Fatigue, post-exercise discomfort and cognitive dysfunction — also known as brain fog — are some of the most common symptoms reported by COVID-19 patients, months after their initial diagnosis.
To better understand brain fog and the ways COVID-19 impacts neurological health, we asked AdventHealth neurologist Hind Kettani, MD, for her expertise and to explain what our medical experts know so far.
In What Ways Does COVID-19 Impact Neurological Health?
The COVID-19 pandemic has resulted in a surge in suicide deaths and mental health conditions, including anxiety and depression. It’s difficult to say if these effects are due to the fear of the disease, social isolation, unemployment, economic burden, worsening of existing conditions or biological changes in the brain.
There has also been a concern about the mental health and psychological sequels of the COVID-19 infection. The rise in suicide deaths is an area of particular concern.
Other neurological symptoms seen in people with COVID-19 include loss of smell, inability to taste, muscle weakness, tingling or numbness in the hands and feet, dizziness, confusion, trouble with concentration, delirium, seizures and stroke.
How Would You Describe the Term “COVID Brain”?
Delirium and septic encephalopathy, also known as brain dysfunction, are common in severely ill patients. The most typical neurological features associated with COVID-19 include:
- Smell dysfunction (more frequent in mild cases and especially in younger people and females)
- Headache
- Muscle pain (common in both mild and severe cases)
- Ischemic stroke
What Are Some Complications That COVID-19 Survivors Face?
The long-term cognitive effects of COVID-19 might be linked to underlying inflammatory processes. Still, it’s equally likely that patients with COVID-19 experience silent strokes or a lack of oxygen that damages their brains.
Silent strokes typically impact the brain’s white matter — the wiring between brain cells that enables different parts of the brain to communicate with each other. This wiring is essential for focusing. When it is damaged, the ability to focus is impaired.
There is one inevitable conclusion from the current studies: COVID-19 infection frequently leads to brain damage. Neurologic complications occur in approximately half of all hospitalized COVID-19 patients.
Although many people who have recovered from coronavirus can resume their daily lives without difficulty (even if they have some deficits in attention), there are a number of people who may experience difficulty now or later.
Are There Risk Factors That Lead to Neurological Issues in COVID-19 Patients?
New research* suggests that up to 14% of people who develop severe COVID-19 complications have an inadequate interferon response. Interferon is a medication used to treat infections and it is a protein naturally produced by the body.
In some people, this happens because their own antibodies mistakenly attack and neutralize their interferons. Other people have a genetic mutation that prevents their body from producing enough of a certain type of interferon.
An inadequate interferon response could help explain why some people — especially some young people without underlying conditions — get so much sicker than others their age.
Another important reason for differences in severity of COVID-19 illness is also related to the immune system. If the immune system doesn't turn off once the virus is controlled, it can go into overdrive. This could result in an intense and widespread inflammatory response damaging tissues throughout the body. This is often referred to as a cytokine storm.
Are Treatment Options Available for COVID-19 Patients With Neurological Issues?
The type of treatment that patients receive depends on their symptoms. For example, for a patient with acute encephalitis, or inflammation of the brain due to infection, symptomatic therapy would likely be offered. It aims to balance electrolytes, fluid levels and body temperature.
If the course of the disease is severe, supportive intensive care therapy is appropriate, including intubation and respiration, thrombosis prophylaxis, neuromonitoring and escalating therapy of increased intracranial pressure.
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