The Next Health Crisis
Schultz is hopeful that many people experiencing persistent cognitive issues from COVID-19 will eventually improve. Many stroke and traumatic brain injury patients experience spontaneous recovery, in which the brain heals itself within three to six months.
But others worry that cognitive issues caused by COVID-19 may lead to dementia. At the Alzheimers Association International Conference in July, scientists presented research showing that hospitalized COVID-19 patients had similar blood biomarkers, neurodegeneration, and inflammation to those with Alzheimers disease. The research has not yet been peer-reviewed.
Heather Snyder, vice president of medical and scientific relations at the Alzheimer’s Association, cautions that the findings dont necessarily mean someone who gets COVID-19 is more likely to develop Alzheimers or another type of dementia. Were still trying to understand those associations, she says.
For now, there are no specific treatments for COVID-related brain fog, memory loss, and other cognitive effects. Instead, doctors are using cognitive therapy, occupational therapy, or speech-language pathology to treat symptoms. Many studies, like the NIH one, are trying to understand the underlying mechanisms of cognitive dysfunction in long COVID patients in hopes of identifying potential treatments.
We and others are collecting anecdotal data from patients on what has helped them, but we are far from definitive therapeutics, Frontera says.
Peering In At The Brain’s Response To Covid
In August 2021, a preliminary but large-scale study investigating brain changes in people who had experienced COVID-19 drew a great deal of attention within the neuroscience community.
In that study, researchers relied on an existing database called the UK Biobank, which contains brain imaging data from over 45,000 people in the UK going back to 2014. This means crucially that there was baseline data and brain imaging of all of those people from before the pandemic.
The research team analyzed the brain imaging data and then brought back those who had been diagnosed with COVID-19 for additional brain scans. They compared people who had experienced COVID-19 to participants who had not, carefully matching the groups based on age, sex, baseline test date and study location, as well as common risk factors for disease, such as health variables and socioeconomic status.
The team found marked differences in gray matter which is made up of the cell bodies of neurons that process information in the brain between those who had been infected with COVID-19 and those who had not.
Specifically, the thickness of the gray matter tissue in brain regions known as the frontal and temporal lobes was reduced in the COVID-19 group, differing from the typical patterns seen in the group that hadn’t experienced COVID-19.
Be Aware Of Warning Signs For Covid
You may be familiar with the respiratory/flu-like symptoms of COVID-19, including fever, cough, fatigue, and shortness of breath. As well, pay attention to potential neurological symptoms.
Any change in headaches, new headaches, or new continuous severe types of headaches should prompt patients to reach out to their doctors to consider a COVID-19 diagnosis, Dr. Kuruvilla advises. Any new symptom of loss of smell or taste should also be warning signs for the disease. These three symptoms are the most frequent neurological manifestations and should prompt an immediate medical evaluation, she says. Early detection of neurological deficits may lead to improved clinical outcomes. It can also help prevent further transmission of the disease.
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The Science Behind How The Coronavirus Affects The Brain
New research could help explain why thousands of Covid-19 survivors are facing debilitating neurological symptoms months after initially getting sick. WSJ breaks down the science behind how the coronavirus affects the brain, and what this could mean for long-haul patients. Illustration: Nick Collingwood/WSJ
News moves fast, and there’s not always time to untangle the complex forces driving the day’s biggest stories. WSJ Explains breaks down big market moves, business and economic trends, and scientific developments to help you stay ahead of the curve.
Nerve Damage Including Peripheral Neuropathy
Some symptoms experienced by some people weeks to months after COVID infection suggest the peripheral nervous system, the vast communication network that sends signals between the central nervous system and all other parts of the body, is impaired. Peripheral nerves send many types of sensory information to the central nervous system , such as a message that the feet are cold. They also carry signals from the CNS to the rest of the body, including those that control voluntary movement. Nerve dysfunction is also a known complication in those with critical care illness such as the acute respiratory distress syndrome.
Symptoms of peripheral neuropathy vary depending on the type of nervesmotor, sensory, or autonomicthat are damaged.
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Major Cognitive Effects Of Covid
In survivors of intensive care unit stays due to acute respiratory failure or shock from any cause, one-third of people show such a profound degree of cognitive impairment that performance on neuropsychological testing is comparable to those with moderate traumatic brain injury. In daily life, such cognitive effects on memory, attention, and executive function can lead to difficulties managing medications, managing finances, comprehending written materials, and even carrying on conversations with friends and family. Commonly observed long-term psychological effects of ICU stays include anxiety, depression, and post-traumatic stress disorder . Effects due to COVID ICU stays are expected to be similar a prediction that has already been confirmed by the studies in Britain, Canada, and Finland reviewed above.
What Do We Know About The Effects Of Sars
Much of the research to date has focused on the acute infection and saving lives. These strategies have included preventing infection with vaccines, treating COVID-19 symptoms with medicines or antibodies, and reducing complications in infected individuals.
Research shows the many neurological symptoms of COVID-19 are likely a result of the bodys widespread immune response to infection rather than the virus directly infecting the brain or nervous system. In some people, the SARS-CoV-2 infection causes an overreactive response of the immune system which can also damage body systems. Changes in the immune system have been seen in studies of the cerebrospinal fluid, which bathes the brain, in people who have been infected by SARS-CoV-2. This includes the presence of antibodiesproteins made by the immune system to fight the virusthat may also react with the nervous system. Although still under intense investigation, there is no evidence of widespread viral infection in the brain. Scientists are still learning how the virus affects the brain and other organs in the long-term. Research is just beginning to focus on the role of autoimmune reactions and other changes that cause the set of symptoms that some people experience after their initial recovery. It is unknown if injury to the nervous system or other body organs cause lingering effects that will resolve over time, or whether COVID-19 infection sets up a more persistent or even chronic disorder.
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How To Stay Safe And Protect Yourself
Even if the rate of vaccinating people increases, it may still be a while before you get to roll up your sleeve and even then, it could take months for the spread to slow. In the meantime, its important to take extra precautions, especially if you suffer from underlying conditions that can put you at greater risk of developing COVID-19 and associated brain symptoms. Heres what to do:
What Should You Do If You Think You Have Post
Unfortunately, there’s no established treatment for post-COVID-19 cognitive side effects. Some clinicians are treating patients with low-dose stimulants . Others suggest awakening the senses by introducing strong smells. Still others are experimenting with behavioral strategies such as meditation, exercise and support groups and psychological counseling.
“If you’re experiencing cognitive symptoms after a case of COVID-19, you should see your primary care provider,” Dr. Kremen says. “Your doctor can rule out other issues, such as thyroid disease, high blood sugar and other medical causes of cognitive impairment.” And if your doctor suspects your symptoms are COVID-19-related, the symptoms are likely to dissipate over time.
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Older Adults Are More Likely To Have Neurological Issues After Covid
Another study conducted in Argentina found that adults over the age of 60 were likely to have issues with cognitive function, such as memory loss and confusion, after a Covid-19 infection. Gabriel A. de Erausquin, a neurology researcher at the University of Texas Health Science Center at San Antonio, says his study showed that among people age 60 and over, close to 60% of those exposed to Covid-19 have trouble with memory and cognition. This represents an almost tenfold increase in neurological issues in this population, he says. Interestingly, adults who have lost their sense of smell during a Covid-19 infection are more likely to have brain issues. This may be a clue to the relationship between Covid-19 and degenerative brain diseases like Alzheimers disease, which can also involve loss of smell. The regions affected by both overlap, De Erausquin says. If these seniors dont recover fully, then we are facing potentially a very large increase in Alzheimers cases, he says. De Erausquin plans to follow the 234-person study group for the next five years to see if the cognitive issues in older adults improve like those in Kanbergs study.
Why Our Brains Struggle To Make Sense Of Covid
Many patients who are hospitalized for COVID-19 are discharged with symptoms such as those associated with a brain injury. These include “forgetfulness that impairs their ability to function,” de Erausquin says. “They complain about trouble with organizing their tasks, and that entails things such as being able to prepare a meal.”
But COVID-19 also appears to produce many other brain-related symptoms ranging from seizures to psychosis, a team reports in the Jan. 5 issue of the journal Alzheimer’s & Dementia. The team, which included de Erausquin, says severe COVID-19 may even increase a person’s risk of developing Alzheimer’s disease.
For many affected patients, brain function improves as they recover. But some are likely to face long-term disability, de Erausquin says.
“Even if the proportion, the rate, is not very high, the absolute number of people who will suffer these consequences is likely to be high,” he says, because so many people have been infected.
Scientists are still trying to understand the many ways in which COVID-19 can damage the brain.
It’s been clear since early in the pandemic that the infection can lead to blood clots that may cause a stroke. Some patients also suffer brain damage when their lungs can no longer provide enough oxygen.
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Anxiety Depression And Stress Post
The outbreak of COVID-19 is stressful for many people. People respond to stress in different ways and it is normal to experience a range of emotions, including fear, anxiety, and grief. Being isolated from others during the infection, the real risk of death, and the stress of hospitalization and critical care can trigger post-traumatic stress disorder. In addition, given the contagious nature of COVID-19, the individual is often not the only affected person in the family or circle of friends, some of whom may even have died. Some people may develop a mood or anxiety disorder. For information on post-COVID stress and coping, see the National Institute of Mental Healths resources at National Institute of Mental Health’s Director, Dr. Gordon In the News and NIMH Shareable Resources on Coping with COVID-19.
Adopt Or Maintain Good Health Habits
Its always essential to control blood pressure, diabetes, and any other underlying health issues you may have, advises Dr. Danoun. Avoid smoking and alcohol, eat a healthy diet, get enough rest. If you do contract COVID-19, all of these things will create a nourishing environment for your body to recover.
Prioritizing sleep is of particular importance, as too little shuteye may weaken your defenses against a virus. As you await your chance to receive the COVID-19 vaccine, its helpful to know that sleep can also optimize your immune systems response to a vaccine, in part because its a great stress reducer and stress can hamper the bodys immune response. One study found that the flu vaccine appears to be more effective responses are quicker, more robust, and longer lasting in people who get a sufficient duration of sleep for the two nights prior to receiving the shot, and other studies have made similar findings in response to other vaccines.
Finally, speak to your health care provider about which vitamin supplementation is important for you, Dr. Kuruvilla suggests. Some studies, though certainly not all, have shown that low vitamin D levels can leave you more vulnerable to COVID-19 and result in more severe disease.
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Trial Studying Technique To Clear Brain Fog After Covid
A new clinical trial at UAB aims to improve cognitive function in patients with “brain fog” and other lingering cognitive symptoms after they have recovered from COVID-19.Even after their bodies have cleared the virus that causes COVID-19, many patients experience long-term effects. One of the most troubling is a change in cognitive function commonly called brain fog that is marked by memory problems and a struggle to think clearly. A new clinical trial at UAB is testing a proven rehabilitation method to remedy that.
A report on 120 patients in France, , found that more than a third had memory loss and 27% had cognitive difficulties months after recovering from COVID-19. In another study, a hospital network in Chicago reported that, among 509 patients, nearly a third experienced altered mental function of these, 68% were unable to handle routine daily activities such as cooking or paying bills.
What is it like to live in the fog?
One physician described it as akin to the fuzzy-headed feeling the day after a sleepless night. A researcher in the United Kingdom, discussing an initial report on more than 84,000 people, said in severe cases it is as if the brain had aged 10 years, almost overnight. Patients talking to the New York Times said it is debilitating, it feels as though I am under anesthesia and everything in my brain was white static. Several described how the brain fog has made it difficult or impossible for them to return to work.
What Did The Researchers Do
The study analyzed health information from 3,744 people who had been hospitalized with COVID-19. Participants were identified through the Global Consortium Study of Neurologic Dysfunction in COVID-19 and the European Academy of Neurologys Neuro-COVID Registry .
The researchers looked at the participants hospitalization records for many possible neurological effects, including self-reported symptoms such as headache and loss of taste or smell and symptoms observed by hospital staff, such as fainting, coma, seizure, encephalopathy , meningitis, and aphasia .
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Read More About The Vaccine Rollout:
For instance, a recent US study that analysed brain tissue from eight patients who died from COVID-19 found no traces of the virus in the samples.
But the research did find more signs of inflammation in the brain tissue of COVID-19 patients than the control group, suggesting that inflammatory responses triggered by the virus in other parts of the body can kickstart inflammation in the brain.
Tissa Wijeratne, a neurologist at the University of Melbourne, has also found inflammatory markers linked with the immune response in the blood of patients who experience neurological issues months after they were first infected with the virus.
The virus doesn’t have to go to the brain to make an impact, said Professor Wijeratne, who is currently investigating the long-term neurological effects of COVID-19.
My hypothesis is that this is largely driven by a maladaptive, persistent low-grade immune reaction.
And while it’s too early to know for sure, there’s a strong possibility that inflammation could be one of the main culprits behind lingering neurological symptoms, said the George Institute’s Professor Anderson.
We know that severe viral infections can cause inflammation in the brain, he said.
For instance, the stress of having the infection itself could also have an effect on the brain and cognition, particularly for those who have been in hospital, said Professor Hannan.
We need much more research, he said.
What Is The Typical Recovery From Covid
Fortunately, people who have mild to moderate symptoms typically recover in a few days or weeks. However, some people who have had only mild or moderate symptoms of COVID-19 continue to experience dysfunction of body systemsparticularly in the lungs but also possibly affecting the liver, kidneys, heart, skin, and brain and nervous systemmonths after their infection. In rare cases, some individuals may develop new symptoms that stem from but were not present at the time of initial infection. People who require intensive care for Acute Respiratory Distress Syndrome, regardless of the cause, usually have a long period of recovery. Individuals with long-term effects, whether following mild or more severe COVID-19, have in some cases self-identified as having long COVID or long haul COVID. These long-term symptoms are included in the scientific term, Post Acute Sequelae of SARS-CoV-2 Infection .
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In Neurons Of The Cerebral Cortex Signs Of Distress
Activation levels of hundreds of genes in all major cell types in the brain differed in the COVID-19 patients brains versus the control groups brains. Many of these genes are associated with inflammatory processes.
There also were signs of distress in neurons in the cerebral cortex, the brain region that plays a key role in decision-making, memory and mathematical reasoning. These neurons, which are mostly of two types excitatory and inhibitory form complex logic circuits that perform those higher brain functions.
The outermost layers of the cerebral cortex of patients who died of COVID-19 showed molecular changes suggesting suppressed signaling by excitatory neurons, along with heightened signaling by inhibitory neurons, which act like brakes on excitatory neurons. This kind of signaling imbalance has been associated with cognitive deficits and neurodegenerative conditions such as Alzheimers disease.
An additional finding was that peripheral immune cells called T cells, immune cells that prowl for pathogens, were significantly more abundant in brain tissue from dead COVID-19 patients. In healthy brains, these immune cells are few and far between.
Viral infection appears to trigger inflammatory responses throughout the body that may cause inflammatory signaling across the blood-brain barrier, which in turn could trip off neuroinflammation in the brain, Wyss-Coray said.