Fatigue and cognitive impairment in post-COVID syndrome: possible treatment approaches

Post-COVID syndrome can develop in all patients who have had COVID-19, regardless of the disease severity. Clinical manifestations postCOVID syndrome vary greatly, but the most common symptoms include fatigue, anxiety and depression disorders (ADDs), and cognitive impairment (CI).

Objective: to evaluate the efficacy and safety of Cholytilin (choline alfoscerate) and the combined drug MexiB 6 in patients with post-COVID syndrome and fatigue, ADDs, and CI.

Patients and methods. The study included 100 patients aged 22 to 71 years who have had COVID-19 5.4 months ago. Inclusion criterion: cognitive complaints, fatigue, and emotional disturbances. The evaluation included neurological exam, Montreal Cognitive Assessment Scale (MoCA), Frontal Assessment Battery (FAB), 10-words list task, Multidimensional Fatigue Inventory (MFI-20), Hospital Anxiety and Depression Scale (HADS). Study participants were divided into two groups. Patients who had ADDs (anxiety/depression level according to HADS ≥8 points; n=50) were prescribed with MexiB 6 (1 tablet three times per day). Patients with CI (mean MoCA score ≤25 points; n=50) were prescribed with Cholytilin (2 capsules (800 mg) in the morning and 1 capsule (400 mg) at lunchtime). The follow-up period was 60 days.

Results and discussion. According to MoCA scores, a decrease in cognition was observed in 58% of participants, while 28% did not notice CI earlier. ADD fere present in 51%, and fatigue — in 100% of patients. We observed a significant reduction in fatigue severity (from 62.42±7.18 to 52.32±16.36 points; p<0.05) in patients prescribed with MexiB 6. The majority of patients noted a significant increase in physical activity, decreased fatigue, improvement of attention and physical well-being, and increased workplace efficiency. We also found a significant decrease in ADDs severity: ADDs either regressed completely (in 42% of participants) or became subclinical (in 48%; р<0.001). CI severity also reduced according to mean МоСА (from 26.60±1.31 to 27.28±1.39 points; p<0.05) and FAB (from 16.98±1.06 to 17.20±0.90 points; p<0.05) scores. In a subgroup of patients with mild CI treated with Cholytilin mean МоСА (from 23.50±0.99 to 26.36±1.34; р<0.001) and FAB (from 16.02±0.91 to 16.96±0.99; р<0.001) scores significantly increased. Complete regression of CI was observed in 74% of participants (р<0.001). We also found a decrease in ADDs (р<0.001) and fatigue (mean MFI-20 scores decreased from 42.28±10.73 to 35.60±8.10; р<0.001) severity in all study participants.

Conclusion. Patients who have had COVID-19, regardless of the disease severity, have a high prevalence of fatigue, ADDs and CI, and MexiB 6 and Cholytilin have a potential in their treatment.

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