Summary: Long COVID, which affects 7% of U.S. adults, often includes debilitating brain fog. Symptoms such as forgetfulness and difficulty concentrating affect daily life and work. A new study highlights that although brain fog often goes away, it has a significant impact on mental function. Coping strategies and effective treatments are crucial to managing this condition.
Highlights:
- Long COVID brain fog affects 17 million American adults, causing cognitive problems.
- Symptoms include slow thinking, forgetfulness and difficulty concentrating.
- Treatment options include lifestyle changes, cognitive strategies, and medications.
Source: Yale
“Brain fog” is one of the most debilitating problems experienced by people with Long COVID, an illness in which COVID-19-like symptoms persist or develop after the acute infection has passed.
People who suffer from brain fog say they are unable to think clearly, forgetful, and cannot focus their attention or find the right words in a conversation.
An estimated 7% of adults, or about 17 million people, in the United States reported having long COVID in March 2024, based on data from the Centers for Disease Control and Prevention (CDC).
Estimates vary as to exactly how many of these people have difficulty with cognitive functions, but in one study of people with Long COVID, almost half reported having poor memory or brain fog.
For most people, brain fog from long COVID eventually goes away, but it can still have a transformative impact on lives.
“It’s definitely not subtle,” says neurologist Lindsay McAlpine, MD, who directs the Yale Medicine NeuroCovid Clinic and works with neurologist Serena Spudich, MD, MS, to research cognitive dysfunction related to Long COVID.
“People have told me they are good at multitasking, but with brain fog they can only do one thing at a time. Other patients changed jobs because they could no longer handle the tasks, stress, or thinking load of their previous job.
There is no cure for Long COVID or brain fog, but experts are learning more about how to care for patients with it, Dr. McAlpine adds.
Below, providers from Yale Medicine and Yale New Haven Health answer questions about Long COVID brain fog and what to do about it.
1. What is Long COVID brain fog?
Brain fog is not an official medical diagnosis; rather, it is a colloquial term for a range of significant and persistent neurocognitive impairments that cause symptoms such as slow thinking, difficulty processing information, forgetfulness, and an inability to concentrate, pay attention or to concentrate.
With Long COVID, the exact combination of brain fog symptoms varies from person to person.
The disease can affect anyone who has had COVID, regardless of their age or the severity of their initial COVID infection.
Brain fog is considered a long-lasting symptom of COVID if it is present three months after the person had COVID and if it persists for more than two months, Dr. McAlpine says. It usually disappears completely between six and nine months after infection, although in some people it lasts up to 18 months or longer, Dr. McAlpine says.
Scientists do not yet have a solid understanding of what causes Long COVID brain fog. One theory is that the SARS-CoV-2 virus that causes COVID persists in the gut after the acute infection subsides, and that changes in the gut have been associated with changes in brain function.
Dr. McAlpine also cited a small study published in February 2024 in Natural neuroscience which used a specialized type of MRI (called contrast-enhanced dynamic magnetic imaging) to show that some Long COVID patients with brain fog have dysregulation of the blood-brain barrier, a network of tissues and blood vessels that protects the brain from harmful substances.
2. How to detect Long COVID brain fog?
There is no single test to confirm that someone has Long COVID, and the same is true for brain fog. But a neurological exam and cognitive tests can identify deficits in a person’s brain functions.
Likewise, there is no specific cognitive screening test for people with Long COVID, but a number of tests used to assess conditions like dementia can help determine if a person has it, says Dr. McAlpine .
“We look for deficits in language, working memory, declarative memory (a type of long-term memory), motor function and perception,” she says.
It is helpful to know if a patient has other symptoms of long COVID, which are wide-ranging and can include fatigue, difficulty breathing, heart palpitations, headache, stomach pain and joint pain, among other things, she adds.
3. Can brain fog be a sign of another illness?
Yes, some people develop new pathologies when they suffer from long COVID; The disease can also aggravate existing conditions and “unmask” previously existing but undiagnosed illnesses, says Dr. McAlpine.
“That’s why the patient’s history and clinical history is really important, because if brain fog is not COVID-related, then we need to think about different causes,” she says.
Blood tests, including a complete blood count and a comprehensive metabolic panel, help rule out problems such as thyroid disease or vitamin B-12 deficiency, which are known to cause cognitive symptoms.
Syphilis and human immunodeficiency virus (HIV) are also conditions to look for, depending on the patient’s risk, says Dr. McAlpine.
“Obstructive sleep apnea (OSA) is another potential cause of cognitive dysfunction and is often diagnosed in people with Long COVID,” says Dr. McAlpine. “Or they had sleep apnea before and it was tolerable for them, but after COVID they became much more susceptible to it and had more symptoms.
Similarly, a subset of patients in Dr. McAlpine’s practice had or had not been diagnosed with attention-deficit/hyperactivity disorder (ADHD) before COVID, and long COVID caused a “dramatic worsening” of their symptoms of ADHD, including forgetfulness and lack of concentration. associated with brain fog, she says.
“Some found that the medications they were taking for ADHD no longer worked for them,” she says.
“I have also treated people who had always suspected they had ADHD, but who were functioning well and coping well. Their coping skills stopped working with Long COVID.
There are other conditions, such as chronic fatigue syndrome and postural orthostatic tachycardia syndrome (POTS), that are associated with cognitive dysfunction independent of Long COVID.
“In people with brain fog who have these syndromes as part of their long COVID, the brain fog may not improve until we address these issues,” says Dr. McAlpine.
4. How do you treat Long COVID brain fog?
Long-term COVID-related brain fog goes away in the majority of people who have it, but lifestyle practices can help, says Dr. McAlpine. For example, “we know that exercise boosts cognition in everyone, even in patients with dementia.”
Maintaining healthy sleep habits, staying hydrated, minimizing alcohol consumption and avoiding tobacco are also helpful, she says.
“There’s also an element of mood, which is important,” adds Dr. McAlpine, explaining that many people with symptoms of brain fog also have depression or anxiety, and those who had previous problems mental health professionals may notice a worsening of these problems. “But if a mental health problem is diagnosed, it requires treatment. »
Additionally, Dr. McAlpine says many of his patients have responded well to two medications: N-acetylcysteine (NAC) and guanfacine.
In 2020, Arman Fesharaki-Zadeh, MD, PhD, a behavioral neurologist and neuropsychologist at Yale Medicine, discovered that medications could help Long COVID patients with brain fog, when he realized that one of its Long COVID patients had similar cognitive symptoms. to patients with a history of traumatic brain injury (TBI) and post-concussion syndrome.
NAC was being tested for the treatment of head trauma and also helped with cognitive deficits. He added guanfacine, which was developed by Yale neuroscientist Amy Arnsten, PhD, and has been used to treat ADHD.
The two published a small study in the November 2023 issue of Neuroimmunology Reports, and now researchers hope to secure funding for larger clinical trials. In the meantime, NAC is available over-the-counter and patients can obtain an off-label prescription for guanfacine from their doctor.
“COVID vaccines have also been shown to relieve long COVID symptoms like brain fog, but there are no guarantees,” says Dr. McAlpine.
“We had many patients during our first wave of COVID who had significant brain fog post-COVID, and their symptoms improved with their first vaccination. But I’ve seen this happen less lately, perhaps because more people are vaccinated. This may be more of a “first wave” phenomenon.
5. Are there strategies to help people deal with brain fog?
While some people experience more severe brain fog than others, many find there are strategies that can help, says Kaleigh Frame, MA, CCC-SLP, a speech-language pathologist at Yale New Haven Health who has treated patients with Long COVID who have already been seen by a Yale Medicine neurologist. She suggests strategies based on the types of cognitive deficits they are struggling with.
First, it teaches patients to develop “self-advocacy skills,” such as letting others know about their limitations due to brain fog. It also contributes to “metacognition,” which she describes as a person’s ability to evaluate their own cognitive abilities.
For example, they decide how they are doing at different times on a scale of 1 to 10 and record their numbers on a calendar or notes app.
“This can help determine if there are patterns of brain fog throughout the day, and it can also help track progress or decline,” she says.
“So, the next one…
News Source : neurosciencenews.com
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