Summary: Long-term covid, which affects 7% of US adults, often involves debilitating brain fog. Symptoms such as forgetfulness and difficulty concentrating can affect daily life and work. New research shows that brain fog, which often clears up, can have a significant impact on brain function. Effective coping strategies and treatments are critical to managing this condition.
Key facts:
- Long-term covid brain fog affects 17 million US adults, causing cognitive impairment.
- Symptoms include slow thinking, forgetfulness and difficulty concentrating.
- Treatment options include lifestyle changes, cognitive strategies, and medications.
Source: Yale
“Brain fog” is one of the most debilitating problems experienced by people with chronic Covid, a condition in which Covid-19-like symptoms persist or develop after the acute infection has passed.
People who experience brain fog report that they can’t think clearly, forget, and can’t concentrate or find the right words in a conversation.
About 7% of adults in the United States—or about 17 million people—reported having chronic COVID-19 in March 2024, according to data from the Centers for Disease Control and Prevention (CDC).
Estimates vary on exactly how many of those people struggle with cognitive function, but one study of people with prolonged Covid reported that nearly half experienced poor memory or brain fog.
For most people, the lingering Covid brain fog will eventually go away, but it can still have a life-changing impact.
“It’s definitely not subtle,” says neurologist Lindsay McAlpine, who directs Yale Medicine’s NeuroCovid Clinic and works with neurologist Serena Spudich, MD, MS, to investigate long-term Covid-related cognitive impairment.
“People have told me they’re amazing at multitasking, but with brain fog they can only do one thing at a time. Other patients have changed jobs because they couldn’t handle the stress, the stress, and the pressure of thinking.
There is no cure for chronic Covid or mental fog, but professionals are learning more about how to care for patients with the disease, Dr. McAlpine added.
Below, providers at Yale Medical and Yale New Haven Health answer questions about lingering Covid brain fog and what to do about it.
1. What is prolonged covid brain fog?
Brain fog is not an official medical diagnosis; Rather, it is a catchall term for a variety of significant, persistent neurocognitive impairments that result in symptoms such as slow thinking, difficulty processing information, amnesia, and an inability to focus, concentrate, or concentrate.
In chronic covid, the exact combination of brain fog symptoms varies from person to person.
Regardless of their age or the severity of their first covid infection, the disease can affect anyone with covid.
Dr. McAlpine says that mental fog is considered a long-term symptom of Covid if it appears three months after the person has contracted Covid and lasts for more than two months. The disease usually clears up within six to nine months of infection, although in some people it can last up to 18 months or more, Dr. McAlpine said.
Scientists still don’t have a solid understanding of what causes the long-lasting Covid brain fog. One theory is that SARS-CoV-2, the virus that causes Covid-19, remains in the gut after the acute infection has cleared, and changes in the gut are linked to changes in brain function.
Dr. McAlpine also cited a small study published in February 2024 Nature Neuroscience He used a special type of MRI (called dynamic contrast-enhanced magnetic imaging) to show that some chronic Covid patients with brain fog have a blood-brain barrier, a problem with the network of tissues and blood vessels that protect the brain from harmful substances.
2. How do you clear the long covid brain fog?
There is no single test that can confirm that someone has prolonged covid, and the same goes for mental fog. But neurological testing and cognitive testing can identify abnormalities in a person’s brain function.
Similarly, there is no specific cognitive test for people with prolonged Covid, but several tests used to assess conditions such as dementia can help determine whether someone is experiencing it, says Dr McAlpine.
“We’re looking for language deficits, working memory, expressive memory [a type of long-term memory]motor function and cognition,” she says.
It helps to know if a patient has other chronic covid symptoms, which can include general fatigue, shortness of breath, palpitations, headache, stomach pain and joint pain, among others.
3. Can brain fog be a symptom of another disease?
Yes, some people develop new conditions when they have prolonged covid. The condition can “mask” and “mask” pre-existing but undiagnosed illnesses, Dr. McAlpine said.
“That’s why it’s so important to take the patient’s history and clinical history, because if brain fog isn’t related to COVID, we have to think about different causes,” she says.
Blood work, including a complete blood count and comprehensive metabolic panel, can help rule out problems such as a thyroid condition or vitamin B-12 deficiency, which can cause cognitive symptoms.
Syphilis and human immunodeficiency virus (HIV) are also conditions to test for to determine the patient’s risk for those conditions, Dr. McAlpine said.
“Obstructive sleep apnea (OSA) is another possible cause of cognitive impairment, and is often diagnosed in people with prolonged covid,” says Dr. McAlpine. Or they had sleep apnea before and it was tolerable for them, but after COVID they became more sensitive to it and more symptoms appeared.
Similarly, a subset of patients in Dr. McAlpine’s practice had pre-Covid diagnosed or undiagnosed attention-deficit/hyperactivity disorder (ADHD), and long-term COVID caused a “dramatic worsening” of their ADHD symptoms, including forgetfulness and inattention. She says it’s linked to brain fog.
“Some find that the medication they were taking for ADHD stops working for them,” she says.
“I’ve also cared for people who always suspected they had ADHD, but they were high-functioning and stable. Their resistance stopped working with prolonged COVID.
There are other conditions associated with cognitive impairment independent of chronic covid, such as chronic fatigue syndrome and postural orthostatic tachycardia syndrome (POTS).
“Part of the long-term covid is that in people with brain fog who have these syndromes, until we address these conditions, the brain fog will not improve,” Dr. McAlpine said.
4. How do you deal with prolonged covid brain fog?
Long-term Covid brain fog clears up in most people, but lifestyle changes can help, says Dr McAlpine. For example, “One thing we know is that exercise improves cognition in everyone, even dementia patients.
Maintaining healthy sleep habits, staying hydrated, reducing alcohol consumption and avoiding tobacco can also help, she says.
“There’s also an important emotional component,” adds Dr. McAlpine. Many people with brain fog symptoms experience depression or anxiety, and people with pre-existing mental health problems notice that they get worse. But if a mental health problem is diagnosed, it needs treatment.
In addition, Dr. McAlpine said that many of her patients responded well to two medications: N-acetylcysteine (NAC) and guanfacine.
In the year In 2020, Arman Fesharaki-Zadeh, MD, PhD, a behavioral neurologist and neuropsychologist at Yale Medicine, discovered that the drugs could help chronic Covid patients with brain fog, when one of his chronic Covid patients was experiencing similar cognitive symptoms. For patients suffering from post-concussive syndrome in the history of traumatic brain injury (TBI).
NAC was being tested for the treatment of TBI and also helped with cognitive deficits. It added guanfacine, developed by Yale neuroscientist Amy Arnston, PhD, and used to treat ADHD.
The two published a small study in the November 2023 issue Neuroimmunology reports, and now researchers are hoping for funding for large-scale clinical trials. In the meantime, NAC is available by prescription, and patients can get an off-label prescription for guanfacine from their doctor.
“There has also been evidence that Covid vaccines help with chronic symptoms of Covid, such as brain fog, but there are no guarantees,” Dr McAlpine said.
“In the first wave of covid we had many patients who had bad brain fog after covid and their symptoms improved with their first vaccination. But I’ve seen that happen recently, probably because more people are vaccinated. That might be more of a ‘first wave’ phenomenon.
5. Are there strategies to help people cope with brain fog?
While some people experience more severe brain fog than others, many find that there are strategies that can help, says Kaleigh Frame, MA, CCC-SLP, a speech-language pathologist at Yale New Haven Health who has previously cared for chronic COVID patients. He was seen by a Yale medical neurologist. She offers strategies based on the types of cognitive deficits they are struggling with.
First, she teaches patients to develop “self-advocacy skills,” such as being aware of other people’s limitations due to brain fog. She also understands “metacognition,” which she describes as a person’s ability to evaluate one’s own cognitive abilities.
For example, they rate how they are doing at different times on a scale of 1 to 10 and record their numbers on a calendar or reminder app.
“This can help detect brain fog during the day, and track progress or decline,” she says.
“Then the next time you see your neurologist, it won’t be obvious, because you have a written record that you can refer to.”
Another strategy is “brain budgeting,” which involves estimating how much mental energy you have in a day (based on your log) and prioritizing when and how best to use it, ensuring you have time to rest and let your brain work. Power is not used quickly. “Someone might say, ‘I can do these six things, but I need a rehab break in between,'” Frame said.
Frame has specific recommendations for the following brain fog issues:
- memory problems; Try visualization techniques (picture what you want to remember in your head), auditory practice (repeating the thing in your head as a short list), and active listening (repeating back what the person you’re talking to said). . She suggests that people use these techniques for specific practical tasks that they see as the priorities of their day.
- inability to concentrate; During brain fog, “take minimal stimulation breaks,” says Frame. Find a quiet, perhaps dark, area in another room (if possible), put the phone down, close your eyes, and set a timer for a few minutes to regroup. One approach is to do this four times a day to prevent brain fog instead of using breaks as time to recover from stress.
- Difficulty finding the right word; One technique is called semantic feature analysis. “You have a target in your head—whatever the missing word is—and you talk around it,” Frame says. For example, if the target is “lilacs”, it can help to define the group, which is plants; Then the physical characteristics such as purple color and strong smell; And finally, she described their location as a garden. “If you can express it fluently in conversation, you’ll either eventually get the word out or your conversation partner will.”
6. How to get rid of prolonged covid brain fog?
It is impossible to assume that someone will have prolonged covid and/or brain fog. Long-term covid is more likely to occur in people with severe covid illness, pre-existing medical conditions, and unvaccinated people, according to the CDC.
But people with mild infections have long-term symptoms of Covid, and Dr. McAlpine has had healthy patients in their 20s and 30s with brain fog.
If you have brain fog, it’s important to get treatment, Frame says. While everyone is different, both Frame and Dr. McAlpine say treatment and support can help in many cases.
So long news of covid research
Author: Cathy Catella
Source: Yale
Contact: Kathy Catella-Yale
Image: Image credited to Neuroscience News.