Since the neurologic symptoms of some COVID patients ('brain fog') resemble those ofpatients with concussion, the aim of this study is to identify EEG and cognitive functionchanges in COVID patients. We will use the FDA cleared BrainScope medical device inconjunction with standard neurocognitive tests to identify correlations with electricalbiomarkers and to potentially identify new, unique patterns of altered brain electricalactivity associated with COVID-19 infection. A baseline assessment will be performedshortly after hospital presentation and then a second evaluation will be performed 45-60days post hospital discharge to reassess clinical status, brain electrical biomarkers andneurocognitive performance. The goal will be to develop an objective measurement of brainfunction/dysfunction associated with COVID-19 infection which might be employed in futurestudies of treatments for COVID-19 brain fog and to aid in tracking recovery.
1. Screening and Consent - Patients with a diagnosis of COVID-19 will be asked by the
research personnel if they are experiencing symptoms of 'brain fog' (confusion,
altered memory, headache, trouble concentrating.) Those responding affirmatively
will be asked to complete a brief mental status exam (mini MoCA). Those patients
scoring 25 or less out of 30 will then move forward to the formal written consent
process. We will also recruit 5 control patients who are COVID positive but are not
experiencing 'brainfog' symptoms.
2. Electroencephalogram (EEG) - We will perform an EEG using a Brainscope device.
3. Neurocognitive Assessment (brain function tests) - While the EEG electrodes are
still attached, we will perform these assessments that test attention,
concentration, reaction time, processing speed, decision making, and executive
function. These are called the Structural Injury classifier (SIC) and Concussion
Index (CI) assessments that are computed using FDA cleared algorithms for the
likelihood of structural brain injury and the likelihood and severity of brain
function impairment.
4. Full MoCA assessment - After the Brainscope evaluation patients will be asked
questions on the paper-based full MoCA cognitive assessment and the score will be
recorded.
5. Concussion Symptom Inventory (CSI) - Study personnel will ask questions about
symptoms using the CSI which is a standardized tool for evaluating injured patients
who have concussion.
6. Inventory of COVID Symptoms - Research personnel will collect information about
COVID symptoms using standardized PROMIS surveys. (Dyspnea severity and Physical
Function)
7. Demographics - We will collect demographic information that includes age and sex,
along with vital signs, pulse oximetry, and supplemental oxygen requirement,
physical exam, neurological exam, lab test results, medications given during
hospitalization, and results of any imaging done on the head during hospitalization.
Standard laboratory results including blood counts, chemistry and biomarkers of
inflammation obtained as standard of care will be recorded.
8. Follow-up Visit - Participants will return to the clinic for a follow-up visit 45-60
days after discharge from the hospital. At that visit the Brainscope EEG, mental
function tests, and symptom surveys will be repeated.
Diagnostic Test: Brainscope modified EEG and cognitive testing
Modified EEG performed using BrainScope device along with cognitive testing performed
with BrainScope device and other surveys.
Inclusion Criteria:
- Current COVID 19 infection
- Experiencing 'brain fog' symptoms (e.g.confusion, mental slowness, unable to
concentrate)
- GCS of 14 or 15
- sufficient mental capacity to provide informed consent
- hemodynamically stable
- able to cooperate with EEG collection and neurometric testing
- admitted to a floor bed rather than ICU
Exclusion Criteria:
- Head or facial trauma
- Any abnormality that would prevent electrodes from being placed on the head
- Known central nervous system (CNS) disease i.e. MS, Parkinson's disease
- Know seizure disorder
- Known dementia
- Metabolic encephalopathy i.e. uremia, hepatic
- Alcohol intoxication to the point they cannot give consent
- Hypoxia that is not corrected to 92% by nasal cannula, or simple face mask
- Chronic alcohol or drug dependence
- Prior cerebrovascular accident (CVA)
- Prior brain surgery
- Known brain mass
- Receiving sedation medications at time of consent
- End stage renal disease (ESRD) on dialysis
- Acute psychosis
University Medical Center of El Paso
El Paso, Texas, United States
Investigator: Leann Rodriguez
Contact: 915-215-4976
rod72863@ttuhsc.edu
Edward Michelson, MD
915 215 4600
edward.michelson@ttuhsc.edu
Susan Watts
915 215 4633
susan.watts@ttuhsc.edu
Edward Michelson, MD, Principal Investigator
Chair, Dept of Emergency Medicine; TTUHSC El Paso