Cognitive function and impact on driving after SARS-COV-2 infection in a man with long-standing HIV infection: a case report

The patient is a 62-year-old man with a history of HIV infection since 1991. He was treated with antiretroviral medications since that time, including multidrug combinations beginning in 1994. He reports a nadir CD4 count of 81 in 1993. At the time of his first contact with us in 2019, he had a nondetectable viral load (< 20 copies/mL) and a CD4 count of 712.

In May of 2019, the patient was recruited for a study of computer-based cognitive training (CCT) and transcranial direct current stimulation (tDCS) for HIV-associated mild neurocognitive disorder (MND). During telephone screening, he reported a history of HIV infection and current subjective cognitive difficulties including memory dysfunction. Testing confirmed objective deficits, and he met Frascati criteria for mild neurocognitive disorder (Antinori et al. 2007).

As part of this study, he completed a battery of neuropsychological tests before and after the study and at 1-month follow-up. Measures of psychomotor speed are most relevant to his post-COVID-19 function and are presented here. Baseline assessment was in May 2019, with follow-ups in August and September (Ownby and Kim 2021). As a follow-up, participants completed a driving simulator evaluation. He completed this evaluation in September 2019 and showed performance above average for persons 50 years and older with HIV-related cognitive disorders (Foley et al. 2013).

The patient was contacted in February 2022 as part of recruitment for a mixed-methods study of post-COVID-19 symptomatology (Thomas-Purcell et al. 2023). He completed a telephone screening, online self-report questionnaires, and a 45-min interview online by video conference as part of that study. The patient contracted COVID-19 in March of 2020 and met 2020 CDC case criteria for probable COVID-19. Symptoms reported by the patient during the acute phase included fever, rigors, myalgia, severe headache, fatigue, and coughing. Since recovering from the initial infection, he reports new symptoms of atrial fibrillation, shortness of breath, “brain fog,” fatigue, sleep disturbance, and difficulty in driving. He stated that he was fearful of driving, sometimes feeling confused and lost. He had limited his driving to daytime and in clear weather, relying on ride sharing services at other times.

Because of the previous assessments and his current complaints about driving, we undertook an assessment of his current functioning. The patient consented to re-assessment consisting of measures of psychomotor speed and attention, including the Trail Making Test (Reitan and Wolfson 1993); the Digit Span and Coding subtests of the Wechsler Adult Intelligence Scale, 4th ed. (Wechsler 2008); the Grooved Pegboard Test (Lafayette Instrument Company 2002); and the standard driving simulation.

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