A controversial topic…. a neuropsychological review.
- Thanks to vaccinations and more widely available treatments, many patients who contract COVID-19 can avoid getting seriously ill, being hospitalized for treatment, or even dying.
- But even a symptom-free case of COVID can result in “Long COVID”, a condition that includes a wide range of symptoms from fatigue, difficulty thinking, behavior change, to a new diagnosis of diabetes or heart and lung problems. People with Long COVID may be dealing with a single symptom or several at the same time. The symptoms can last from days to weeks to months.
- The National Institute of Health (NIH) refers to long-term COVID-19, with many names. One of them used here is Long COVID, and these patients are referred to as “long haulers.”
- The most common symptoms of Long COVID include fatigue, shortness of breath, cough, dizziness, palpitations, hair loss, gastrointestinal symptoms, heartburn, altered sense of smell and taste, and finally, brain fog, the area we shall focus upon here.
- Let’s review the research literature* investigating cognitive (thinking) functioning in patients with persistent complaints. Persistent means a more chronic stage of recovery approximately 5.5 months after the COVID-19 diagnosis. The studies showed mild cognitive deficits seen on neuropsychological testing that involved attention, processing speed, and organizational abilities. The findings suggested that psychological factors and other persisting symptoms (example, sleep, fatigue) play a significant role in patients reporting thinking deficits in the long haulers of COVID-19.
- Thinking changes were found in patients during the acute or the early stage of the illness; however, the source of the thinking changes beyond five and a half months is unclear. There were patients requiring higher levels of acute care who did not demonstrate greater cognitive deficits during comprehensive neuropsychological examination. Nonetheless, findings are conflicting in the research.
- One possible explanation for the cognitive findings is that other factors such as mood difficulties, sleep dysfunction, and fatigue contribute to a person’s thinking.
- The most striking finding in many of the studies is that over 70% of patients had previously been diagnosed with depression or anxiety prior to the COVID-19 infection. This high prevalence of prior psychological symptoms is consistent with previous findings in the clinical literature on COVID-19.
- The research suggests the importance of assessing and addressing psychological and cognitive symptoms in patients beyond five to six months.
- For “Long COVID”, there are many effective treatments for symptoms such as heart and lung-related issues, but fewer treatments for other COVID symptoms such as cognitive complaints and chronic fatigue have been established.
- There is no current specific treatment for Long COVID, and each symptom should be assessed and treated. For example, the psychological changes of anxiety, depression, and PTSD – all possible symptoms – often respond well to available treatments such as medication and medical adjustment counseling focusing on compensatory strategies for the cognitive inefficiencies that patients experience.
Robert B. Sica, PhD, ABN
Board Certified, Neuropsychology
Principal and Director of NRS|LS
*Archives of Clinical Neuropsychology, Volume 37, Issue 4, June 2022, Pages 729-737