Infection can cause cognitive impairment
As we know, symptoms can vary widely depending on the infection and the person who has it. But one side effect that doesn’t get much press has been labeled “brain fog” (i.e. deficits in cognitive domains such as memory, reasoning, problem-solving, concentration, language, and how fast someone can make sense of information). Cognitive decline following viral infection has been studied for years and has been seen in conditions as diverse as hepatitis c, herpes, HIV, and Epstein-Barr — conditions also believed to have a possible role in the development of Alzheimer’s. (1)
Researchers think that these and other diseases could be a result of a virus’ direct attack to the Central Nervous System (CNS) [i.e. the brain and spinal cord] or through indirect means such as making the blood too “thick”, changing how our genes work, inflammation, an abnormal immune response, or an infection of brain cells. These processes may cause physical changes to various parts of the brain and how they operate, in both individuals who were well before they got COVID and in those who already had struggles with their thinking skills. (1)
“Brain fog” in COVID patients
Cognitive difficulties resulting from viruses can be fleeting or more enduring in nature, and are now being seen in patients who have had even mild cases of COVID. (5)
“The cognitive problems emerging from mild to moderate cases of COVID-19 are so new that researchers have struggled to define them...[A recent] study led by Igor Koralnik, the director of the Neuro COVID-19 Clinic at Chicago’s Northwestern Memorial Hospital, analyzed the first 100 ‘long COVID’ sufferers who came to the clinic...None had ever been hospitalized for COVID-19, yet 85 percent had four or more neurological complaints, including ‘brain fog’...”. (7)
Examples from Penn’s Post-COVID Clinic, include a lady (once a vigorous reader) who could no longer even read one page, and who had to give up both of her part-time jobs; as well as a cardiologist who could no longer remember common phrases such as “blood pressure”. (7) Dr. Benjamin Abramoff, the clinic’s director, “had never seen so many people with a single viral illness stay so impaired for so long”. (7) Other premier medical centers across the country are seeing the same. Dr. Tamara Fong, a neurologist at Beth Israel Deaconess Medical Center in Boston, has likened her patients’ symptoms to what is often seen in individuals who have experienced a concussion. (7)
Treatments and Resources
Dr. Fong has found that the most helpful interventions are similar to the ones used with brain injuries: first, ensure healthy sleep patterns; second, reduce stress and initiate gentle physical exercise; third, engage in cognitive rehabilitation through routine and slowly expanding mental activities that can “stimulate growth of neurons and strengthen their interconnectedness in affected areas of the brain”. (7) The sooner these treatments are put into place, the better.
Another potential treatment being studied is medication. Investigations have found that those who have “long COVID” and cognitive difficulties have higher levels of a certain molecule in their blood, as compared to those with “long COVID” who do not have these cognitive problems. This molecule affects certain cells in the CNS, which in turn, influences inflammation and infections in the brain. Drugs that help keep this process in check, such as NSAIDs and tetracyclines are now being reviewed. (5)
Perhaps one of the most exciting ventures to date has been the development of the NeuroCOVID Project by the National Institute of Neurological Disorders and Stroke.
Initiated at NYU Langone Health, with clinical partners around the nation, this databank allows for providers to send de-identified information on their COVID patients, as well as specimens such as blood samples. This data will help researchers explore multiple facets of this disease, including patterns of neurological symptoms, how long these complications are lasting, and whether these side effects are more common in certain populations. (2, 3)
Could stroke and aneurysm survivors be a group that is at higher risk for cognitive complications from COVID? We don’t know yet. But the only way to find out is for survivors to reach out to their physicians, informing them of any neurological side effects from COVID they may be experiencing (e.g. a decline in thinking skills, headaches, numbness/tingling, speech problems) and encouraging their doctors to partner with the national NeuroCOVID Project. It is also extremely important for the patient’s own personal recovery to ask their provider as soon as possible for a referral to a local post-COVID center such as those available at Good Samaritan Hospital (6) and UC Health (4) where interdisciplinary staff can assist with cognitive rehabilitation and other services.
Conclusion
“It is important that health professionals be aware of the potential impact of COVID-19 in [the] Central Nervous System, especially in cognition. It could impact not only older individuals with cognitive impairment, but also healthy individuals more susceptible to it. More studies should be done to identify these susceptible individuals, its relationship with disease severity, the pathophysiological mechanisms of this impairment, as well as to understand the long-term consequences of the cognitive deficits. Health managers should also promote campaigns and continuing education programs to help physicians and other health professionals to identify and deal with these emerging issues...[T]he need of an approach to deal with these cognitive impairments is urgent. The spread of cognitive rehabilitation techniques is indispensable...[and] the use of therapeutic agents to prevent and treat cognitive impairment following virus infections” should continue to be explored. (1)
Note: Practitioners interested in becoming a clinical partner to the NeuroCOVID Project can obtain information at https://bit.ly/3ceLHVe.
References:
Damiano, R.F., Guedes, B.F., Castanho de Rocca, C., de Pádua Serafim, A., Castro, L. H. M., Demarchi Munhoz, C., Nitrini, R., Filho, G. B., Eurípedes, C. M., Lucchetti, G., and Forlenza, O. (2022). Cognitive decline following acute viral infections: literature review and projections for post-COVID-19. European Archives of Psychiatry and Clinical Neuroscience, 272(1): 139–154.
NYU Langone Health. COVID-19 Neuro Databank-Biobank. Med.nyu.edu.
Rubin, R. (2021). Collecting Data about COVID-19-Related Brain Symptoms. Journal of the American Medical Association, 325 (8), 712.
UC Health. UC Health Launches Region’s First Post-COVID-19 Clinic. UCHealth.com: August 2, 2021.
Venkataramani, V., & Winkler, F. (2022). Cognitive Deficits in Long Covid-19. New England Journal of Medicine, 1813-1815.
Vilines, J. New clinics open to treat ‘long COVID-19’. SpectrumNews1.com: Aug. 31, 2021.
Weintraub, P. (2021). The Way Out of Brain Fog. The Atlantic, April 9.
Dr. Nicole Best (“Nikki”) is a Clinical Psychologist and 3-time ruptured brain aneurysm survivor. She earned her Doctorate in Psychology (PsyD) from Wright State University School of Professional Psychology, and completed a Post-Doctoral Fellowship at The Ohio State University Medical Center, Dept. of Physical Medicine & Rehabilitation, Division of Rehabilitation Psychology. Thereafter, she worked for almost 14 years in the VA Healthcare System before leaving on Disability after her 3rd subarachnoid hemorrhage. She has extensive experience performing psychotherapy and neuropsychological and decisional capacity evaluations with patients suffering from a wide range of medical conditions, including dementia, traumatic brain injury, stroke, and terminal illness.