MR. Identification of cognitive load-dependent activation patterns using working memory task-based fMRI at various levels of difficulty. Sci Rep. 2023;13(1):16476.
  26. Grant DA, Berg E. A behavioral analysis of degree of reinforcement and ease of shifting to new responses in a Weigl-type card-sorting problem. Journal of experimental psychology. 1948;38(4):404.
  27. Shahgholian M, Azadfallah P, Fathi-Ashtiani A, Khodadadi M. Design of the Wisconsin Card Sorting Test (WCST) computerized version: Theoretical fundamental, developing and psychometrics characteristics. Clinical Psychology Studies. 2012; 1(4): 110-134.
  28. eukert X, Steindorf K, Schagen SB, Runz A, Meyer P, Zimmer P. Hippocampus-Related Cognitive and Affective Impairments in Patients With Breast Cancer-A Systematic Review. Front Oncol. 2020;10:147.
  29. Mena-Vázquez N, Ortiz-Márquez F, Ramírez-García T, Cabezudo-García P, García-Studer A, Mucientes-Ruiz A, Lisbona-Montañez JM, Borregón-Garrido P, Ruiz-Limón P, Redondo-Rodríguez R, Manrique-Arija S. Impact of inflammation on cognitive function in patients with highly inflammatory rheumatoid arthritis. RMD open. 2024;10(2):e004422.
  30. Godara M, Everaert J, Sanchez-Lopez A, Joormann J, De Raedt R. Interplay between uncertainty intolerance, emotion regulation, cognitive flexibility, and psychopathology during the COVID-19 pandemic: a multi-wave study. Sci Rep. 2023;13(1):9854.
  31. Frolli A, Ricci MC, Di Carmine F, Lombardi A, Bosco A, Saviano E, Franzese L. The impact of COVID-19 on cognitive development and executive functioning in adolescents: a first exploratory investigation. Brain sciences. 2021;11(9):1222.
  32. Crivelli L, Calandri I, Corvalán N, Carello MA, Keller G, Martínez C, Arruabarrena M, Allegri R. Cognitive consequences of COVID-19: results of a cohort study from South America. Arq Neuropsiquiatr. 2022 Mar;80(3):240-247.
  33. Wang W, Cui R, Leng L, Wang G, Peng G. Cognitive Impairment in the Post-Acute Phases of COVID-19 and Mechanisms: An Introduction and Narrative Review. J Alzheimers Dis Rep. 2024;8(1):647-658.

 

Journal of Patient Safety & Quality Improvement
Volume 13, Issue 2
Spring 2025
Pages 89-100