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. 2023 Dec;20(6):495–504. doi: 10.36131/cnfioritieditore20230604

The Hidden Impact of Covid-19 on Memory: Disclosing Subjective Complaints

Graziella Orrù 1,✉, Angelo Gemignani 1, Enrico Cipriani 1, Mario Miccoli 2, Rebecca Ciacchini 1, Cristiana Cancemi 1, Danilo Menicucci 1, Carmen Berrocal Montiel 1, Andrea Piarulli 1, Ciro Conversano 1
PMCID: PMC10852411  PMID: 38344466

Abstract

Objective

A significant body of research has suggested that the contraction of SARS-CoV-2 may cause memory impairment, even in the months following recovery. In this regard, studies suggest that COVID-19 predominantly targets structures and cortices within the temporal lobe, and the hippocampus, a critical brain structure for memory and spatial navigation.

The purpose of this study was to investigate the potential impact of the COVID-19 pandemic on subjective memory complaints, which represent an individual’s perception of subtle changes in memory in the absence of an objective memory impairment.

Method

to explore how the COVID-19 pandemic may affect subjective memory complaints, we incorporated ad hoc self-reported measures of subjective memory complaints, the "Subjective Memory Complaints Questionnaire" (SMCQ) and the "Prospective and Retrospective Memory Questionnaire" (PRMQ), in our cross-sectional study. Both measures referred to two periods: the pre-pandemic period (T0) and the moment of survey administration (T1) (December 28th, 2021, to February 6th, 2022).

Results

207 Italian participants accessed the survey, out of which 189 participants were included in the final sample. The majority of the participants were females, and their age ranged from 55 to 65 years. The study revealed a significant increase in the total PRMQ score at T1 compared to T0 (p = 0.02). However, no significant differences were found between PRMQ and SMCQ scores of COVID-19-negative individuals and those who tested positive for COVID-19 in the last 12 months from the date of completing the survey. McNemar's test showed a statistically significant increase in the score of item 1 (“Do you think that you have a memory problem?” (p = 0.016) and item 10 (“Do you lose objects more often than you did previously”) (0.019) of the SMCQ, while for the PRMQ, significant increases were found in several individual items.

Conclusions

our study suggests that subjective memory complaints increased during the pandemic, potentially due to the compound effects of stress and social isolation, rather than solely due to COVID-19 infection. Although a marginal association between COVID-19 and reported prospective memory issues was detected, further investigation is warranted to understand its persistent effects.

Keywords: subjective memory complaints, memory complaints, memory loss, prospective and retrospective memory, PMRQ, COVID-19

Introduction

In the last few years, people worldwide have been exposed to the continual impact of the COVID-19 pandemic caused by the SARS-CoV-2 virus. When the condition was first identified towards the end of 2019, the illness was primarily classified as a respiratory syndrome, with symptoms that significantly affected the respiratory system (Ciotti et al., 2020). As the body of literature on the topic continues to develop, it has become increasingly clear that the virus infiltrates and significantly affects a wide range of organs and systems. Various complications, including cardiovascular, renal, gastroepatic, thromboembolic, cerebrovascular, and neurological complications have been identified (Ferrucci et al., 2021; Orrù et al., 2021a; Ritchie et al., 2020; Ye et al., 2020). Furthermore, there is substantial evidence indicating that individuals who have contracted the virus may experience symptoms that persist after the initial illness and during their post-recovery phase. This has resulted in the widespread recognition of the concept of “Long Covid Syndrome” (Crook et al., 2021; Garg et al., 2021; Orrù et al., 2021b). As known, the impact of a disease on the psychological individuals’ system exponentially increases the risk of damage (both in terms of physical and mental illness) the more the consequences are widespread and potentially chronic (Bourmistrova et al., 2022; Higgins et al., 2021; Orrù et al., 2020a; Dell’Osso et al., 2015; Piccinni et al., 2012; Dell’Osso et al., 2011; Marazziti et al., 2008; Vita et al., 2020; Martino et al., 2021; Conversano & Di Giuseppe, 2021; Orrù et al., 2020b). Psychological aspects of the Covid-19 pandemic should also be considered, given the significant psychosocial impact on the entire world population, in all age groups, both for patients and healthcare professionals dealing with difficult working and communication conditions (Lenzo et al., 2021; Sharifi et al., 2021; Raudenská et al., 2020; Muratori & Ciacchini, 2020; Iasevoli et al., 2012). Knowing the long-term effects of the disease would allow researchers in the health and psychological fields to intervene with punctual and innovative techniques (Linnhoff et al., 2022; Wells et al., 2021; Orrù et al., 2020b; Mazza et al., 2020).

The SARS-CoV-2 has the potential to enter the brain through various “neuroinvasion pathways” (Bougakov et al., 2021; Orrù et al., 2020b), including the olfactory nerve (Mahalakshmi et al., 2021). Once the virus enters through this pathway, it can spread to the entorhinal cortex and adjacent structures within the temporal lobe, bypassing the blood-brain barrier; the barrier's compromised state may be due to systemic inflammation (Welcome & Mastorakis, 2021). The pathogen may affect the central nervous system through secondary mechanisms, such as blood clotting that can cause a stroke (Hess et al., 2020; Spence et al., 2020), hypoxia resulting from respiratory failure, or damage to white matter damage and encephalopathy caused by an abnormal immune response (Garg et al., 2021). Studies suggest that COVID-19 predominantly targets structures and cortices within the temporal lobe (Kremer et al., 2020; Ritchie et al., 2020). Animal studies and human neuroimaging studies have also revealed that the hippocampus, a critical brain structure for memory and spatial navigation, is particularly vulnerable (Soung et al., 2022). SARS-CoV-2, like other coronavirus, can elicit a variety of acute neurological symptoms. These symptoms include loss of sense of smell and taste (anosmia and ageusia, respectively), dizziness, headaches, temporary cognitive dysfunction, seizures, loss of consciousness, and strokes (Collantes et al., 2021; Orrù et al., 2020b; Sharifian-Dorche et al., 2020). In regard to the neuropsychological domains, studies have also shown that patients may experience impairments in memory, attention, executive functions, verbal fluency, and paresthesias (Daroische et al., 2021; Fiorenzato et al., 2021).

A significant body of research has suggested that the contraction of SARS-CoV-2 may cause memory impairment, even in the months following recovery (Ahmed et al., 2022; Keijsers et al., 2022; Rogers et al., 2020; Søraas et al., 2021). This effect appears to be more pronounced in patients who have been hospitalized or have had a particularly severe infection (Hampshire et al., 2021), or those who have experienced a longer-than-average recovery period (Ahmed et al., 2022). However, it is important to note that this impairment in memory functions may not necessarily be due solely to the viral infection. Measures such as lockdowns, social distancing, and pandemic anxiety as well as the possibility of grief, may have contributed to a decrease in cognitive functioning through a significant increase in stress and its negative psychophysiological effects (Liston et al., 2009). Indeed, high levels of stress have been shown to dysregulate the HPA axis, which can negatively affect working memory (WM) and information recall (Qin et al., 2009).

Beside these factors, there have been numerous accounts of individuals experiencing a subjective distortion of time perception during the pandemic. Italian young adults, in particular, have reported this phenomenon to be associated with a decline in sleep quality, as well as increased levels of anxiety and depression (Cellini et al., 2020). This temporal distortion has also been linked to a decrease in prospective memory (PM) functioning, which plays a role in the perception of time (Pisano et al., 2021). Moreover, the psychological complications emerging from the prevalent state of social isolation as a result of the pandemic should not be disregarded or underestimated. Social interaction is a key factor in human welfare, whereas social isolation can act as powerful stressor. The latter has been linked to a compromised immune functioning, heightened susceptibility to cardiovascular disease, endocrine dysregulation, and alterations in hippocampal plasticity, all of which are linked to memory deterioration (Cacioppo & Cacioppo, 2014). In this context, recent research has established a strong association between lockdown isolation due to lockdowns and impairments in memory and executive functioning (Ingram et al., 2021). Particularly, it has been shown a notable correlation between difficulties in memory and the experience of quarantine or self-isolation (i.e., Santangelo et al., 2021).

Lockdowns and quarantines not only affect cognitive functioning due to extended social isolation but had a significant impact on mental health and psychological distress (Di Giuseppe et al., 2020). Depressive symptoms have been detected in individuals who recovered from the infection, as well as those who never infected (Mazza et al., 2022; Vindegaard & Benros, 2020). Similarly, a global increase in symptoms of anxiety disorders (Chen et al., 2020), post-traumatic stress disorder (PTSD) (Chamaa et al., 2021), insomnia (Xu et al., 2022), obsessive compulsive disorder (OCD) (Guzick et al., 2021), has been reported. Reduction in hippocampal volume and episodic memory impairment were consistently associated with both depression and insomnia (Sheline et al., 2002) (Riemann et al., 2009). PTSD diagnoses are often linked to memory impairments and are both a consequence and a risk factor for the disorder itself (Cardenas et al., 2011). Considering this body of literature, our retrospective study aims to investigate pandemic–related differences in memory impairments in the general population through a subjective/self-reported approach. The rationale for this choice is that subjective memory complaints are linked to actual memory loss and neurological damage (Mitchell, 2008; Mitchell et al., 2014). Moreover, using self-reported tools allows for mass screening of memory complaints in the population due to their ease of implementation through survey. If a link between subjective complaints and COVID-19 infection is found, self-reported measures may be of used to screen for possible infection complications. While subjective memory complaints in COVID-19 infection were already examined in previous research (Andersson et al., 2022; Feter et al., 2021; Søraas et al., 2021), only one employed a validated self-reported psychometric measure (Llana et al., 2023), and none of them investigated prospective memory. Thus, we plan to administer self-reported psychometric measures of everyday memory difficulties via an online survey. Specifically, we aimed at assessing the subjective memory complaints (SMCs), which represent an individual’s perception of subtle changes in memory in the absence of an objective memory impairment (Steinberg et al., 2013).

Methods

Inclusion criteria and recruitment strategy

To be eligible for this research, participants needed to provide informed consent and be at least 18 years old. Participants were recruited by sharing the survey link on social media and message boards targeting students and faculty members of the University of Pisa, Italy. Prior to conducting the study, we used G*Power ver. 3.1 to calculate that a sample size of approximately 200 participants would allow us to detect moderate significant differences between test scores with sufficient statistical power (dz = 0.20; 1 – β = 0.80).

Materials

To explore how the COVID-19 pandemic may affect subjective memory complaints (SMCs), we incorporated ad hoc questionnaire items, as well as two self-reported measures of SMCs, namely the “Subjective Memory Complaints Questionnaire” (SMCQ; Youn et al., 2009), and the “Prospective and Retrospective Memory Questionnaire” (PRMQ; Smith et al., 2000), into our survey.

Subjective (SMCQ) Memory Complaints Questionnaire

The SMCQ is a self-reported psychometric questionnaire consisting of 14 yes/no questions referring to commonly reported SMCs (Youn et al., 2009). As there was no validated Italian language version is available, we conducted a back translation of the questionnaire with the authorization of the original authors. The back-translation process consisted of three steps: first, two Italian translations of the test were produced by the authors (IT1, CC; IT2, EC), which were combined into a single translation after resolving discrepancies (IT12). Then, two independent native English speakers translated IT12 back to Italian. Finally, a definitive English translation was performed by one of the authors (GO) after reconciling the last discrepancies, which was implemented in the questionnaire. The Cronbach’s α value was 0.76 at T0, and 0.81 at T1. The fully back-translated questionnaire can be found in the supplementary materials.

Prospective Questionnaire and (PRMQ) Retrospective Memory

The PRMQ is a self-reported psychometric questionnaire consisting of 16 items rated on a 5-point Likert scale ranging from “Very often” to “Never” (Crawford et al., 2003). A high score on the questionnaire indicates a subjective impairment of memory functioning. This instrument measures common everyday memory failures that involve prospective (eight items) and retrospective (eight items) memory processes. In our study, we employed the Italian version of the questionnaire developed by Smith and colleagues (Smith et al., 2000). The Cronbach’s α value was 0.95 at T0 and 0.96 at T1.

Study Procedure

Participants were directed to the Google Forms platform through a survey link, where they were asked to provide their informed consent for the study and the handling of sensitive data. The survey was open for a total of 41 days, from December 28th, 2021, to February 6th, 2022. Upon giving their consent, participants were assigned a unique identification number for anonymity purposes. The protocol of the present study was reviewed and approved by the Bioethics Committee of the University of Pisa.

The survey consisted of nine sections and required approximately 15 minutes to complete:

  1. Title page: this section served as the introduction to the survey and contained information about the survey’s purpose.

  2. Informed consent form: participants were provided with a detailed description of the study’s content and purpose, as well as other relevant information, and a form to gather informed consent.

  3. Declaration of legal age: participants were required to declare whether they were aged 18 years or older in order to proceed with the survey.

  4. Demographic information: this section included questions about gender identification, age, education, family status, cohabitation status, and the nation or region where participants were currently residing.

  5. Employment status: participants were asked about their employment status and weekly hours spent working.

  6. SMCQ administration: participants were asked to fill out the SMCQ twice. First, they were asked to recall the time before the pandemic (T0 = Fall of 2019), then they were asked to answer the questionnaire referring to the present moment (T1).

  7. PRMQ administration: similar to the SMCQ, participants were asked to fill out the PRMQ twice. First, they were asked to refer to the time before the pandemic (T0 = Fall of 2019), then they were asked to refer to the present moment (T1) (time of completing the survey).

Upon completing the survey, participants were provided with an empty text box where they could include any further details or feedbacks, they deemed appropriate.

Data Analysis

Data analysis was performed using R 4.0.3 and XLSTAT software (Addinsoft Inc, New York) in Microsoft Excel for Mac (ver. 16.69). Demographic characteristics are presented as number (n) of participants and relative frequency (percentage; %). To compare the scores between the pre-pandemic status (T0), and the status at survey completion (T1), we used the Wilcoxon sign-rank test for total scores, the McNemar test for item-wise SMCQ scores, and the Wilcoxon sign-rank test for item-wise PRMQ scores. Moreover, we performed a Mann-Whitney U test to compare the differences (delta, Δ) in PMRQ scores and SMCQ scores from T0 to T1, between negative participants and participants positive at the time of the survey, and between negative participants and those that reported being positive in the last 12 months.

Ethical Approval

All procedures followed the ethical standards. The protocol of the present study was reviewed and approved by the Ethics Committee of the University of Pisa (Protocol number: 16436).

Results

Participants

A total of 207 participants accessed our survey. Fifteen of them declined to provide informed consent and 3 reported being under 18 years old, thus, making them ineligible for the study. Our final sample consisted of 189 participants, 136 of whom were females (72%), while 2 (1%) preferred not to disclose their gender identity. The majority of participants aged between 55 and 65 years old (19%). All participants were Italian citizen. Table 1 presents a summary of demographic statistics of the sample.

Table 1.

Summary of demographic variables of the sample

Demographics n (% of sample)
Age (years)
18-24 28 (15%)
25-34 23 (12%)
35-44 18 (10%)
45-54 53 (28%)
55-65 54 (29%)
> 65 13 (7%)
Gender
Male 51 (27%)
Female 136 (72%)
Other 2 (1%)
Education (Years)
8 5 (3%)
13 94 (50%)
16 24 (13%)
18 46 (24%)
21 20 (11%)
Covid-19 positivity in the last 12 months
Yes 31 (16%)
No 146 (77%)
Doesn’t know 12 (6%)
Covid-19 positive at the time of completing the survey
Yes 14 (7%)
No 163 (86%)
Doesn’t know 12 (6%)
Vaccine received
Yes 186 (98%)
No 2 (1%)
Not yet 1 (1%)
No. of doses received
No doses 3 (2%)
1 dose 8 (4%)
2 doses 68 (36%)
3 doses 110 (58%)
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Differences in reported PRMQ and SMCQ scores from pre-pandemic to survey administration.

We employed a Wilcoxon Sign Rank test to investigate the differences in total SMCQ scores referred to the pre-pandemic period (T0) and the moment of survey administration (T1) reported values. The analysis reveals that there is an increase in total score between T0 and T1, approaching the significance level (V = 636.5; mT0 (SD) = 2.61(2.48); mT1 (SD) = 2.84 (2.81); p = 0.056). ✝Similarly, we employed a Wilcoxon sign-rank test to examine the differences between pre-pandemic (T0) and survey moment (T1) PRMQ scores. The results indicate a significant increase of the total PRMQ score at t1 (V = 4115; mT0 (SD) = 31.77 (11.69); mT1 (SD) = 33.70 (13.49); p = 0.02*).

Differences between COVID-19 negative individuals, currently positive individuals, and those who positive in the last 12 months.

To examine differences in PRMQ and SMCQ scores between individuals who reported never testing positive for COVID-19, those who tested positive at least once in the last 12 months, and those who were positive at the moment of survey administration, we calculated the differences (delta, Δ) between pre-pandemic (T0) and survey time (T1) in the PRMQ and SMCQ scores in the three groups (negatives: n = 146, positives: n = 31, presently positives: n = 14). We then performed a Mann-Whitney U test for independent samples.

The results showed no statistically significant difference in PRMQ scores between the negative and positive individuals at the time of completing the survey (U = 1295; p = 0.72). However, there was an approaching significance difference between the negatives and positives group in the last year (U = 1921; Median T0 (IQR) = 0 (-2–2); Median T1 (IQR) = 1(0.5–6); p = 0.056). ✝

For SMCQ scores, no statistically significant difference was detected between negatives and positives at the time of the survey (U = 1407,5; p = 0.26), and the negatives and positives group in the last 12 months (U = 2640; p = 0.402).

Item-wise differences in reported SMCQ scores from before the pandemic, to the survey moment

We performed a McNemar’s test determine the differences for each individual item. The results indicate that there is a statistically significant increase in the score of item 1 (“Do you think that you have a memory problem?”; Q = 5.818; p = 0.016, %Yes at T0 = 19.6%, %Yes at T1 = 24.3%) and item 10 (“Do you lose objects more often than you did previously?” Q = 5.5; p = 0.019, %Yes at T0 = 26.4%, %Yes at T1 = 32.8%), while the remaining items did not show any statistically significant difference. A summary of item-wise differences in SMCQ score is displayed in table 2.

Table 2.

Item-wise McNemar test for SMCQ scores (T1-T0; n = 189).

Item No. English Text Italian Text Q %Yes T0 %Yes T1 p Value
1 “Do you think that you have a memory problem?” “Pensa di avere un problema di memoria?” 5.818 19.6% 24.3% 0.016*
2 “Do you think that your memory is worse than 10 years ago?” “Pensa che la sua memoria sia peggiore rispetto a 10 anni fa?” 1.563 56.6% 59.8% 0.211
3 “Do you think that your memory is poorer than that of other people of a similar age?” “Pensa che la sua memoria sia peggiore rispetto a quella delle persone con un’età simile alla sua?” 0.083 15.9% 15.9% 0.773
4 “Do you feel that your everyday life is difficult due to memory decline?” “Sente che la sua vita quotidiana sia difficoltosa a causa del declino della memoria?” 3.125 6.9% 10% 0.077
5 “Do you have difficulty in remembering a recent event?” “Ha difficoltà nel ricordare un evento recente?” 0.444 8.5% 10% 0.505
6 “Do you have difficulty in remembering a con-versation from a few days ago?” “Ha difficoltà nel ricordare una conversazione di qualche giorno fa?” 0.125 13.2% 14.3% 0.724
7 “Do you have difficulty in remembering an appointment made a few days ago?” “Ha difficoltà nel ricordare un appuntamento preso qualche giorno fa?” 0.063 18.5% 17.5% 0.803
8 “Do you have difficulty in recognizing familiar people?” “Ha difficoltà nel riconoscere persone familiari?” 0 0% 0.5% 1.000
9 “Do you have difficulty in remembering where you placed objects?” “Ha difficoltà nel ricordare dove ha messo degli oggetti?” 0.063 38.1% 38.1% 0.803
10 “Do you lose objects more often than you did previously?” “Smarrisce oggetti più frequentemente rispetto a una volta?” 5.500 26.4% 32.8% 0.019*
11 “Have you become lost near your home?” “Si è perso nei pressi della sua casa?” NA 0% 0% NA
12 “Do you have difficulty in remembering 2 or 3 items to buy when shopping?” “Ha difficoltà nel ricordare due o tre articoli da comprare quando fa la spesa?” 0.900 28.6% 30.7% 0.343
13 “Do you have difficulty in remembering to turn off the gas or lights?” “Ha difficoltà nel ricordarsi di spegnere il gas o la luce?” 0.250 4.2% 5.3% 0.617
14 “Do you have difficulty in remembering the phone numbers of your own children?” “Ha difficoltà nel ricordarsi i numeri di telefono dei suoi figli? 0 24.9% 24.3% 1.000
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Notes: The table displays English and Italian test for each item, as well as test statistics (Q), percentages of individuals answering “Yes” at T0 and T1, and p values. We could not compute differences for item 11 due to every participant giving the same answer. *: p ≤ 0.05.

Item-wise differences in reported PRMQ scores from before the pandemic, to the survey moment

We conducted a single-item analysis of PRMQ and found significant increases in scores for most of the items. In the retrospective scale: item 2 (“Do you fail to recognise a place you have visited before?”; V = 273; mT0 (SD) = 1.66 (0.78); mT1 (SD) =1.76 (0.83); p = 0.008); item 6 (“Do you fail to recognise a character in a radio or television show from scene to scene?”; V = 310; mT0 (SD) = 1.64 (0.86); mT1 (SD) =1.79 (0.94); p = 0.001); item 08 (“Do you fail to recall things that have happened to you in the last few days?”; V = 189; mT0 (SD) = 1.69 (0.88); mT1 (SD) = 1.92 (1.03); p < 0.001); item 11 (“Do you mislay something that you have just put down, like a magazine or glasses?”; V = 496; mT0 (SD) = 2.23 (1.06); mT1 (SD) = 2.36 (1.14); p = 0.013); item 13 (“Do you look at something without realizing you have seen it moments before?”; V = 441; mT0 (SD) = 1.70 (1.82); mT1 (SD) = 1.82 (1.01); p = 0.014); and item 15 (“Do you forget what you watched on television the previous day?”; V = 323; mT0 (SD) = 1.80 (0.92); mT1 (SD) = 1.95 (0.97); p = 0.004).

In the prospective scale: item 3 (“Do you fail to do something you were supposed to do a few minutes later even though it's there in front of you, like take a pill or turn off the kettle?”; V = 416; mT0 (SD) = 1.94 (0.95); mT1 (SD) = 2.07 (1.03); p = 0.004); item 7 (“Do you forget to buy something you planned to buy, like a birthday card, even when you see the shop?”; V = 623; mT0 (SD) = 1.97 (0.97); mT1 (SD) = 2.14 (1.02); p = 0.003); item 10 (“Do you intend to take something with you, before leaving a room or going out, but minutes later leave it behind, even though it’s there in front of you?”; V = 661; mT0 (SD) = 2.18 (1.02); mT1 (SD) = 2.36 (1.13); p = 0.003); item 12 (“Do you fail to mention or give something to a visitor that you were asked to pass on?”; V = 600; mT0 (SD) = 2.05 (0.95); mT1 (SD) = 2.20 (1.06); p = 0.008**); and item 14 (“If you tried to contact a friend or relative who was out, would you forget to try again later?”; V = 417.5; mT0 (SD) = 2.05 (0.95); mT1 (SD) = 2.21 (1.07); p = 0.002).

However, no statistically significance difference was found for items 1, 4, 5, 9, and 16. Table 3 shows a summary of item-wise differences in PRMQ scores.

Table 3.

Item-wise Wilcoxon’s sign rank test for PRMQ scores (T1-T0; n = 189)

Item No. English Text Italian Text V M T0 (IQR) M T1 (IQR) m T0 (SD) m T1 (SD) p Value P/R
1 “Do you decide to do some- thing in a few minutes' time and then forget to do it?” “Si dimentica di fare qualcosa che aveva deciso di fare pochi minuti prima?” 1779 3 (2–3) 2 (1–3) 2.41 (0.96) 2.32 (1.04) 0.126 P
2 “Do you fail to recognise a place you have visited before?” “Non riesce a riconoscere un luogo che aveva visitato in precedenza?” 273 1 (1–2) 2 (1–2) 1.66 (0.78) 1.76 (0.83) 0.008** R
3 “Do you fail to do something you were supposed to do a few minutes later even though it's there in front of you, like take a pill or turn off the kettle?” “Non fa qualcosa che ha programmato di fare qualche minuto più̀ tardi anche se è di fronte a Lei. Per esempio, prendere una pillola o spegnere il fuoco?” 416.5 2 (1–3) 2 (1–3) 1.94 (0.95) 2.07 (1.03) 0.004** P
4 “Do you forget something that you were told a few minutes before?” “Si dimentica di fare qualcosa che le era stato detto di fare qualche minuto prima?” 965.5 2 (1–3) 2 (1–3) 2.15 (1.05) 2.21 (1.04) 0.344 R
5 “Do you forget appoint- ments if you are not prompted by someone else or by a reminder such as a calendar or diary?” “Si dimentica appuntamenti a meno che non le siano ricor- dati da qualcuno o qualcosa. Per esempio il calendario o l’agenda?” 673 2 (1–3) 2 (1–3) 2.13 (1.07) 2.50 (1.16) 0.059† P
6 “Do you fail to recognise a character in a radio or television show from scene to scene?” “Le succede di non ricon- oscere un personaggio alla radio o alla televisione tra una scena e l’altra?” 310 1 (1–2) 1 (1–2) 1.64 (0.86) 1.79 (0.94) 0.001*** R
7 “Do you forget to buy some- thing you planned to buy, like a birthday card, even when you see the shop?” “Si dimentica di comprare qualcosa che aveva inten- zione di comprare, anche quando vede il negozio?2 623 1 (1–3) 2 (1–3) 1.97 (0.97) 2.14 (1.02) 0.003** P
8 “Do you fail to recall things that have happened to you in the last few days?” “Non riesce a ricordare cose che le sono accadute negli ultimi giorni?” 340 1 (1–2) 2 (1–3) 1.69 (0.88) 1.92 (1.03) < 0.001*** R
9 “Do you repeat the same story to the same person on different occasions?” “Le capita di ripetere lo stesso racconto alla stessa persona in una diversa occasione?” 549.5 2 (1–3) 2 (1–3) 2.05 (1.04) 2.14 (1.13) 0.077 R
10 “Do you intend to take something with you, before leaving a room or going out, but minutes later leave it behind, even though it’s there in front of you?” “Ha intenzione di prendere qualcosa con lei prima di lasciare una stanza o di uscire di casa ma pochi minuti dopo lo dimentica anche se è di fronte a lei?” 661 2 (1–3) 2 (1–3) 2.18 (1.02) 2.36 (1.13) 0.003** P
11 “Do you mislay something that you have just put down, like a magazine or glasses?” “Smarrisce cose che aveva appena posato come riviste o occhiali?” 496 2 (1–3) 2 (1–3) 2.23 (1.06) 2.36 (1.14) 0.013* R
12 “Do you fail to mention or give something to a visitor that you were asked to pass on?” “Si dimentica di menzionare o dare qualcosa a qualcuno che le viene a far visita?” 600 2 (1–3) 2 (1–3) 2.05 (0.95) 2.20 (1.06) 0.008** P
13 “Do you look at something without realising you have seen it moments before?” “Le capita di guardare qualcosa senza rendersi conto che l’aveva vista pochi momenti prima?” 441 1 (1–2) 1 (1–2) 1.70 (1.82) 1.82 (1.01) 0.014* R
14 “If you tried to contact a friend or relative who was out, would you forget to try again later?” “Se ha provato a contattare un amico/a o un parente senza riuscirci, si dimentica poi di riprovare più tardi?” 417.5 2 (1–3) 2 (1–3) 2.05 (0.95) 2.21 (1.07) 0.002** P
15 “Do you forget what you watched on television the previous day?” “Si dimentica cosa ha visto alla televisione il giorno prec- edente?” 323 2 (1–2) 2 (1–3) 1.80 (0.92) 1.95 (0.97) 0.004** R
16 “Do you forget to tell someone something you had meant to mention a few minutes ago?” “Si dimentica di dire a qualcuno ciò che solo pochi minuti prima aveva intenzi-one di comunicargli?” 794 2 (1–3) 2 (1–3) 2.11 (0.96) 2.20 (1.10) 0.084 P
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The table displays the English and the Italian version of the questionnaire item by item, as well as test statistics (V), medians (M) and interquartile ranges (IQR) for T0 and T1, means (m) and standard deviations (SD) for T0 and T1, and p values. Items belonging to the prospective scale are marked with a “P”, while those belonging to the retrospective scale are marked with a “R”. *: p ≤ 0.05 ** p ≤ 0.10 †: Value approaching significance.

Discussion and limitations

Our findings indicate that participants reported significant differences in both PRMQ (p < .001) and almost significant SMCQ scores from the pre-pandemic period to the time of answering the survey. Interestingly, individuals reported more subjective memory impairments at the time of answering the survey rather than the period referred to the pandemic. No differences in scores were observed between individuals who tested negative for COVID-19 and those who had tested positive at the time of completing the survey, suggesting that COVID-19 infection alone may not account for the increase in subjective memory complaints. Instead, it is possible that the compound effects of pandemic-related stress and social isolation due to lockdowns and social distancing may be responsible for this increase.

We observed a slight difference in PRMQ scores between individuals who tested negative at the time of completing the survey and those who tested positive for COVID-19 within the past twelve months, which was almost statistically significant (p = 0.56). Although this result was marginal, it suggests the possibility of a persistent effect or long-lasting effect of COVID-19 infection on prospective memory, which warrants further investigation.

Our findings indicate a more pronounced impact on PRMQ scores, both overall and item-wise. This might suggest that prospective memory could be particularly susceptible to the effects of the pandemic, possibly because it involves a complex integration of memory and executive functions (Kliegel et al., 2002; Martin et al., 2003; Orrù et al., 2009).

It is noteworthy that a few of the significant single-item differences we detected pertained to items which involved spatial memory, such as forgetting the location of objects, or being unable to recognize places. Misplacing items was a common complaint. Spatial memory is closely associated with the function of the hippocampus and its neighbouring areas, which may be particularly susceptible to viral invasion due to their proximity to the olfactory bulb (Bougakov et al., 2021; Orrù et al., 2020b). Additionally, a few items regarding the recognition of people, both real and fictional, were also noteworthy. This could be due to impairment in the function of ventral structures like the fusiform face area (FFA).

Given the context of our study, which involves an explorative online survey, it is worth noting that participants typically have no incentive to feign or exaggerate memory impairment symptoms (Sartori et al., 2017; Sartori et al., 2019). This factor strengthens the validity of our findings related to memory complaints in the context of Covid-19. Despite it, the present study suffered a number of limitations and weaknesses. First, although statistically significant, the subjective differences we detected could be attributed to a recall bias. In general terms, individuals tend to remember past events and emotions less negatively than they actually were, and this bias may have influenced the recollections of the participants. The pandemic-induced stress may have further amplified this “nostalgic” perspective on their past selves. Second, the use of snowball sampling is known to result in sampling biases. In our study, the sample was composed by female-identifying individuals and thus not representative of the general population. Additionally, the absence of an objective measure of the memory performance limits the possibility of making inferences on whether the differences detected in our study were due to actual differences or merely a result of the participants’ subjective perception. Furthermore, the small sample size reduces the statistical power and the capability of detecting subtle effects.

Acknowledgments

We would like to thank Aleandra Viti, Linda Trogi and Alessandro Muller who helped us during the initial phase of setting up this study. We also thank Silvia Sabbatini for her contribution on the last phase of this manuscript editing.

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