The Impact of COVID-19 on the Brain

COVID-19 & BRAIN FUNCTIONING

Our social and scientific communities alike have been drastically uprooted since the novel coronavirus impacted the world last December. This article tackles questions regarding COIVD’s effects on the brain, cognition (thinking clarity), and general life functioning related to contracting the coronavirus, as well as discussing the road to recovery (read time: 10 mins)

Image credit: Yamamoto, Ariumi, Nishida, Yamamoto, Bauer, Gojobori, Shimotohno, & Mizokami, 2020 (linked)

Side-effects? Am I a long-hauler? What does this illness really look like?

Although the respiratory side effects are readily discussed, research on other significant side effects are now begining to emerge. In fact, a subset of individuals populalry termed “long-haulers” have reported symptoms that continue to affect their lives, even months after they are considered to have “recovered” or produced a negative COVID test. You might have seen the CBS 60 Minutes news special highlighting such cases. Clealry, the range of symptoms is not fully understood, however, here is what we do know:

• In one of the largest studies yet, published in The Lancet journal on April 6, 2021, researchers reviewed the records of more than 236,000 COVID-19 patients and found:

  • 34% of COVID-19 patients went on to receive a diagnosis for a neurological or psychological disorder within 6 months of contracting COVID-19.

• Apart from COVID alone, the researchers found:

  • there was a 44% increased risk for neurological and psychological illnesses in COVID patients compared to patients recovering from the flu.

  • Although mental health symptoms following COVID-19 are generally more common than neurological complications, the seriousness of both symptoms should be considered as society continues to understand this illness, its trajectory, and recovery.

INITIAL NEUROLOGICAL SYMPTOMS

So what are the neurological complications that can occur if one gets sick with COVID-19? The most common neurological symptoms reported include:

• Headaches and dizziness

• Myalgias (muscle aches and pains)

• Encephalopathy (damage or disease that affects the brain)

• Dysgeusia (distortion of the sense of taste)

• Anosmia (loss of smell)

• Impaired cognition (brain fog)

In a study from a large medical center in Chicago, researchers found:

• More than 40% of patients with COVID-19 reported having at least one of these symptoms at the outset of treatment, and more than 80% reported having at least one of these symptoms during the course of the illness.

Another initial neurological complication that can sometimes occur is delirium.

• Delirium is a syndrome caused by a medical condition (such as COVID-19) and results in acute changes in cognition, attention, and awareness.

• In older patients with COVID-19 who present to the emergency room, there is a significant rate of delirium documented (and some of these patients with no other COVID-19 symptoms).

LONG-TERM NEUROLOGICAL CONSEQUENCES

Research continues to suggest that potential long-term consequences may exist for patients, post-COVID. In particular, cases of mild brain damage due to lack of oxygen (hypoxemia), stroke, and encephalitis (brain infection and swelling) have emerged in the literature.

• Those over the age of 70 may be most vulnerable to these secondary health risks, as their bodies fight to recover from COVID-19.

• Due to these brain insults (e.g., encephalitis, stroke, hypoxemia), profound cognitive impairments can occur. Here are some key points to keep in mind.

  • most of the time, any COVID-related brain damage is mild

  • many survivors, however, report extreme fatigue and overall declines in their mental sharpness and ability

  • These cases may warrant specific investigation from a neuropsychologist

While brain damage can be seen in more severe cases of COVID-19, even mild cases can produce subtle or lingering effects on cognition, as this infection is not fully understood.

• The most common finding is that it can lead to difficulties with sustained attention.

• Many post-COVID individuals describe a kind of “brain fog” associated with their recovery.

• Clinically speaking, brain fog might describe a state of mental confusion or altered mental status — a state of mental functioning that differs significantly from one’s normal range of cognitive ability (or pre-illness baseline).

It is likely that chronic, long-term neuroinflammation can explain these persistent and residual COVID-19 complaints. Such subtle cognitive changes associated with COVID-19 have caused many individuals problems when returning to work and their normal lives. They report that they “just don’t feel completely like themselves.” This can be particularly upsetting for people, as their difficulties may seem largely invisible to others. Furthermore, not all COVID cases behave the same, so it is important to remember:

• It may be easy to feel frustrated, discredited, or shrugged-off by acquaintances who may have recovered without a hitch.

• Even doctors can may come off as invalidating at times. New information is proliferating at an unprecedented rate, and thus, the value of compassion and understanding will be ever-important as we traverse this learning curve together.

LOOKING AHEAD

With the abundance of new research on COVID-19, we still have much to learn about life during and after the virus. Optimistically, however, as we continue to dissect the research, our scientific community will highlight better ways to prevent, screen, and treat COVID-related complications moving forward.

**Receiving accurate information is the first step to a brighter future.

If you have recovered from COVID-19, and feel that you have experienced psychological or cognitive changes as a result of the virus, consulting for a neuropsychological evaluation may be appropriate to assess your current level of functioning – which can support a more personalized understanding of your recovery. To ask questions or discuss your concerns further, please contact us at: (805) 966-6197.

—And as always, remember our informal motto written below:

References

 1.     Couzin-Frankel, J. (2020). From ‘brain fog’ to heart damage, COVID-19’s lingering problems alarm scientists.

2.     Kennedy, M., Helfand, B. K., Gou, R. Y., Gartaganis, S. L., Webb, M., Moccia, J. M., ... & Inouye, S. K. (2020). Delirium in Older Patients With COVID-19 Presenting to the Emergency Department. JAMA network open, 3(11).

3.     Liotta, E. M., Batra, A., Clark, J. R., Shlobin, N. A., Hoffman, S. C., Orban, Z. S., & Koralnik, I. J. (2020). Frequent neurologic manifestations and encephalopathy‐associated morbidity in Covid‐19 patients. Annals of clinical and translational neurology, 7(11), 2221-2230.

4.     Oliu-Barton, M., Pradelski, B. S., Aghion, P., Artus, P., Kickbusch, I., Lazarus, J. V., ... & Vanderslott, S. (2021). SARS-CoV-2 elimination, not mitigation, creates best outcomes for health, the economy, and civil liberties. The Lancet.

5.     Taquet, M., Geddes, J. R., Husain, M., Luciano, S., & Harrison, P. J. (2021). 6-month neurological and psychological outcomes in 236,379 survivors of COVID-10: A retrospective cohort study using electronic health records. The Lancet.

6. Yamamoto, N., et al. “SARS-CoV-2 Infections and COVID-19 Mortalities Strongly Correlate with ACE1 I/D Genotype.” Elsevier, Gene 758. doi: https://doi.org/10.1016/j.gene.2020.144944

7.     Zhou, H., Lu, S., Chen, J., Wei, N., Wang, D., Lyu, H., ... & Hu, S. (2020). The landscape of cognitive function in recovered COVID-19 patients. Journal of Psychiatric Research, 129, 98-102.

For more information about how to best support yourself or your loved ones in older age, please contact me, Dr. Marina Wischnack, Ph.D.

As a psychologist with specialty training in neuropsychological testing, the brain, and behavior, I have the knowledge and experience to help you and your family with diagnosis, treatment planning, and coordination among other professionals (e.g. neurology, radiology, social work, psychiatry). We can make sense of your condition and help you reduce its impact on your family and life.

At Insight Neuropsychology we provide personalized assessment and treatment services to promote cognitive health and well-being. We help you learn about how your child’s brain is functioning and how their environment is affecting them, as INSIGHT is the first step in improving your mental functions.

Want information about Aging-well?

We have online courses available for people across the age range, including a course on mindfulness and the developing brain.

Click the INSIGHT SKILLS link above to see our courses!

Scams Against the Elderly Are HUGE: Luckily Authorities Just Stopped One Large Romance Scam

Dr. Lande and FBI Victim Specialist Debbie Deem

As part of my practice I consult with and provide training to various law enforcement groups on elder abuse. Last week I provided a training for the FBI. One of the main topics I cover is victimization of seniors by mass market scams.

We have all received such solicitations. A computer phone call stating that we owe the IRS, or an email from a member of the Nigerian government who needs help smuggling money out of the country and knows that you would be the perfect person to assist, or perhaps that too good to true connection on a dating website who just never quite seems available to meet in person.

These scams work by convincing us to use emotional reasoning, rather than logical reasoning. They use visceral motivations like fear and greed, along with a sense of authority, to get us to respond. And they require urgency, so that we don’t have time to think about what we are doing.

Unfortunately, older adults are a prime target due to factors such as greater wealth concentration, loneliness, and some of the cognitive processing changes that occur as we age. Scams are a difficult crime to stop as they are cheap and easy to do, and are often based out of the country, making it hard for law enforcement to intervene.

Luckily, as you can read about in this story, Federal authorities were recently able to stop a large romance scam targeting women around the world, but with at least some of the perpetrators based in the US.

Education and awareness is often one of the best ways to prevent yourself and your loved ones from falling victim. Remember, if anyone is demanding an immediate payment, especially with any type of gift card, it is probably a scam.

Remember, you can contact law enforcement if victimized by these scams and it is important to report them. A good place to report them is the FBI’s Internet Crime Complaint Center. Sometimes, if you are quick enough it is even possible to get your or your loved one’s money back.

For a free video on the aging brain and scams, click the button below. There is also a button linking to a recent article I wrote on mass market scams.

Want to talk about these issues in person? Please feel free to reach out to us at Insightneuropsych.com.

Can a Neuropsychological Assessment Help?

Something on Your Mind?

It can be easy to feel like something is wrong with your brain, or a loved one’s.

Perhaps you can’t get your life organized, and a friend tells you to investigate ADHD. Or perhaps you worry that a recent time when you just couldn’t think of a word might have been an early sign of dementia. Perhaps a loved one has had a brain injury, but you are not sure how it is has really affected them. You just know they are not the same.

This Is Where Neuropsychology Comes In

Neuropsychology is the study of how our brain relates to our behavior. As neuropsychologists we study a person’s thinking skills and behavior to determine if there is something to these worries. We explore a person’s strengths and weaknesses to help them gain insight about their brain. The goal is to help protect it, strengthen it, and thrive.

How Neuropsychology Works

You may have seen one of phrenology models before. Unfortunately, it’s not this simple.

One of the best ways to learn how your brain is functioning is to see a neuropsychologist. A clinical neuropsychologist is a licensed psychologist who has obtained further training and specialization in brain functioning, allowing us to better understand and treat conditions that involve both the brain and behavior.

We conduct testing to determine an individual’s pattern of strengths and weaknesses in attention and concentration, learning and memory, language skills, and judgment and reasoning and other cognitive skills. The tests are noninvasive and mostly verbal or paper and pencil. A subject might be asked to solve puzzles or remember a story. Neuropsychological testing does not involve needles or cause hurt or discomfort. Depending on your condition we may or may not use computer-based tests.

Once you finish testing, we compare the results to your peers, other people of your age and education. We call this data norms, or normative data, and it lets us see how your performance relates to everybody else. Yes, your brain slows down a bit as you age, but that doesn’t mean you have dementia. We compare you to other people your age for that reason.  This can help us understand how you learn and identify the types of problems that are holding you back. Analysis of your patterns of performance, along with consideration of medical history and life story can help us understand what is occurring, including what your condition is or what might be holding you back.

Then we get to the important part.

Assessment is just one piece of the process, even if it is the part that everyone thinks about when they think of neuropsychological assessment. Once we assess you, we make recommendations to help you. Good recommendations should be thorough and wide-ranging. We might teach you some new ways of learning or remembering information, or we might suggest breathing techniques that can help overcome test-taking anxiety. We will make recommendations about further education and support for you and family members, and we will discuss how you can adapt your environment to be more efficient and successful. One hint, if you make a place where you always leave your keys or purse, like a bowl on your dresser, you are going to be a lot less likely to lose them. Think an assessment might help you or someone you know, feel free to contact us at insightneuropsych.com today and learn how we can help!

How

Neuropsychology

Helps

1.       Neuropsychological assessment is the best way to measure how your brain’s functioning affects YOU. Although MRIs and other brain scans are important, none examine a person’s actual thinking abilities.

2.       Neuropsychological assessment determines what abilities are truly impaired, by using standardized tests to compare your actual performance to your peers. It is also the most systematic method for monitoring a person’s condition over time to determine if treatment changes are needed.

3.       Neuropsychological assessment assists diagnosis, by identifying patters of performance that are characteristic of certain conditions. It also detects subtle impairments that can cause later problems as people return to their regular activities. This can help target problems that still need to be worked on.

4.       Neuropsychological assessment provides treatment recommendations that are tailored to you to help you be more successful. The goal is to help you improve weaknesses or better compensate for them.

When Should Neuropsychological Assessment Be Sought?

• If you struggle with concentration or memory or it has held you back at times, an assessment may help to clarify the issues and suggest how you can address them.

• If you notice a change in mental functions (such as memory, reasoning, or attention) in yourself or someone else that is affecting the person’s ability functional skills (like forgetting to pay bills or how to use a cell phone), it is time to seek an evaluation to clarify and confirm the difficulties.

• It is especially important in the first few months following a brain illness or injury, as treatment is most effective when it occurs soon after the change in functioning.

Interested in Learning More, or Want an Assessment?

At Insight Neuropsychology we provide personalized assessment and treatment services to promote cognitive health and well-being. We help you learn about how your brain is functioning, as INSIGHT is the first step in improving your mental functions.

Our psychologists have served Ventura and Santa Barbara Counties since 2003. We have experience working in hospital settings, with school settings from elementary to university, and with neurology and other medical specialties.