# Resilience of Neural Networks Underlying the Stroop Effect in the Aftermath of Severe COVID-19: fMRI Pilot Study

## TL;DR

This study explores how the brain's neural networks respond to a cognitive task in people who had severe COVID-19, finding varied activation patterns despite normal task performance.

## Contribution

The study identifies distinct neural resilience profiles in post-severe-COVID-19 patients during a Stroop task, suggesting potential recovery indicators.

## Key findings

- Patients showed normal Stroop task performance despite varied brain activation patterns.
- Two distinct neural response profiles were observed in patients during the Stroop task.
- Activation patterns suggest different resilience profiles in post-severe-COVID-19 patients.

## Abstract

Background: Alterations in resting-state functional connectivity and in activation patterns elicited during cognitive tasks were reported in acute to chronic stages of mild, moderate and critical SARS-CoV-2 infection, suggesting the dysregulation of specialised neural networks. In this pilot study, we report on activation patterns elicited by the colour–word Stroop task in patients who suffered from severe COVID-19 requiring Intensive Care Unit hospitalisation but who had no prior or COVID-19-related brain damage. Methods: Neural activity elicited during a 16 min long colour–word Stroop task was investigated with 3T fMRI 9 months after severe SARS-CoV-2 infection in six patients and in twenty-four control subjects. Results: Patients’ performance in the Stroop task was within normal limits, with the exception of one (out of six) response time in one patient and one (out of six) accuracy measure in another patient. Activation elicited by the Stroop effect, i.e., the contrasting Incongruent vs. Congruent condition, differed between the first and second parts of the task. In controls, the Stroop effect yielded an increase in activity in prefrontal, cingulate and parieto-temporal clusters as well as in the nucleus accumbens during the first part, and the activity receded during the second part in most regions. Two distinct response profiles were found among patients: (i) a Stroop effect-linked increase during the first part followed by a partial decrease during the second part, as in healthy subjects; and (ii) a weak or absent Stroop effect increase during the first part followed by a partial increase during the second part. Conclusions: The normal performance presented by patients on the Stroop task was associated with two distinct activation patterns. They may represent different resilience profiles of the corresponding neural networks and be indicative of propensity for further recovery and/or susceptibility to therapeutic interventions.