A Network Perspective on Neuropsychiatric and Cognitive Symptoms of the Post-COVID Syndrome

Authors

  • Daniel Scharfenberg
    Medical Psychology | Neuropsychology & Gender Studies, Center for Neuropsychological Diagnostic and Intervention (CeNDI), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
  • Ann-Katrin Schild
    Department of Psychiatry, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
  • Clemens Warnke
    Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
  • Franziska Maier
    Department of Psychiatry, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany

Abstract

Many patients that were infected with SARS-CoV-2 experience cognitive and affective symptoms weeks and months after their acute COVID-19 disease, even when acute symptoms were mild to moderate. For these patients, purely neurological explanations are struggling to explain the development and maintenance of the great variety of neuropsychiatric and cognitive symptoms occurring after COVID-19. We provide a psychological perspective based on the network theory of mental disorders as an added explanation that does not displace neurological mechanism but rather complements them. We suggest viewing the SARS-CoV-2 infection as a trigger that first activates nodes in a causally connected network of neuropsychiatric and cognitive symptoms. In the following, activation will spread throughout the network that will get in a self-sustaining stable and dysfunctional state manifesting in ongoing symptoms known as post-COVID-19 syndrome. The network perspective allows to generalize explanations for persistent neuropsychiatric and cognitive symptoms to patients that experienced mild or moderate acute courses of COVID-19, but also to similar phenomena following other viral infections. In addition, it could explain why some symptoms did not occur during acute COVID-19, but develop weeks or months after it. This network perspective shifts the focus from viewing persistent symptoms as a continuation of COVID-19 to acknowledging it as a complex syndrome that indeed originates from the disease but fully unfolds after it (post-COVID). To test the presented network perspective, we will need extensive cross-sectional as well as longitudinal data on cognitive and neuropsychiatric symptoms in post-COVID patients.