{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T03:01:45Z","timestamp":1787022105142,"version":"build-2736575974"},"reference-count":39,"publisher":"Public Library of Science (PLoS)","issue":"6","license":[{"start":{"date-parts":[[2022,6,10]],"date-time":"2022-06-10T00:00:00Z","timestamp":1654819200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>There have been more than 425 million COVID-19 infections worldwide. Post-COVID illness has become a common, disabling complication of this infection. Therefore, it presents a significant challenge to global public health and economic activity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Comprehensive clinical assessment (symptoms, WHO performance status, cognitive testing, CPET, lung function, high-resolution CT chest, CT pulmonary angiogram and cardiac MRI) of previously well, working-age adults in full-time employment was conducted to identify physical and neurocognitive deficits in those with severe or prolonged COVID-19 illness.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>205 consecutive patients, age 39 (IQR30.0\u201346.7) years, 84% male, were assessed 24 (IQR17.1\u201334.0) weeks after acute illness. 69% reported \u22653 ongoing symptoms. Shortness of breath (61%), fatigue (54%) and cognitive problems (47%) were the most frequent symptoms, 17% met criteria for anxiety and 24% depression. 67% remained below pre-COVID performance status at 24 weeks. One third of lung function tests were abnormal, (reduced lung volume and transfer factor, and obstructive spirometry). HRCT lung was clinically indicated in &lt;50% of patients, with COVID-associated pathology found in 25% of these. In all but three HRCTs, changes were graded \u2018mild\u2019. There was an extremely low incidence of pulmonary thromboembolic disease or significant cardiac pathology. A specific, focal cognitive deficit was identified in those with ongoing symptoms of fatigue, poor concentration, poor memory, low mood, and anxiety. This was notably more common in patients managed in the community during their acute illness.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Despite low rates of residual cardiopulmonary pathology, in this cohort, with low rates of premorbid illness, there is a high burden of symptoms and failure to regain pre-COVID performance 6-months after acute illness. Cognitive assessment identified a specific deficit of the same magnitude as intoxication at the UK drink driving limit or the deterioration expected with 10 years ageing, which appears to contribute significantly to the symptomatology of long-COVID.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0267392","type":"journal-article","created":{"date-parts":[[2022,6,10]],"date-time":"2022-06-10T13:39:44Z","timestamp":1654868384000},"page":"e0267392","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":56,"title":["Comprehensive clinical assessment identifies specific neurocognitive deficits in working-age patients with long-COVID"],"prefix":"10.1371","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2465-1521","authenticated-orcid":true,"given":"David A.","family":"Holdsworth","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rebecca","family":"Chamley","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rob","family":"Barker-Davies","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9184-4713","authenticated-orcid":true,"given":"Oliver","family":"O\u2019Sullivan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Ladlow","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James L.","family":"Mitchell","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dominic","family":"Dewson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Mills","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samantha L. 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In: Statistics OfN, editor. UK2022."},{"key":"pone.0267392.ref004","unstructured":"Living with COVID-19\u2014Second Review National Institute of Health Research 2021."},{"key":"pone.0267392.ref005","doi-asserted-by":"crossref","first-page":"n853","DOI":"10.1136\/bmj.n853","article-title":"Fresh evidence of the scale and scope of long covid","volume":"373","author":"M Sivan","year":"2021","journal-title":"BMJ"},{"key":"pone.0267392.ref006","doi-asserted-by":"crossref","first-page":"100683","DOI":"10.1016\/j.eclinm.2020.100683","article-title":"Medium-term effects of SARS-CoV-2 infection on multiple vital organs, exercise capacity, cognition, quality of life and mental health, post-hospital discharge.","volume":"31","author":"B Raman","year":"2021","journal-title":"EClinicalMedicine."},{"issue":"3","key":"pone.0267392.ref007","doi-asserted-by":"crossref","first-page":"e048391","DOI":"10.1136\/bmjopen-2020-048391","article-title":"Multiorgan impairment in low-risk individuals with post-COVID-19 syndrome: a prospective, community-based study","volume":"11","author":"A Dennis","year":"2021","journal-title":"BMJ Open"},{"issue":"10","key":"pone.0267392.ref008","doi-asserted-by":"crossref","first-page":"e2130645","DOI":"10.1001\/jamanetworkopen.2021.30645","article-title":"Assessment of Cognitive Function in Patients After COVID-19 Infection.","volume":"4","author":"JH Becker","year":"2021","journal-title":"JAMA Netw Open"},{"key":"pone.0267392.ref009","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1016\/j.jad.2020.08.001","article-title":"Impact of COVID-19 pandemic on mental health in the general population: A systematic review","volume":"277","author":"J Xiong","year":"2020","journal-title":"J Affect Disord"},{"key":"pone.0267392.ref010","article-title":"COVID-19 induces neuroinflammation and loss of hippocampal neurogenesis.","author":"R Klein","year":"2021","journal-title":"Res Sq."},{"issue":"1","key":"pone.0267392.ref011","doi-asserted-by":"crossref","DOI":"10.3390\/v13010132","article-title":"Neuroinvasion and Encephalitis Following Intranasal Inoculation of SARS-CoV-2 in K18-hACE2 Mice.","volume":"13","author":"P Kumari","year":"2021","journal-title":"Viruses"},{"key":"pone.0267392.ref012","article-title":"Mild respiratory SARS-CoV-2 infection can cause multi-lineage cellular dysregulation and myelin loss in the brain.","author":"A Fern\u00e1ndez-Casta\u00f1eda","year":"2022","journal-title":"bioRxiv"},{"key":"pone.0267392.ref013","doi-asserted-by":"crossref","DOI":"10.1136\/bmjmilitary-2020-001681","article-title":"Defence Medical Rehabilitation Centre (DMRC) COVID-19 Recovery Service.","author":"O O\u2019Sullivan","year":"2021","journal-title":"BMJ Mil Health"},{"key":"pone.0267392.ref014","unstructured":"Research NIfH. 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An Official American Thoracic Society and European Respiratory Society Technical Statement","volume":"200","author":"BL Graham","year":"2019","journal-title":"Am J Respir Crit Care Med"},{"issue":"1","key":"pone.0267392.ref028","doi-asserted-by":"crossref","DOI":"10.1183\/13993003.00016-2016","article-title":"2017 ERS\/ATS standards for single-breath carbon monoxide uptake in the lung","volume":"49","author":"BL Graham","year":"2017","journal-title":"Eur Respir J"},{"key":"pone.0267392.ref029","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1186\/s12968-015-0111-7","article-title":"Normal values for cardiovascular magnetic resonance in adults and children.","volume":"17","author":"N Kawel-Boehm","year":"2015","journal-title":"J Cardiovasc Magn Reson"},{"issue":"3","key":"pone.0267392.ref030","doi-asserted-by":"crossref","first-page":"379","DOI":"10.1093\/ajcn\/79.3.379","article-title":"Waist circumference and not body mass index explains obesity-related health risk","volume":"79","author":"I Janssen","year":"2004","journal-title":"Am J Clin Nutr"},{"issue":"6","key":"pone.0267392.ref031","doi-asserted-by":"crossref","first-page":"441","DOI":"10.1093\/qjmed\/hcg069","article-title":"Waist circumference, waist-to-hip ratio and body mass index as predictors of adipose tissue compartments in men","volume":"96","author":"DC Chan","year":"2003","journal-title":"QJM"},{"issue":"3","key":"pone.0267392.ref032","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1111\/j.0956-7976.2004.01503003.x","article-title":"Transformations in the couplings among intellectual abilities and constituent cognitive processes across the life span.","volume":"15","author":"SC Li","year":"2004","journal-title":"Psychol Sci."},{"issue":"3","key":"pone.0267392.ref033","doi-asserted-by":"crossref","first-page":"306","DOI":"10.1007\/s00213-002-1281-1","article-title":"Acute alcohol effects on cognitive function in social drinkers: their relationship to drinking habits","volume":"165","author":"R Weissenborn","year":"2003","journal-title":"Psychopharmacology (Berl)."},{"issue":"4","key":"pone.0267392.ref034","doi-asserted-by":"crossref","first-page":"695","DOI":"10.1111\/j.1532-5415.2005.53221.x","article-title":"The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment.","volume":"53","author":"ZS Nasreddine","year":"2005","journal-title":"J Am Geriatr Soc."},{"key":"pone.0267392.ref035","doi-asserted-by":"crossref","first-page":"n693","DOI":"10.1136\/bmj.n693","article-title":"Post-covid syndrome in individuals admitted to hospital with covid-19: retrospective cohort study","volume":"372","author":"D Ayoubkhani","year":"2021","journal-title":"BMJ"},{"issue":"11","key":"pone.0267392.ref036","doi-asserted-by":"crossref","first-page":"1265","DOI":"10.1001\/jamacardio.2020.3557","article-title":"Outcomes of Cardiovascular Magnetic Resonance Imaging in Patients Recently Recovered From Coronavirus Disease 2019 (COVID-19).","volume":"5","author":"VO Puntmann","year":"2020","journal-title":"JAMA Cardiol"},{"issue":"1","key":"pone.0267392.ref037","first-page":"116","article-title":"Cardiovascular Magnetic Resonance Findings in Competitive Athletes Recovering From COVID-19 Infection.","volume":"6","author":"S Rajpal","year":"2021","journal-title":"JAMA Cardiol"},{"key":"pone.0267392.ref038","article-title":"Cardiovascular Complications Are Uncommon in Healthcare Workers With Mild or Asymptomatic COVID-19 Infection.","author":"C Berry","year":"2021","journal-title":"JACC Cardiovasc Imaging."},{"issue":"19","key":"pone.0267392.ref039","doi-asserted-by":"crossref","first-page":"1926","DOI":"10.1161\/CIRCULATIONAHA.121.053982","article-title":"Cardiovascular Evaluation After COVID-19 in 137 Collegiate Athletes: Results of an Algorithm-Guided Screening","volume":"143","author":"BS Hendrickson","year":"2021","journal-title":"Circulation"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0267392","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,2,7]],"date-time":"2023-02-07T17:21:48Z","timestamp":1675790508000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0267392"}},"subtitle":[],"editor":[{"given":"Lucette A.","family":"Cysique","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2022,6,10]]},"references-count":39,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2022,6,10]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0267392","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,6,10]]}}}