Study explores ‘brain fog’ in the wake of COVID-19


Many people infected with Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) have experienced persistent health problems.

A recent survey in the UK found that around one in five people had prolonged symptoms of coronavirus disease 2019 (COVID-19) five weeks after infection. Additionally, one in seven people reported persistent symptoms even after twelve weeks.

In addition, it has been found that one in ten people remain ill even a year after infection with COVID-19. This group of individuals is said to be suffering from a “long COVID”.

People with long-lasting COVID experience a reduction in their ability to perform certain daily activities or return to work several weeks after the initial diagnosis of COVID-19.

Long COVID symptoms

Scientists have defined long COVID as a condition of post-acute COVID-19 syndrome, where symptoms persist between 4 and 12 weeks after infection. It also includes the chronic illness COVID-19, where symptoms persist beyond 12 weeks.

People who suffer from long-term COVID often complain of large-scale fluctuating symptoms, such as fatigue, chest pain, shortness of breath, autonomic nervous system disruption, and cognitive dysfunction.

Even though the underlying pathophysiology behind the aforementioned long COVID symptoms remains unclear, scientists have explained the likely reasons for these conditions. They said persistent viraemia, deconditioning, relapse or reinfection, inflammatory immune responses, and several psychological factors are potential contributors to long COVID.

Previous studies have reported that nearly a quarter of a million patients recovered from COVID-19, both hospitalized and out-of-hospital, have succumbed to certain neurological and psychiatric conditions. However, severely infected patients are the most prone to these conditions.

About 25% of patients experienced disturbing moods, such as anxiety. Some patients also report having serious problems such as psychosis.

Several other neurocognitive symptoms experienced by this group include cerebrovascular events, insomnia, dementia, encephalitis, and disorders of the peripheral nerves, nerve roots or plexus.

Additionally, previous investigations associated with long-term outpatient COVID patients have reported short-term memory, impaired attention, and a confused general state of mind known as “brain fog.”

Brain fog and COVID-19

Even though adolescents and children are considered to be at low risk for COVID-19 infection, recent research has shown that brain fog has also been found in this group.

Scientists have identified various possible pathophysiologies of brain fog, such as direct neuroinvasion, neuronal damage or toxicities, glial activation, viral persistence and chronic inflammation, microvascular damage, production of Lewy bodies and activation of autoimmune mechanisms.

Previous studies related to bioimaging had revealed differential loss of gray matter in COVID-19 patients in several key regions of the brain. As a result, people with such cognitive impairments face immense difficulties in their daily activities, such as making decisions, communicating and maintaining social relationships.

A new study

A new study published on the medRxiv* the preprint server focused on three main areas, i.e. a) the neurocognitive symptoms experienced by adults with long COVID, b) the impact of long COVID symptoms on these individuals, and c ) how do these individuals deal with the situation? In addition, the researchers of this study also aimed to reveal the mechanism behind the psycho-cognitive processes and pathological effects behind the long COVID.

This study contained a total of 50 participants, of which 23 were recruited from a previous qualitative study associated with the lived experience of long-term COVID patients, and 27 participants were recruited from online support groups with issues. neurological disorders after infection with COVID-19.

In this study, 84% of the participants were women and 60% were of white British ethnicity. All participants were asked to describe their cognitive symptoms, and the researchers followed up on them via email, 4 to 6 months later.

The authors of this study recorded, transcribed, anonymized the data and coded it using the qualitative data analysis computer software, NVIVO. These data were analyzed by an interdisciplinary team, whose expertise extends to clinical neurosciences, general medicine and the sociology of chronic diseases. The interpretation was then evaluated by three people with brain fog.

Qualitative analysis revealed mixed opinions on the description of the term “brain fog”. However, the researchers obtained detailed descriptions of participants’ experiences with neurocognitive impairments – that is, disorders associated with attention, memory, language and executive functions. They reported the fluctuations in symptoms. Some of the participants revealed that they recovered from all of these symptoms over time.

Researchers have established the interaction between cognitive and physical symptoms, as well as the psychosocial impact on work and personal activities. Participants used several strategies to mitigate the effects of brain fog, such as communication strategies; however, these strategies have had minimal success.

These qualitative findings add to research on the epidemiology and pathophysiology underlying the symptoms caused by COVID-19. These patients should benefit from the following services: an ongoing therapeutic relationship with a clinician who engages with the disease in their personal, social and professional context, as well as access to comprehensive, interdisciplinary and easily navigable specialist services.

Limitations of the study

One of the limitations of this study is that the samples were based entirely in the UK. In addition, the researchers were unable to include samples from different demographics, ethnic minority groups, and professional class diversity was also not well taken into account. Finally, participants were mostly infected during the first wave of the COVID-19 pandemic, and the long COVID has changed significantly since then.

The researchers conclude: “In dealing with COVID-19, it is crucial that health policy begins to shift from an acute disaster response to managing a chronic crisis. This study led neuroscientists and qualitative researchers to align the subjective experience of disease as described directly by patients. with the objective disease models that underlie the treatment options for the persistent “brain fog” experienced by long-term COVID patients. The lingering, deeply crippling impacts on some people revealed here add weight to the arguments that we need to prevent COVID -19 to reduce the burden of this disease on patients, healthcare, and the economy at large. Additionally, it is crucial to mitigate the impact for those already affected through a better understanding of the pathophysiological mechanisms of this neurotrophic virus and further exploration of the best approaches to support cognitive, psychological and occupational restoration. “

*Important Notice

medRxiv publishes preliminary scientific reports which are not peer reviewed and, therefore, should not be considered conclusive, guide clinical practice / health-related behavior, or treated as established information.


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