COVID-19 Linked to Years-Long Cognitive Impairment: Study

Brain fog, the struggle to recall words, and forgetting why you entered a room may be more than mere annoyances. They could be lingering symptoms of COVID-19.

Researchers in the UK found that individuals reporting long-lasting COVID-19 symptoms—persisting for at least three months post-infection—exhibited diminished capabilities in areas such as memory, reasoning, and motor control. The findings were recently published in The Lancet’s eClinicalMedicine journal.

“The fact remains that two years on from their first infection, some people don’t feel fully recovered, and their lives continue to be impacted by the long-term effects of the coronavirus,” Claire Steves, co-author of the study and a professor at King’s College London, wrote.

The study engaged 3,335 individuals from the United Kingdom COVID Symptom Study Biobank for a two-round evaluation spanning July 2021 to June 2022.

The participants, including both those who tested positive for SARS-CoV-2 and and those who tested negative, were assessed across 12 different tasks. These tasks were designed to test cognitive functions such as working memory, attention, reasoning, processing speed, and motor control.

The analysis specifically examined the effects of COVID-19 exposure on cognitive accuracy and reaction time. It also looked into the role of ongoing symptoms after infection with the aim to provide valuable insights into the impact of the virus on mental functions.

Researchers found notable cognitive deficits in individuals who tested positive for SARS-CoV-2 and experienced symptoms for 12 weeks or more. These deficits—detected in areas such as visual memory and attention—were comparable in scale to the effect of aging by 10 years or being hospitalized during the illness. Notably, the deficits persisted almost two years after the infection in some cases, which raised concerns about the lasting effects of COVID-19 on cognitive function.

When asked about the daily implications of cognitive deficits as compared with approximately 10 years of aging, Ms. Steves offered a sobering perspective to The Epoch Times.

“The effects are tangible, and although they are relatively small, they are probably noticeable in everyday life,” she explained.

Ms. Steves said that the data represent an average across varying cases.

“The changes we report are average changes across groups of people, and some people will experience more or less,” she said.

Self-Perception of Illness and Recovery

The study also sheds new light on how people’s self-perception of their recovery from COVID-19 correlates with their actual ongoing symptoms. The research divided individuals who had developed COVID-19 into groups based on their responses to the question, “Thinking about the last or only episode of COVID-19 you have had, have you now recovered and are back to normal?”

Those who answered “Yes, I am back to normal” didn’t show cognitive deficits.

“Importantly, we found no detectable impairment among people who reported as feeling recovered and ‘back to normal’ after their COVID-19 illness, even among individuals who experience long-term symptoms [for as long as or longer than] 12 weeks,” the authors noted.

On the other hand, those who answered, “No, I still have some or all of my symptoms” revealed an increase in cognitive impairment. The study found that psychological distress and fatigue partially mediated these deficits.

According to the study’s authors, self-perceived recovery was “highly correlated with symptom duration.” This discovery aligns with smaller studies that have examined recovery self-assessment.

However, caution in interpretation is advised. Dr. Armen Nikogosian, a medical and functional physician treating long-COVID-19 patients, spoke about the complexity of the issue.

“Patients who suffer from the effects of long COVID are typically sidelined in conventional medicine,” he told Epoch Times. “It’s entirely possible that these patients continue to have symptoms not identified or validated by their health care providers.”

The relationship between self-perception, symptoms, and recovery appears multifaceted, and this study illuminates some aspects of that complexity.

Cognitive Decline Following COVID-19

Cognitive impairments following infections with viruses such as SARS-CoV-2 are well documented, but the experience of living with the resulting “brain fog” is a complex and distressing reality for many.

Dr. Katherine Pannel, a psychiatrist and medical director of Right Track Medical Group in Oxford, Mississippi, experienced brain fog after contracting COVID-19 and describes the frustration of the condition.

“I was hesitant to do any kind of public speaking because I knew what I wanted to say, but I could not find the words. It was so frustrating,” she shared on AMA’s What Doctors Wish Patients Knew.

In January 2021, Jill, a respiratory therapist from Boston, experienced a mild case of COVID-19, marked only by a loss of smell and taste. As the year progressed, symptoms such as fatigue, forgetfulness, and getting lost while driving emerged. Jill’s physician husband helped her to investigate, leading to a diagnosis of mild cognitive decline, believed to be related to COVID-19. They embarked on a regimen of supplements, anticoagulants, red-light therapy, dietary changes, and at-home rehabilitation.

Despite facing setbacks that included microclotting and cognitive impairment, Jill’s continual efforts in rehabilitation—guided by medical professionals—have yielded improvement. Through perseverance and a regimented daily routine focused on diet, exercise, and cognitive training, she has seen progress in her recovery, although challenges remain.

The frustration extends beyond the symptoms themselves, as many sufferers face skepticism and disbelief about their condition, Dr. Pannel said.

“As a psychiatrist, I’m used to stigma surrounding mental health with depression and anxiety, but I’m even starting to see stigma surrounding long-COVID brain fog where a lot of people aren’t believing that it exists,” she said. “And patients are frustrated because they have all these symptoms, but there’s not a lab test or imaging to prove this is what’s going on.”

Solid data backs this anecdotal evidence. A 2022 meta-analysis published in Alzheimer’s and Dementia analyzed 27 studies and found that adults recovering from COVID-19 displayed noticeable deficits in executive functions, attention, and memory up to seven months after infection.

This systematic review, including 2,049 people, shed light on a marked decrease in cognitive scores among those with no prior history of impairment. Determining the underlying causes of cognitive decline following COVID-19 remains a complex and unfolding area of study.

“Often underlying their cognitive decline is chronic inflammatory response syndrome, a complex illness in which individuals process biotoxins differently,” Dr. Nikogosian said.

“Biotoxins from a variety of sources, like mold, pathological gut microbes, Lyme disease, and chronic infections, can lead to chronic inflammation for some individuals.”

This presents a challenge, he said, “when these individuals contract COVID, they struggle to clear the virus, resulting in symptoms such as brain fog.”

Dr. Nikogosian said that treating long COVID isn’t as simple as finding a quick-fix solution. Instead, the underlying health issues must be addressed with care and consideration, reflecting the multifaceted nature of the disease.

Cognitive Decline: Virus or Vaccine?

The intersection of cognitive decline and COVID-19 extends beyond the virus, touching on a growing concern: the potential relationship between cognitive decline and COVID-19 vaccinations. Multiple case studies have identified cognitive decline in individuals following receipt of the COVID-19 vaccine. This phenomenon, labeled functional neurological disorder, has created a parallel dialogue about the cognitive impacts of both the virus and the vaccine.

The authors of the primary study adjusted for vaccination status. “We found only short-term symptoms with the COVID vaccines generally,” they told Epoch Times. “And we have another study which shows that the COVID vaccine seems to improve long-COVID symptoms. That’s in large studies and suggests the vaccine is, overall, helpful.”

In his practice, Dr. Nikogosian doesn’t differentiate between the cognitive decline in patients who’ve received the vaccine and those who were infected with the virus.

“The spike protein operates similarly in both the vaccination and the actual virus, both of which can potentially trigger cognitive problems,” he said.

His perspective underlines the complexity of understanding the cognitive impact in the age of COVID-19, when both the virus and the vaccine present a set of questions and considerations that are still being explored by the medical community.

Study Limitations

The study, while insightful, isn’t without limitations. Data critical to the research—such as prior neurovascular and neurodegenerative comorbidities and pre-infection cognitive assessments—were largely unavailable. Treatment or cognitive rehabilitation information following SARS-CoV-2 infection was also missing.

The cognitive tasks employed weren’t exhaustive, and a more complete understanding might have been possible with full neuropsychological testing. However, such in-depth analysis wasn’t feasible on this scale.

“The biggest limitation to this study is that it relied on voluntary prospective logging of symptoms, which, as we know, is highly subjective. The study offers some excellent insight on COVID-related cognition but needs further scientific validation,” Dr. Nikogosian said.

Selection and participation biases might also have influenced the results, despite efforts to mitigate them. The study’s findings may not be entirely generalizable, given the study’s cohort composition. Notably, there were lower proportions of males, racialized nonwhite ethnic groups, those without a university-level education, and residents of more deprived areas, all compared with the broader UK population.

Navigating the Next Steps

As the understanding of long COVID’s impact deepens, the next chapter will leverage this knowledge into action and guidance. In June 2023, the U.S. Department of Health and Human Services (HHS) took a decisive step by issuing an advisory to assist primary care clinicians in identifying and managing mental health symptoms of long-term COVID-19, including cognitive impairment.

This guidance comes at a crucial time, with the advisory revealing that at least 10 percent of COVID-19 patients experience symptoms of long COVID, a condition that may worsen and continue in a pattern of relapse and recovery.

Dr. Rachel Levine, the department’s assistant secretary for health, has emphasized the importance of this directive, stating, “We know that people living with long COVID need help today, and providers need help understanding what long COVID is and how to treat it. This advisory helps bridge that gap for the behavioral health impacts of long COVID.”

Long COVID is a federally recognized disability. This recognition comes under the Americans with Disabilities Act, Section 504, and Section 1557, specifically when it substantially limits one or more major life activities.

The guidelines provide a clear definition of the impact: “A person with long COVID who experiences memory lapses and ‘brain fog’ is substantially limited in brain function, concentrating, and/or thinking.”

This official recognition underscores the seriousness of long COVID and opens the doors to essential support and accommodation for those living with its lingering effects.

“We don’t know the long-term implications yet, but our findings would suggest that we should keep an eye on this, and be aware and compassionate with colleagues and patients reporting brain fog after COVID-19,” Ms. Steves said.

Treatment protocol for Brain Fog 

  • LDN (low dose naltrexone) appears to play a pivotal role in treatment of many neurological symptoms 
  • Fluvoxamine; Start on a low dose of 12.5 mg/day and increase slowly as tolerated. Some patients report a significant improvement with fluvoxamine while other patients appear to tolerate this drug poorly. Fluoxetine 20 mg/day is an alternative, as are tricyclic antidepressants. 
  • Nigella Sativa; 200-500 mg twice daily. 
  • Valproic acid and pentoxifylline may be of value in these patients. 
  • These symptoms may be mediated by Mast Cell Activation Syndrome (MCAS).
  • Luteolin: Long-COVID syndrome-associated brain fog and chemofog: Luteolin to the rescue [R].
Note: Ivermectin is not thought to readily cross the blood-brain barrier in humans as it is excluded by a P-glycoprotein drug pump (mdr-1). (PubMed)

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