Loading…

Protocol - Long COVID - Symptoms Due to COVID-19 - Memory

Add to My Toolkit
Description

A self-administered questionnaire to better describe and understand the patient experience and recovery of those with confirmed or suspected COVID-19, with a specific emphasis on Long COVID experience especially with memory.

Specific Instructions

None

Availability

Available

Protocol

Memory Symptoms

1. Have you experienced any MEMORY RELATED SYMPTOMS since the start of your COVID-19 illness?

[ ] Yes

[ ] No

2. Which of the following memory symptoms have you experienced since the start of your COVID-19 illness?

[ ] Short-term memory loss (memory that lasts ~30 seconds, i.e. remembering a phone number before writing it down, or forgetting youre in the middle of a task)

[ ] Long-term memory loss (long-term memory can be anything from remembering yesterday, forgetting youve done a task, forgetting recently learned information, or forgetting your third-grade experience)

[ ] Not being able to make new memories

[ ] Forgetting how to do routine tasks (tying your shoe laces, washing your hands)

[ ] None of the above

[ ] Other __________

3. When did you experience these symptoms?

Please mark symptoms for the first 4 weeks, then months (if applicable). Even if you have only experienced these symptoms for part of a week or month, please select it.

Week

1

Week

2

Week

3

Week

4

Month

2

Month

3

Month

4

Month

5

Month

6

Month

7

Memory symptoms

[ ]

[ ]

[ ]

[ ]

[ ]

[ ]

[ ]

[ ]

[ ]

[ ]

Cognitive Function/Brain Fog Symptoms

4. Have you experienced issues with BRAIN FOG (inability to focus, think clearly, plan, process, understand, and maintain a coherent stream of thought; abnormally slow or fast thoughts) since the start of your COVID-19 illness?

[ ] Yes

[ ] No

5. Which of the following brain fog/cognitive functioning symptoms have you experienced since the start of your COVID-19 illness?

[ ] Difficulty with executive functioning (planning, organizing, figuring out the sequence of actions, abstracting)

[ ] Agnosia (failure to recognize or identify objects despite intact sensory functioning)

[ ] Difficulty problem-solving or decision-making

[ ] Difficulty thinking

[ ] Thoughts moving too quickly

[ ] Slowed thoughts

[ ] Poor attention or concentration

[ ] I did NOT have any Brain Fog symptoms

[ ] Other

6. When did you experience these symptoms?

Please mark symptoms for the first 4 weeks, then months (if you havent yet reached a week/month, please leave it blank). Even if you have only experienced these symptoms for part of a week or month, please select it.

Week

1

Week

2

Week

3

Week

4

Month

2

Month

3

Month

4

Month

5

Month

6

Month

7

Brain fog/cognitive functioning symptoms

[ ]

[ ]

[ ]

[ ]

[ ]

[ ]

[ ]

[ ]

[ ]

[ ]

Changes to Daily/Functional Abilities due to memory loss or brain fog

7. Have you felt significantly limited or unable to do any of the following due to MEMORY LOSS OR BRAIN FOG (including issues with attention, cognitive functioning, and awareness) specifically?

Severely

unable

Moderately

unable

Mildly

unable

Able

Not

applicable

Drive

Watch children

Cook or use hot items

Feed yourself

Shower or bathe regularly

Make serious decisions

Leave the house and return without getting lost

Remember the correct month or year

Have conversations with others

Maintain your medication schedule (forgetting to take medication or forgetting youve taken medication)

Work

Follow simple instructions

Communicate your thoughts and needs

Other:

_________

8. Optional: If you have other areas of your life that were affected by memory loss or brain fog, please include them here. Please note whether they were mildly, moderately, or severely limiting.

______________________________________

9. Optional: Please use this space to describe examples of your brain fog, memory loss, and attention span.

Please do not include any identifying information (such as name or location).

______________________________________


Personnel and Training Required

None

Equipment Needs

None

Requirements
Requirement CategoryRequired
Major equipment No
Specialized training No
Specialized requirements for biospecimen collection No
Average time of greater than 15 minutes in an unaffected individual No
Mode of Administration

Self-administered questionnaire

Lifestage

Adult, Senior

Participants

Adults suffering COVID-19 or suspected COVID-19 infection symptoms for longer than 1 week

Selection Rationale

The Memory module extracted from the Online Survey on Recovery from COVID-19 is brief and easy to interpret. This protocol is also available in a wide variety of languages.

Language

English, Other languages available at source

Standards
StandardNameIDSource
Derived Variables

None

Process and Review

Not applicable

Protocol Name from Source

Online Survey on Recovery from COVID-19

Source

Davis, H., Assaf, G., McCorkell, L., Wei, H., Low, R., Re'em, Y., & Akrami, A. (2021). Questionnaire to Characterize Long COVID: 200+ symptoms over 7 months (in 9 languages) (Version 4). figshare. https://doi.org/10.6084/m9.figshare.13642553.v4 (['http://patientresearchcovid19.com/']) 

General References

None

Protocol ID

992002

Variables
Export Variables
Variable Name Variable IDVariable DescriptiondbGaP Mapping
PX992002_Long_Covid_Symptoms_Memory_Brain_Fog
PX992002040000 Have you experienced issues with BRAIN FOG more
(inability to focus, think clearly, plan, process, understand, and maintain a coherent stream of thought; abnormally slow or fast thoughts) since the start of your COVID-19 illness? show less
N/A
PX992002_Long_Covid_Symptoms_Memory_Brain_Fog_Experience_Symptoms
PX992002060000 When did you experience these symptoms? more
Please mark symptoms for the first 4 weeks, then months (if you haven't yet reached a week/month, please leave it blank). Even if you have only experienced these symptoms for part of a week or month, please select it. Brain fog/cognitive functioning symptoms: show less
N/A
PX992002_Long_Covid_Symptoms_Memory_Brain_Fog_Symptoms
PX992002050000 Which of the following brain fog/cognitive more
functioning symptoms have you experienced since the start of your COVID-19 illness? show less
N/A
PX992002_Long_Covid_Symptoms_Memory_Examples_Brain_Fog
PX992002090000 Optional: Please use this space to describe more
examples of your brain fog, memory loss, and attention span. Please do not include any identifying information (such as name or location). show less
N/A
PX992002_Long_Covid_Symptoms_Memory_Experienced_Memory_Symptoms
PX992002020000 Which of the following memory symptoms have more
you experienced since the start of your COVID-19 illness? show less
N/A
PX992002_Long_Covid_Symptoms_Memory_Experienced_Memory_Symptoms_Other
PX992002020100 Which of the following memory symptoms have more
you experienced since the start of your COVID-19 illness? Other show less
N/A
PX992002_Long_Covid_Symptoms_Memory_Memory_Loss_Communcate
PX992002071300 Have you felt significantly limited or more
unable to do any of the following due to MEMORY LOSS OR BRAIN FOG (including issues with attention, cognitive functioning, and awareness) specifically? Communicate your thoughts and needs: show less
N/A
PX992002_Long_Covid_Symptoms_Memory_Memory_Loss_Conversations
PX992002070900 Have you felt significantly limited or more
unable to do any of the following due to MEMORY LOSS OR BRAIN FOG (including issues with attention, cognitive functioning, and awareness) specifically? Have conversations with others: show less
N/A
PX992002_Long_Covid_Symptoms_Memory_Memory_Loss_Cook_Hot_Items
PX992002070300 Have you felt significantly limited or more
unable to do any of the following due to MEMORY LOSS OR BRAIN FOG (including issues with attention, cognitive functioning, and awareness) specifically? Cook or use hot items: show less
N/A
PX992002_Long_Covid_Symptoms_Memory_Memory_Loss_Drive
PX992002070100 Have you felt significantly limited or more
unable to do any of the following due to MEMORY LOSS OR BRAIN FOG (including issues with attention, cognitive functioning, and awareness) specifically? Drive: show less
N/A
PX992002_Long_Covid_Symptoms_Memory_Memory_Loss_Feed_Yourself
PX992002070400 Have you felt significantly limited or more
unable to do any of the following due to MEMORY LOSS OR BRAIN FOG (including issues with attention, cognitive functioning, and awareness) specifically? Feed yourself: show less
N/A
PX992002_Long_Covid_Symptoms_Memory_Memory_Loss_Follow_Instructions
PX992002071200 Have you felt significantly limited or more
unable to do any of the following due to MEMORY LOSS OR BRAIN FOG (including issues with attention, cognitive functioning, and awareness) specifically? Follow Simple Instructions: show less
N/A
PX992002_Long_Covid_Symptoms_Memory_Memory_Loss_Leave_Return_House
PX992002070700 Have you felt significantly limited or more
unable to do any of the following due to MEMORY LOSS OR BRAIN FOG (including issues with attention, cognitive functioning, and awareness) specifically? Leave the house and return without getting lost: show less
N/A
PX992002_Long_Covid_Symptoms_Memory_Memory_Loss_Limited_Medication_Schedule
PX992002071000 Have you felt significantly limited or more
unable to do any of the following due to MEMORY LOSS OR BRAIN FOG (including issues with attention, cognitive functioning, and awareness) specifically? Maintain your schedule (forgetting to take medication or forgetting you've taken medication): show less
N/A
PX992002_Long_Covid_Symptoms_Memory_Memory_Loss_Make_Decisions
PX992002070600 Have you felt significantly limited or more
unable to do any of the following due to MEMORY LOSS OR BRAIN FOG (including issues with attention, cognitive functioning, and awareness) specifically? Make serious decisions: show less
N/A
PX992002_Long_Covid_Symptoms_Memory_Memory_Loss_Other
PX992002071400 Have you felt significantly limited or more
unable to do any of the following due to MEMORY LOSS OR BRAIN FOG (including issues with attention, cognitive functioning, and awareness) specifically? Other: show less
N/A
PX992002_Long_Covid_Symptoms_Memory_Memory_Loss_Other_Specify
PX992002071401 Have you felt significantly limited or more
unable to do any of the following due to MEMORY LOSS OR BRAIN FOG (including issues with attention, cognitive functioning, and awareness) specifically? Other. Please specify show less
N/A
PX992002_Long_Covid_Symptoms_Memory_Memory_Loss_Remember_Correct_Year_Month
PX992002070800 Have you felt significantly limited or more
unable to do any of the following due to MEMORY LOSS OR BRAIN FOG (including issues with attention, cognitive functioning, and awareness) specifically? Remember the correct month or year: show less
N/A
PX992002_Long_Covid_Symptoms_Memory_Memory_Loss_Shower_Bathe_Regularly
PX992002070500 Have you felt significantly limited or more
unable to do any of the following due to MEMORY LOSS OR BRAIN FOG (including issues with attention, cognitive functioning, and awareness) specifically? Shower or bathe regularly: show less
N/A
PX992002_Long_Covid_Symptoms_Memory_Memory_Loss_Watch_Children
PX992002070200 Have you felt significantly limited or more
unable to do any of the following due to MEMORY LOSS OR BRAIN FOG (including issues with attention, cognitive functioning, and awareness) specifically? Watch Children: show less
N/A
PX992002_Long_Covid_Symptoms_Memory_Memory_Loss_Work
PX992002071100 Have you felt significantly limited or more
unable to do any of the following due to MEMORY LOSS OR BRAIN FOG (including issues with attention, cognitive functioning, and awareness) specifically? Work: show less
N/A
PX992002_Long_Covid_Symptoms_Memory_Memory_Related_Symptoms
PX992002010000 Have you experienced any MEMORY RELATED more
SYMPTOMS since the start of your COVID-19 illness? show less
N/A
PX992002_Long_Covid_Symptoms_Memory_Other_Affected_Areas
PX992002080000 Optional: If you have other areas of your more
life that were affected by memory loss or brain fog, please include them here. Please note whether they were mildly, moderately, or severely limiting. show less
N/A
PX992002_Long_Covid_Symptoms_Memory_When_Experienced_Symptoms
PX992002030000 When did you experience these symptoms? more
Please mark symptoms for the first 4 weeks, then months (if applicable). Even if you have only experienced these symptoms for part of a week or month, please select it. Memory Symptoms: show less
N/A
Long COVID
Measure Name

Long COVID - Symptoms Due to COVID-19

Release Date

March 17, 2023

Definition

This is a measure of an individual’s new or continuing COVID-19 symptoms.

Purpose

Presence of lingering COVID-19 symptoms is a sign of Long COVID, and use of this measure helps with understanding people’s experience with COVID-19 and implications of Long COVID.

Keywords

University College London, UCL, COVID, long COVID, memory, cognitive function, brain fog, daily or function ability changes

Measure Protocols
Protocol ID Protocol Name
992001 Long COVID - Symptoms Due to COVID-19 - Screener
992002 Long COVID - Symptoms Due to COVID-19 - Memory
992003 Long COVID - Symptoms Due to COVID-19 - Neurology
992004 Long COVID - Symptoms Due to COVID-19 - Psychological Risk Factors
992005 Long COVID - Symptoms Due to COVID-19 - Speech, Language, and Hearing
992006 Long COVID - Symptoms Due to COVID-19 - Psychiatric (Short Form)
992007 Long COVID - Symptoms Due to COVID-19 - Psychiatric (Long Form)
992008 Long COVID - Symptoms Due to COVID-19 - Temperature Regulation and Cardiovascular
992009 Long COVID - Symptoms Due to COVID-19 - Cardiovascular Symptom Course
992010 Long COVID - Symptoms Due to COVID-19 - Respiratory
992011 Long COVID - Symptoms Due to COVID-19 - Gastrointestinal (Long Form)
992012 Long COVID - Symptoms Due to COVID-19 - Gastrointestinal (Short Form)
992013 Long COVID - Symptoms Due to COVID-19 - Allergies
992014 Long COVID - Symptoms Due to COVID-19 - Skin and Hair
992015 Long COVID - Symptoms Due to COVID-19 - Ocular (Long Form)
992016 Long COVID - Symptoms Due to COVID-19 - Ocular (Short Form)
992017 Long COVID - Symptoms Due to COVID-19 - Genitourinary
992018 Long COVID - Symptoms Due to COVID-19 - Muscle and Joint
992019 Long COVID - Symptoms Due to COVID-19 - Tooth Pain
992020 Long COVID - Symptoms Due to COVID-19 - Pediatric
Publications

There are no publications listed for this protocol.