Alterações metabólicas e declínio cognitivo na COVID longa
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Publicado
Aug 7, 2025
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Resumo
Objetivo: Revisar criticamente a literatura científica sobre a associação entre disfunção cognitiva em pacientes com COVID longa e a presença de distúrbios metabólicos, especialmente aqueles relacionados ao perfil cardiometabólico. Métodos: Revisão integrativa da literatura nas bases PubMed, SciELO, LILACS e Latindex, no período de janeiro de 2021 a abril de 2025. A seleção dos estudos seguiu critérios pré-definidos com base na estrutura PICO. Resultados: Vinte e seis estudos foram incluídos. Sintomas como névoa mental, déficits de memória e disfunção executiva foram recorrentes e frequentemente associados a hiperglicemia, resistência à insulina e índice de massa corporal elevado. Achados de PET com 18F-FDG revelaram hipometabolismo cerebral, com maior frequência nas regiões do córtex frontal (45%), lobo temporal (36%) e tálamo (27%). A presença de alterações metabólicas agravou os desfechos cognitivos, especialmente em pacientes com comorbidades prévias como diabetes tipo 2 e obesidade. Considerações finais: Há evidências crescentes de que disfunções metabólicas, incluindo alterações na glicemia e disfunção mitocondrial, contribuem para os déficits neurocognitivos na COVID longa. Esses achados reforçam a importância de abordagens multidisciplinares que incluam a regulação metabólica e a reabilitação cognitiva como estratégias para o manejo desses pacientes.
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Como Citar
PantojaT. J. C., RibeiroR. dos S., MonteiroA. R. L., ReisC. M. G. dos, & MenezesD. C. de. (2025). Alterações metabólicas e declínio cognitivo na COVID longa. Revista Eletrônica Acervo Saúde, 25(8), e21088. https://doi.org/10.25248/reas.e21088.2025
Seção
Revisão Bibliográfica
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Referências
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33. RUDROFF T. Frontal-striatal glucose metabolism and fatigue in patients with multiple sclerosis, long COVID, and COVID-19 recovered controls. Experimental Brain Research, 2024; 242(9): 2125–2136.
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37. SOLLINI M, et al. Long COVID hallmarks on [18F]FDG-PET/CT: a case-control study. European Journal of Nuclear Medicine and Molecular Imaging, 2021; 48(10): 3187–3197.
38. SZÖGI T, et al. Novel biomarkers of mitochondrial dysfunction in Long COVID patients. GeroScience, 2025; 47(2): 2245–2261.
39. THEOHARIDES T, et al. Long-COVID syndrome-associated brain fog and chemofog: Luteolin to the rescue. BioFactors (Oxford, England), 2021; 47(2): 232–241.
40. VERGER A, et al. Reorganization of brain connectivity in post-COVID condition: a {18}$F-FDG PET study. EJNMMI Research, 2025; 15(1): 28.
2. AZEREDO A, et al. Prevalence and associated risk factors of post-COVID-19 syndrome in healthcare workers. Journal of Occupational and Environmental Hygiene, 2024; 21(12): 843–846.
3. BARRETO A, et al. Metabolic disorders and post-acute hospitalization in black/mixed-race patients with long COVID in Brazil: A cross-sectional analysis. PloS One, 2022; 17(10): e0276771.
4. CEBAN F, et al. Fatigue and cognitive impairment in Post-COVID-19 Syndrome: A systematic review and meta-analysis. Brain, Behavior, and Immunity, 2022; 101: 93–135.
5. CULL O, et al. Radiological markers of neurological manifestations of post-acute sequelae of SARS-CoV-2 infection: a mini-review. Frontiers in Neurology, 2023; 14: 1233079.
6. DEBSP, et al. Post-COVID-19 Brain [18F]FDG-PET Findings: A Retrospective Single-Center Study in the United States. AJNR. American Journal of Neuroradiology, 2023; 44(5): 517–522.
7. DETERS J, et al. Effect of Post-COVID-19 on Brain Volume and Glucose Metabolism: Influence of Time Since Infection and Fatigue Status. Brain Sciences, 2023; 13(4): 675.
8. DRESSING A, et al. Neuropsychologic Profiles and Cerebral Glucose Metabolism in Neurocognitive Long COVID Syndrome. Journal of Nuclear Medicine : Official Publication, Society of Nuclear Medicine, 2022; 63(7): 1058–1063.
9. FERNÁNDEZ-ORTEGA M, et al. Cognitive dysfunction, diabetes mellitus 2 and arterial hypertension: Sequelae up to one year of COVID-19. Travel Medicine and Infectious Disease, 2023; 52: 102553.
10. FERRUCCI R, et al. Brain positron emission tomography (PET) and cognitive abnormalities one year after COVID-19. Journal of Neurology, 2023; 270(4): 1823–1834.
11. FREREJJ, TENOEVER BR. Cardiometabolic syndrome - an emergent feature of Long COVID? Nature Reviews. Immunology, 2022; 22(7): 399–400.
12. GALÚCIO V, et al. Evaluation of the Hematological Patterns from Up to 985 Days of Long COVID: A Cross-Sectional Study. Viruses, 2023; 15(4): 879.
13. GOEHRINGER F, et al. Brain {18}F-FDG PET imaging in outpatients with post-COVID-19 conditions: findings and associations with clinical characteristics. European Journal of Nuclear Medicine and Molecular Imaging, 2023; 50(4): 1084–1089.
14. GUEDJE, et al. {18}F-FDG brain PET hypometabolism in patients with long COVID. European Journal of Nuclear Medicine and Molecular Imaging, 2021; 48(9): 2823–2833.
15. HOROWITZ T, et al. Persistent brain metabolic impairment in long COVID patients with persistent clinical symptoms: a nine-month follow-up [18F]FDG-PET study. European Journal of Nuclear Medicine and Molecular Imaging, 2024; 51(11): 3215–3222.
16. HUGON J, et al. Long COVID: cognitive complaints (brain fog) and dysfunction of the cingulate cortex. Journal of Neurology, 2022a; 269(1): 44–46.
17. HUGONJ, et al. Cognitive decline and brainstem hypometabolism in long COVID: A case series. Brain and Behavior, 2022b; 12(4): e2513.
18. IVCHENKO G, et al. Mild post-COVID syndrome in young patients. Terapevticheskiiarkhiv, 2023; 95(8): 674–678.
19. KATO B, et al. Avaliação dos fatores de risco para o desenvolvimento do deficit cognitivo pós-COVID-19. Revista Eletrônica Acervo Saúde, 2024; 24(8): e15620.
20. LAM G, et al. Characterizing long-COVID brain fog: a retrospective cohort study. Journal of Neurology, 2023; 270(10): 4640–4646.
21. LAPAJ, et al. Prevalence and Associated Factors of Post-COVID-19 Syndrome in a Brazilian Cohort after 3 and 6 Months of Hospital Discharge. International Journal of Environmental Research and Public Health, 2023; 20(1): 848.
22. LEG, et al. Impact of elevated body mass index (BMI) on cognitive functioning and inflammation in persons with post-COVID-19 condition: a secondary analysis. Acta Neuropsychiatrica, 2024; 36(4): 211–217.
23. MADDALONI E, et al. Cardiometabolic multimorbidity is associated with a worse Covid-19 prognosis than individual cardiometabolic risk factors: a multicentre retrospective study (CoViDiab II). Cardiovascular Diabetology, 2020; 19(1).
24. MARTINI A, et al. Persistent dysfunctions of brain metabolic connectivity in long-covid with cognitive symptoms. European Journal of Nuclear Medicine and Molecular Imaging, 2025; 52(3): 810–822.
25. MENEZES D, et al. Metabolic Profile of Patients with Long COVID: A Cross-Sectional Study. Nutrients, 2023; 15(5): 1197.
26. MEYER M, et al. Long-term neuropsychological consequences of severe COVID-19 infection: the NEUROCOG-COVID study. Journal of Neurology, 2025; 272(5): 363.
27. MISKOWIAK K, et al. Cerebral Metabolic Rate of Glucose and Cognitive Tests in Long COVID Patients. Brain Sciences, 2022; 13(1): 23.
28. MORANDA, et al. Similar patterns of [18F]-FDG brain PET hypometabolism in paediatric and adult patients with long COVID: a paediatric case series. European Journal of Nuclear Medicine and Molecular Imaging, 2022; 49(3): 913–920.
29. OUZZANI M, et al. Rayyan — um aplicativo web e móvel para revisões sistemáticas. Syst Rev, 2016; 5: 210.
30. PASINI E, et al. Serum Metabolic Profile in Patients With Long-Covid (PASC) Syndrome: Clinical Implications. Frontiers in Medicine, 2021; 8: 714426.
31. RAVEENDRAN AV. Long COVID-19: Challenges in the diagnosis and proposed diagnostic criteria. Diabetes Metab Syndr, 2021; 15(1): 145-146.
32. ROZENBLUML, et al. Cognitive Impairment and Brain Metabolic Changes in Post-Acute Sequelae of COVID-19: Insights From an [18F]FDG PET/CT Cohort Study. Clinical Nuclear Medicine, 2025; 50(3): e146–e153.
33. RUDROFF T. Frontal-striatal glucose metabolism and fatigue in patients with multiple sclerosis, long COVID, and COVID-19 recovered controls. Experimental Brain Research, 2024; 242(9): 2125–2136.
34. SAKAMOTO J, et al. Changes in cerebral glucose metabolism among mild long COVID patients: an [18F]FDG PET/CT study. Brazilian Journal of Medical and Biological Research = Revista Brasileira de Pesquisas Medicas e Biologicas, 2024; 57: e14228.
35. SCHERERP, et al. Post-acute sequelae of COVID-19: A metabolic perspective. eLife, 2022; 11.
36. SOFF S, et al. Association of glycemic control with Long COVID in patients with type 2 diabetes: findings from the National COVID Cohort Collaborative (N3C). BMJ Open Diabetes Research & Care, 2025; 13(1): e004536.
37. SOLLINI M, et al. Long COVID hallmarks on [18F]FDG-PET/CT: a case-control study. European Journal of Nuclear Medicine and Molecular Imaging, 2021; 48(10): 3187–3197.
38. SZÖGI T, et al. Novel biomarkers of mitochondrial dysfunction in Long COVID patients. GeroScience, 2025; 47(2): 2245–2261.
39. THEOHARIDES T, et al. Long-COVID syndrome-associated brain fog and chemofog: Luteolin to the rescue. BioFactors (Oxford, England), 2021; 47(2): 232–241.
40. VERGER A, et al. Reorganization of brain connectivity in post-COVID condition: a {18}$F-FDG PET study. EJNMMI Research, 2025; 15(1): 28.