Combination of transcranial direct current stimulation with online cognitive training improves symptoms of Post-acute Sequelae of COVID-19: A case series.

Abstract Post-Acute Sequelae of COVID-19 (PASC) has been associated with cognitive impairment and complains in up to 90% of individuals after the infection by COVID 19. In this context, there is an urgent need to develop treatments for this disorder. Transcranial direct current stimulation (tDCS) is a non-invasive brain stimulation intervention that can modulate neuronal excitability and improve PASC neurocognitive symptoms. Here, we investigated the effects of this intervention in a case series of four patients with cognitive symptoms using the Assessment of PASC (A-PASC) inventory. The intervention consisted of 20-minute, 2mA, 20 daily sessions of bilateral prefrontal (anodal-left/cathodal-right) tDCS (1x1 Mini-CT, Soterix Medical, New York, NY) plus online cognitive training using the BrainHQ platform (Posit Science, San Francisco, Glenn Smith). Several neuropsychological domains were assessed at baseline and endpoint. After treatment ,all participants described cognitive and emotional complaints decreasing. The neuropsychological assessment showed that the participants performed better for delayed and immediate recall in the verbal episodic memory task. They showed an improving trend in lexicon assessment, and in phonemic verbal fluency. The same was observed for the sustained attention task. Also, the participants showed a trend in becoming faster and more accurate in processing speed, and in executive function (inhibitory control, cognitive flexibility and time management). These are preliminary results from a pilot study that preceded an ongoing, double-blinded, randomized controlled trial comparing the effects of cognitive training combined with sham or active tDCS at University of São Paulo, Brazil. Research Category and Technology and Methods Clinical Research: 9. Transcranial Direct Current Stimulation (tDCS) Keywords: transcranial direct current stimulation , cognitive training , cognitive impairment, Post-Acute Sequelae of Sars-Cov2