November 28, 2022 – In early September, about a week after recovering from COVID-19, Barry Sanders went to the bank to pay a bill. But by mistake, she transfers a large amount of money from the wrong account.
“I’m talking about $20,000,” she says. “I had to go back [later] and fix it. “
Sanders, 83, has never had such confusion. Suddenly, the Albuquerque, New Mexico, resident finds herself looking out of a book and not remembering what she just read. She would stand up from her chair, forgetting what she meant to do.
“I kind of thought it was just the aging process,” she says. Besides sudden balance problems, restlessness, and annoying postnasal drip, the overall effect was “subtle, but frightening,” she says.
After 5 days of this, I went to bed and slept through the night. I woke up in the morning to find her balanced, her sinuses cleared, and the mental fog gone. I realized what she was experiencing was not a rapid onset of dementia, but a short, merciful form of prolonged COVID.
somewhere in between 22% And the 32% of people recovering from COVID-19 experience “brain fog,” an unscientific term used to describe sluggish or sluggish thinking. While this is distressing at any age, it can be particularly distressing for older patients and their caregivers, who fear they are experiencing or witnessing not only an after-effect of an illness, but the onset of a permanent loss of thinking skills. And some scientists are beginning to confirm what doctors, patients and their families can already see: Older patients who have had COVID-19 have a higher risk of developing dementia, or if they already have mental confusion, the disease may worsen their condition.
British scientists who have studied medical records from around the world are mentioned in the journal Lancet Psychiatry In August, people who had recovered from COVID-19 were more likely to develop thinking problems and dementia even after two years.
The end of 2022 studyPublished in the journal JAMA Neurology, screening older patients for COVID-19 a year after they were discharged from hospitals in Wuhan, China. Compared to uninfected people, those who survived a severe case of COVID-19 were at greater risk of early infection, late decline, and gradual decline in their thinking skills. The study found that those who survived a mild infection were more likely to have early regression.
Eran Metzger, MD, assistant professor of psychiatry at Beth Israel Deaconess Medical Center in Boston, says he’s noticed that COVID-19 makes some older patients disoriented, and that their brains don’t regain their former clarity.
“We see a gradual decline in their cognition during a COVID episode, and then they don’t go back to baseline,” says Metzger, MD, medical director at Hebrew SeniorLife.
New research is beginning to support such findings.
A study published in the journal showed that people who contracted COVID-19 were twice as likely to be diagnosed with Alzheimer’s disease in the 12 months after infection, compared to those who did not contract COVID. nature in September, which analyzed health care databases of the US Department of Veterans Affairs.
Joshua Kahan, MD, a cognitive neurologist at Northwestern University, advises caution about applying such a label simply selected from a patient’s medical chart. After all, he notes, few patients undergo testing to ensure they have the proteins associated with Alzheimer’s disease.
“Perhaps a more appropriate conclusion from this would be that there is an increased risk of dementia after COVID infection, but we don’t know if it is really Alzheimer’s or not,” he says.
There could be a number of reasons why COVID-19 causes a decline in thinking skills, says Michelle Monje, a neuroscientist and neuro-oncologist at Stanford University.
In a paper published in October in the journal cellMonji and her co-author Akiko Iwasaki, PhD, professor of immunobiology at Yale University, suggested six possible triggers for COVID-induced brain fog: inflammation in the lungs and respiratory passages that leads to inflammation and dysfunction of the central nervous system; autoimmune reactions that damage the central nervous system; a brain infection directly caused by the coronavirus (although they note that this is rare); reactivation of the Epstein-Barr virus, which can lead to neuroinflammation; caused by the Corona virus. and/or complications from severe cases of COVID-19, likely to involve periods of low blood oxygen and multi-organ failure.
The scientific understanding of brain fog is “part of the emerging picture that inflammation elsewhere in the body can metastasize and become inflammation in the brain,” Monje says. “Once inflammation occurs in the brain…it can lead to an imbalance in other cell types that normally support healthy cognitive function.”
One problem with the concept of brain fog is that, like the term itself, the condition can be difficult to define for clinicians and patients alike, and difficult, if not impossible, to capture on common cognition tests.
These days, patients often turn up at the Alzheimer’s Center of Excellence, in Syracuse, New York, and complain that they “don’t feel the same” as they did before contracting COVID-19, says Sharon Brangman, MD, the center’s director and chief of geriatrics. at the Graduate Medical University.
But evidence of cognitive impairment is not there.
“There’s nothing we can find, objectively, that’s wrong with them,” she says. “It’s not severe enough to get a low score on a mental status test.”
Specialized, targeted tests can find some potential signs, says Kahan, who assesses patient cognition in the Long COVID Clinic at Northwestern University.
He often finds that his longtime COVID patients score in the low normal range on cognitive tests.
“Patients have a complaint that something has changed, and we don’t have a pretest,” he says. “So it’s possible that they might have been in the high normal range or the upper range, but you just don’t know.”
He says he’s seen very high-performing people, such as lawyers, CEOs, PhDs, and other professionals, who take tests that could be construed as mundane, but given their level of achievement, “you’d expect [higher scores]. “
Like Sanders, many of those who have muddled thinking after contracting the coronavirus are reverting to their earlier states of mind. A study published in the journal Brain connections It was found in January that people who had recovered from COVID-19, even if they had a mild illness, were more likely to develop memory and other cognitive problems in the months after infection. But after nine months, the former Covid patients had returned to their normal level of cognition, a team from Britain’s Oxford University reported.
Notably, the average age of the subjects in the study was 28.6.
At Northwestern Clinic, Kahan is treating patients who have had cognitive problems caused by the coronavirus for months or even years. Kahan says the rehabilitation program involves working with patients to come up with ways to compensate for cognitive deficits — such as making lists — in addition to brain exercises. Over time, patients may achieve an improvement of 75% to 85%, he says.
Monje hopes that science will one day find ways to completely reverse the decline.
“I think the most common contributor to brain fog is this neuroinflammation, which causes malfunctions in other cell types,” she says. “And the, At least in the laboratoryWe can salvage that in mouse models of brain fog chemotherapy, which gives me hope that we can salvage that for people.”