I’m reluctant to write about this because there’s a tendency to fall into the trap of blaming every episode of human stupidity on COVID, when people were plenty stupid before the pandemic. But I haven’t been able to get this paper, “Selective visuoconstructional impairment following mild COVID-19 with inflammatory and neuroimaging correlation findings” out of my mind, and I think it’s important and disturbing (there’s a ‘lay’ discussion here).

In the paper, the researchers were attempting to correlate inflammatory markers and changes in brain structure (yes, COVID does change your brain structure, but it’s just a cold amirite?) with cognitive dysfunction as determined by various tests of cognition among people who had mild cases of COVID. When they administered various tests of cognition, one in four ‘failed’ what is known as the Rey-Osterrieth Complex Figure (ROCF) test, where subjects are supposed to copy what looks like an abstract art fish. Here is the figure alongside a ‘good’ result:

Meanwhile, here are some of the failures:

Maybe the one on the bottom right is sort of… ok, but the rest aren’t even close. Remember, one out of four did this poorly. As the authors describe in an interview (boldface mine):

When one person in the first group of four or five people drew a poor copy of the complex fish figure, Romano-Silva says they initially dismissed it as an outlier. Then they noticed it was one person in every group. “It caught our attention because it’s not normal,” he says. “Usually, you’d find like 5-8% of people in the general population in this age group that would show this kind of change. But 25% was too much. So, we investigated.”

…Romano-Silva adds it’s “really worrying” because the group’s mean age was 38 and mostly highly educated professionals such as physicians and nurses, as recruitment took place during the initial stage of the pandemic. Interestingly, he notes participants did better on the memory and recall portion of the test, drawing the complex figure from memory better after five minutes and again after 30 minutes. “This shows it’s specialized to visuospatial organization,” Romano-Silva says. “A person looks at it and cannot organize visuospatially what they are seeing. But by memory, they are able to recruit other areas of the brain so they can make the drawing much better.”

I have no idea what the implications of this are, for let’s say, surgery. Or driving. Or standardized test scores. Though I imagine good is the wrong adjective. \It’s also not clear if this is permanent–and they may learn to compensate by ‘remembering’ the image. But this is really… not good. And around twenty percent (remember, some will fail in the absence of COVID) is so high, that even if things like vaccination lower the chance of this happening, we’re still looking at a non-trivial fraction of people with this dysfunction several months after infection.

In the paper, the authors conclude (boldface mine):

We observed significant cognitive impairment only in the ROCF, a drawing task test used to assess visuospatial abilities, executive functions and memory. The deficits observed in the ROCF could not be explained by socio-demographic factors, ophthalmologic deficits or psychiatric symptoms, suggesting cognitive deficit secondary to SARS-CoV-2 infection. Other factors which may influence performance, such as motor coordination, spatial neglect, visual attention, semantic knowledge, intelligence and executive functions were not likely to explain the observed difficulties, since we did not find any significant differences in other non-verbal (Trail Making Test and Five Points Test) and verbal tests (verbal fluency, digit span) also related to these processes.

In drawing a complex figure, as in the ROCFT, the patient must organize visual and spatial information in a planned manner to execute the drawing per se, a processes that demand several more specific cognitive abilities related to perceiving, processing, storing and recalling visuospatial information, both regarding shape and position, as well the planning and execution of the drawing per se.

These processes involve multiple brain regions, including the occipito-parietal regions, the dorsal and ventral streams and connections with the cingulate, medial temporal and frontal cortices, integrating the perception and interpretation of the visual information with memory and executive systems. Drawing tasks have been getting attention lately for their sensitivity to study visuospatial deficits, which were shown to be early biomarkers of neurodegenerative disorders, such as Alzheimer’s and Parkison’s disease.

The COVID-19 individuals investigated herein were often unable to produce a proper copy of Rey’s figure, and had difficulties in memory. Immediate and delayed recall seems to be secondary to the copy impairment. The lack of ability to assemble or organize parts into a whole object or figure is considered constructional apraxia, a neuropsychological syndrome which results in inability to accurately reproduce two-dimensional or three-dimensional visual models [41]. Constructional apraxia might follow acquired brain lesions or aging-related neurodegenerative diseases which affect the parietal or frontal lobes, but it is very uncommon in younger patients as the ones in our study, with a mean age of 38 years… The performance on visuoconstruction and memory tests, such as the ROCF, are associated with different aspects of everyday life, including the capacity to learn, problem-solving skills, and activities of daily living.

I keep writing this, but I’m not going to stop: you are not the weirdo if you are still trying to avoid (re)infection.

And I can’t help but think that some of the odd behavior people are observing, as well as things like increased car accidents, isn’t just due to the social stresses of the pandemic, but to actual cognitive problems.

But the pandemic is over, and everything is fine, so no need to worry I guess.