387. Understanding the Impact of COVID-19 on Cognitive Function Using a Scalable, App-based, Self-administered Tool in the Military
Authors: Andronescu Liana , Richard Stephanie A , Hone Emily , Scher Ann , Lindholm David , Mende Katrin , Ganesan Anuradha , Huprikar Nikhil , Lalani Tahaniyat , Smith Alfred , Mody Rupal , Jones Milissa U , Colombo Rhonda , Ewers Evan , Berjohn Catherine , Maldonado Carlos , Edwards Margaret Sanchez , Rozman Julia , Rusiecki Jennifer , Byrne Celia , Simons Mark P , Tribble David R , Tribble David R , Burgess Timothy , Rubin Leah H , Severson Joan , O’Connell Robert , Pollett Simon , Agan Brian 
Published: November 2023

Abstract

Background
SARS-CoV-2 infections have been associated with self-reported impaired cognitive function, but research examining objective cognitive assessments is scant. Given the potential impact of long-term cognitive impairment, it is important to characterize this post-infection phenotype.

Methods
The Epidemiology, Immunology, and Clinical Characteristics of Emerging Infectious Diseases with Pandemic Potential (EPICC) study is a longitudinal cohort assessing the impact of SARS-CoV-2 infection in Military Health System (MHS) beneficiaries. A subset of EPICC enrollees consented to cognitive assessment using the Brain-Baseline Assessment of Cognition and Everyday Functioning app (BRACE; Digital Artefacts LLC, Iowa City, IA) and completed 4 tasks: Trails Making Tests A and B, Stroop task, and Visuospatial Short-term Memory task. Participants completed the tasks in August-September 2022 and were categorized as impaired if their mean completion time was &gt;1 SD above the control sample mean.

Results
A total of 482 participants completed the cognitive assessments, 71% of whom had a known history of SARS-CoV-2 infection. Among those with a history of SARS-CoV-2 infection, the mean time between first positive SARS-CoV-2 test and module completion was 9 months (SD=5). Participants were primarily active duty service members (80%), male (65%), and non-Hispanic white (70%). SARS-CoV-2 infections were primarily mild or asymptomatic with only 14 (4.1%) hospitalized. Logistic regression models adjusted for sex, race/ethnicity, age, and education showed no difference in impairment in any of the BRACE tests comparing those with and without a history of SARS-CoV-2 infection (Figure 1). Age was a risk factor for impairment across all tests with each additional year increasing risk of impairment by 6-8% (95% CI: 1.04 – 1.11).Figure 1.Adjusted odds of scoring &gt;1 SD above mean completion time of SARS-CoV-2 negative participantsLogistic regression adjusted for age, sex, race/ethnicity, and education

Conclusion
MHS beneficiaries with a history of SARS-CoV-2 infection did not demonstrate a long-term higher prevalence of objectively measured cognitive impairment compared to participants without SARS-CoV-2 infection after adjusting for demographic variables. Further study is needed to understand the incongruence between reported cognitive symptoms and objectively measured cognitive performance.

Disclosures
Julia Rozman, BS, AstraZeneca: TBD Mark P. Simons, PhD, AstraZeneca: The IDCRP and HJF were funded to conduct an unrelated phase III COVID-19 monoclonal antibody immunoprophylaxis trial as part of US Govt COVID Response Timothy Burgess, MD, MPH, AstraZeneca: The IDCRP and the Henry M. Jackson Foundation (HJF) were funded to conduct an unrelated phase III COVID-19 monoclonal antibody immunoprophylaxis trial Simon Pollett, MBBS, AstraZeneca: The IDCRP and the Henry M. Jackson Foundation (HJF) were funded to conduct an unrelated phase III COVID-19 monoclonal antibody immunoprophylaxis trial