Editor’s Note: Find the latest long COVID-19 news and guidance at Medscape’s Long COVID Resource Center.
Kate Whitley has been terrified of COVID-19 since the beginning of the pandemic because she has Hashimoto’s disease, an autoimmune disease, and she knew she was at high risk for complications.
It was natural for her to be worried. Two months after being infected in September 2022, a 42-year-old Nashville man was diagnosed with long-term COVID-19. For Whitley, the resulting head fog was the most difficult factor. She owns a successful paper goods store, but she can’t remember the basic parts of her job. She can’t stand loud noises and it distracts her so much that she can’t remember what she was doing.
Whitley doesn’t like the word “brain fog”. Because those words don’t explain the dramatic turmoil in her life over the past seven months.
“I can’t think of anything else,” she said. “It makes me realize that I am nothing without my brain. Sometimes I feel like a shell of my former self.”
Brain fog is one of the most common symptoms of long-term COVID-19, but it’s also one of the least understood. According to reports, 46% of people diagnosed with long-term new coronavirus infection complain of foggy heads and memory loss. Many clinicians agree that the term is ambiguous and often does not accurately describe the condition. This makes it difficult for doctors to diagnose and treat. There are no standardized tests for this disease and no guidelines for symptom management or treatment.
“There’s not a lot of imprecision in the term because it can mean different things to different patients,” says James C. Jackson, M.D., a neuropsychiatrist at the Vanderbilt University School of Medicine and author of the new book. said. Clearing the Fog: From Long-Term COVID-19 Survival to Thrive—A Practical Guide.
Dr. Jackson, who began treating Whitley in February 2023, said brain fog doesn’t develop gradually, so it makes more sense to call it a brain injury or acquired brain injury (ABI). . The new coronavirus damages the brain and causes injuries. Hypoxic brain injury due to lack of oxygen to the brain in patients who have had COVID-19 for a long time, who were previously admitted to the intensive care unit and who may have been on a ventilator. may occur.
There is some evidence that persistent neuroinflammation in the brain caused by activation of the immune system can cause damage, even among mildly ill patients with acute COVID-19.
In both cases, the results can be debilitating. Whitley also suffers from dysautonomia. This is a disorder of the autonomic nervous system that causes dizziness, sweating, and headaches along with fatigue and palpitations.
She is very forgetful and said that when she meets people socially, she worries about what they will say. “She can’t remember the details of other people’s lives, so I feel like she’s always stepping into herself,” she says.
Brain disorders such as Alzheimer’s disease and other dementias are characterized by slow decline, whereas ABI develops more abruptly and may include loss of executive function and attention.
“If you have a brain injury, you’re normally fine, but then something happens (in this case, COVID-19) and you have cognitive changes right after that,” Jackson said.
Furthermore, ABI is an actual diagnosis whereas brain fog is not.
“For brain injuries, there’s a treatment called cognitive rehabilitation,” Jackson said.
Treatment may include speech therapy, cognitive therapy, and occupational therapy. A meeting with a neuropsychiatrist is also done to treat any mental and behavioral disorders that may result. Jackson said many patients aren’t 100% cognitively or physically functional, but they can make progress enough that they don’t have to give up things like driving and, in some cases, work.
Other experts agree that prolonged COVID-19 can damage the brain.His April 2022 study published in the journal Nature We found strong evidence that SARS-CoV-2 infection can cause brain-related abnormalities, such as decreased gray matter in specific parts of the brain such as the prefrontal cortex, hypothalamus, and amygdala.
In addition, white matter, located deep in the brain and responsible for exchanging information between different parts of the brain, may also be at risk of being damaged by the virus, according to research published in the journal in November 2022. It says.journal SN Comprehensive Clinical Medicine.
Dr. Tyler Reid-Bell, a researcher who specializes in viruses that cause brain damage, said calling this “fog” makes it easier for clinicians and the public to ignore its severity. He is a research fellow in the Department of Psychiatry at the University of California, San Diego. Head fog can make driving and returning to work particularly dangerous. Due to difficulty concentrating, patients are much more likely to make mistakes that lead to accidents.
“The novel coronavirus is very invasive to the brain,” Bell said.
Some argue that this is a hasty decision. Dr. Carla L. Thompson, chief neuropsychologist at the COVID-19 Recovery Clinic at the University of North Carolina School of Medicine, said that in the more severe cases of COVID-19 that cause a lack of oxygen to the brain, it makes sense to call it brain damage. agree that But brain fog may be linked to other long-lasting COVID-19 symptoms, not just brain damage.
Both chronic fatigue and sleep deprivation are well-reported symptoms of long-term COVID-19 and negatively impact brain function, she said. Sleep disturbances, heart problems, dysautonomia, and emotional distress can also affect brain function after COVID-19. Finding the right treatment requires identifying all the factors that contribute to cognitive impairment.
Part of the problem with treating long-term COVID-19 brain fog is that diagnostic techniques are not sufficiently sensitive to detect the inflammation that may be causing the damage.
Grace McCombie, M.D., who leads a long-term COVID-19 recovery study at the University Hospital Medical System in Cleveland, Ohio, said that brain inflammation could be detected in a similar way that researchers have identified biomarkers that help diagnose chronic diseases. He said he is working to identify biomarkers that can be detected. fatigue syndrome. Additionally, a new study was published last month. JAMA For the first time, 12 long-lasting COVID-19 symptoms have been clearly defined, including brain fog. All these contribute to the development of clear diagnostic criteria.
“Achieving some degree of consistency in diagnosing symptoms among clinicians would make a big difference,” said McComsey.
Whitley is grateful for the care she has received so far. She is being seen by a cognitive rehabilitation therapist. The therapist assesses her memory, cognition, and attention span, and gives her tools to break down simple tasks like driving so she doesn’t feel overwhelmed. She got behind the wheel and got back to her business.
But perhaps most importantly, Whitley joined a support group led by Jackson. This group includes people experiencing the same symptoms as her. They understood when she was in her darkest.
“Talking to other survivors was the only solace in all this,” Whitley said. “Together we grieve for all that has been lost.”
source of information
Kate Whitley, longtime coronavirus patient
JAMA Network, “Long-term COVID-19 symptom prevalence and correlations in US adults,” October 2022.
James C. Jackson, Ph.D., Psychology, Director of Long-term Outcomes, Center for Critical Illness, Brain Impairment, and Survivors (CIBS) at Vanderbilt University Medical Center.
Oxford Open Immunology, “Long Novel Coronavirus Brain Fog: A Neuroinflammatory Phenomenon?” September 2022.
Nature, “SARS-CoV-2 is associated with brain structural changes in the UK Biobank,” April 2022.
SN General Clinical Medicine, “Brain fog as a long-term sequela of COVID-19,” November 2022.
Dr. Tyler Reed Bell, Research Fellow in Psychiatry at the University of California, San Diego.
Dr. Carla L. Thompson, Chief Neuropsychologist at the University of North Carolina School of Medicine’s COVID-19 Recovery Clinic.
Grace McCombie, who leads the long-term COVID RECOVER study at the University Hospital Medical System in Cleveland, Ohio.
Stanford News Center, “Researchers Identify Biomarkers Associated with Chronic Fatigue Syndrome Severity,” July 2017.
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