Introduction

Over the past five centuries, pandemics have emerged approximately every 36 years¹. According to the World Health Organization (WHO), SARS-CoV-2 has become a global public health crisis²-⁴, with 701.168.995 million cases globally, including 110.309.712 in the United States and 6.387.145 in Colombia, with 143,110 registered deaths in this country⁵,⁶. Although the mortality rates have decreased, there is still a latent risk of reinfection⁷ and vulnerable and marginalized populations will be the most affected⁸,⁹.

Prison facilities with overcrowding issues and a lack of preventive measures have become a health risk in the face of SARS-CoV-2¹⁰,¹¹. In Colombia, 785 positive cases had been detected in prisons in the southwestern region¹²-¹⁴. The SARS-CoV-2 virus can affect the central and peripheral nervous system, with possible effects on cognitive health¹⁵-²⁰, increasing the risk of neurocognitive disorder in the domains of executive function, memory, and attention, in people with medical comorbidities and social vulnerabilities²¹.

Subjective complaints of cognitive impairment in prisoners are important for assessing neurocognitive disorders⁴,¹⁸,¹⁹, as they become a predictor of mild cognitive impairment (MCI) in the pre-dementia stages of Alzheimer’s disease, although they do not affect instrumental daily living skills²¹,²². However, the relationship between SARS-CoV-2 and cognitive impairment is not yet fully understood²³,²⁴, which warns of possible additional economic burdens on the social security system³, increasing morbidity and mortality²⁵,²⁶. Consequently, further studies are needed to understand the impact of the virus on inmates’ cognitive health²⁷.

Research method

This was descriptive and correlational cross-sectional study. The population consisted of adult males deprived of liberty in the southwestern region of Colombia. The sample consisted of 47 participants with a positive polymerase chain reaction (PCR) test who willingly agreed to participate in the study, having previously signed the informed consent, following the guidelines and ethical codes for individuals persons deprived of liberty (PDL).

Results

The sample was made up of 47 people (PDL) (Table 1). It is observed that, in all PDL, 97.9% presented a positive PCR test result; only one participant did not identify that he contracted the SARS-CoV-2 virus. In general, reference is made in this study to adult participants, with the highest percentage falling within a range of 31-50 years of age (48.9%) (Table 1).

The place of residence of 61.7% of the participants is the department of Valle del Cauca, Colombia, and 38.3% state a different place of origin, where 61.70 % are in urban areas. On the other hand, 78.9% have been in prison from 1 to 3 years, and in terms of occupation before entering prison, the majority were independent workers (66%); 55.3% lived with the nuclear family, 51.1% were single or divorced, and 74.5% had a basic primary and secondary education, while 23.40% of the PDL had technical and/or university education.

Medical comorbidities were present in 66% of the PDL (Table 2). 25.5% were found to be drug dependent; 34.04% reported smoking habits; 25.53% reported consumption of alcohol and 19.15% reported suicidal ideation or attempts. On the other hand, during the SARS-CoV-2 viral condition period, respiratory and sense organs problems were observed in 78.7% and gastrointestinal problems in 76.6% and neurological problems (headache, dizziness, confusion) in 70.2%, among others.

The MoCA test scores are presented in table 3, which shows that 76.6% of the participants obtained a normal score in cognitive processes, while 19.2% presented moderate cognitive impairment. According to the BANFE-2 executive functioning questionnaire behavioral scale (Table 3), normal executive functioning is evident in 68.1% and severe damage is found in 2.1% for the PDL surveyed.

Significant statistical differences were obtained between the diagnosis of SARS-CoV-2 and cognitive health in the total score of the MoCA test and the subjective perception of executive functioning of the BANFE-2 behavioral scale (Table 4). Positive associations can be observed (Table 4) that indicate an inversely proportional relationship between the variables. Thus, values directly related to the total MoCA score are identified in the orientation category, which is inversely related to common cold (−0.255) and respiratory symptoms (−0.255); with the sense organs category variable (−0.294) and gastrointestinal category variable (−0.356). As for the MoCA abstraction category variable, it is inversely related (−0.319).

Discussion

The purpose of this research was to evaluate the possible effects of SARS-CoV-2 on cognitive health and the subjective perception of executive function, with particular emphasis on incarcerated adults, as a contextual factor that intervenes in this relationship. Emerging scientific research has suggested a close correlation between SARS-CoV-2 and neurodegenerative disorders. However, it is unknown whether a causal association exists, and the direction of the cognitive effect remains uncertain³¹. The SARSCoV-2 disease pandemic imposed an unprecedented lifestyle dominated by social isolation.

The PDL were considered one of the highest risk groups in the coronavirus pandemic, in part, due to the unfavorable conditions they experienced before their detention, such as social segregation, poverty, marginalization and exclusion, as well as punitive criminal policies that favored overcrowding⁵,⁹. These conditions imposed significant challenges in the management of prison guidelines to reduce the spread of the virus, following WHO recommendations⁵. All these particularities had repercussions on the PDL, since, given the probability of being infected, they were isolated from other inmates, and visits from judicial defenders, family, and friends were restricted, which possibly worsened the cognitive and behavioral awareness of people in quarantine³². As a result, a was low participation of PDL was evident, since, of 118 people with positive PCR test results, only 47 agreed to participate in this study; the rest indicated that the PCR test was negative despite the statistics reporting otherwise, and therefore, reason for which they did not participate in the investigation. Various investigations suggest the existence of biases and sample reduction because respondents may lie on their answers, especially in studies that address viral diseases, addictions to psychoactive substances, and when examinees are exposed to different surveyors³³. This bias is also reflected in this investigation, where 61.7% of those surveyed affirmed that they did not have smoking habits, 74.5% stated that they did not have alcoholism and 25.5% asserted that they were drug dependent. These data do not contrast with the reality of medium-security penitentiary and prison institutions (National Penitentiary and Prison Institute - INPEC, as per its acronym in Spanish) in the western region. In this sense, the national government allocates a large budget to strengthen the program of attention to the consumption of psychoactive substances in PDL, under the responsibility of the INPEC at the national level, according to official data from this public institution³².

The results of this study confirm that there is no long-term alteration of cognitive functions and the subjective perception of executive functioning, three months late after SARS-CoV-2 infection in adults deprived of liberty who did not experience serious medical complications, such as admission to the Intensive Care Unit without mechanical ventilation, critical respiratory conditions, or sedation, and were not associated with the aging factor.

These findings are consistent with the research of Stawicki et al. (2020), who stated that the majority of young adults who presented SARS-CoV-2 with febrile symptoms, fatigue, myalgia and dyspnea without medical complications, evolving towards a mild to moderate flu-like illness resolved approximately in the 1^st weeks without cognitive sequelae⁵. These data are also consistent with this investigation in that the sample ranged from 31 to 55 years of age, being adults who have been in prison 1-3 years on average (78.9%). Following the same psychometric line in this study, a negative association was found between the MoCA orientation variables and the common cold (−0.255), respiratory (−0.255), sense organs (−0.294), and gastrointestinal (−0.356) categories symptoms, as well as in the MoCA abstraction variable, where an inverse relationship was found (−0.319).

These SARS-CoV-2 symptoms are consistent with the prevalent data in scientific investigations that affirm the presence of systemic, pulmonary, and gastrointestinal symptoms, the latter being more frequent in the diagnosis of the disease¹⁶ and when these symptoms are combined with cognitive health³⁴, they have indicated that there is no cognitive deterioration and that, in addition, they are in line with this research because they affirm that, 67 % of a French sample did not present impairment in executive function, nor failures in attentional processes only the remaining 33% who presented executive functioning deficits after overcoming the SARS-CoV-2 disease³⁵.

In a retrospective study, a low incidence of 8.6% of neurological symptoms was identified in a cohort of 360 Mexican patients who contracted the virus²⁶. In a peer-reviewed meta-analysis with a sample of 3,559 confirmed SARS-CoV-2 cases from several countries of the world, no systematized neuropsychological evaluations that could account for neurological failures were included, so a clear causal link could not be established³⁵. Another neurobiological study has demonstrated that, the symptomatology of mild SARS-CoV2 does not cross the blood-brain barrier in patients, which does not predict any possible central nervous system involvement³⁶. A relevant piece of information that could influence adequate cognitive functioning is the higher number of education years, which allows greater cognitive reserve³⁷. In the present sample, it was found that 74.47% of the participants had secondary education training, which could have been achieved through the training and stimulation provided by the intramural rehabilitation programs of the penitentiary centers and the productive projects run by the National Learning Service (SENA, as per its acronym in Spanish). In addition, there are other non-formal education programs aimed at the INPEC’s self-sufficiency, such as those related to work, teaching, and artistic activities, all of them supported by the fundamental right to education in Colombia and the national penitentiary treatment process³².

Neuropsychology literature explains that the maintenance of educational content and acquired skills requires constant stimulation and practice to be preserved and maintained over time; otherwise, they could deteriorate substantially. Therefore, changes in the social, cultural, educational, and non-formal education contexts can positively influence performance on cognitive scales or standardized neuropsychological tests²⁸,³⁸.

Conclusion

This study confirms that SARS-CoV-2 infection does not show evidence of nervous system involvement in adults who had not experienced severe symptoms or required hospitalization at second and third level healthcare centers for virus-related symptoms. Therefore, possible long-term effects would not be generated. According to reported medical and scientific literature, it has been demonstrated that the presence of mild SARS-CoV-2 signs and symptoms for example, such as a common cold, does not indicate an impact on the central nervous system and, nor in cognitive health. In this study, it was identified that the majority of the examined participants had a normal range score on both tests. The values obtained from the scores showed negative associations, indicating an inverse proportional relationship between the variables. Although, the data from this research cannot be generalized due to the reduced sample of the PDL.