Link Between Post Covid Syndrome and Cognitive Impairment

The Hidden Long-Term Cognitive Impairment Effects of COVID-19

Cognitive impairment is when a person has difficulty remembering, learning new things, concentrating, or making decisions which affect their everyday life. The COVID-19 pandemic has now cost the lives of as many Americans as the First World War, Vietnam and Korea combined. Most of these deaths are because of the well-known pulmonary problems of the coronavirus. It has become increasingly recognized, although, that the virus also attacks the nervous system.

Primary Care Physicians in a large Chicago medical center found that more than 40% of patients with COVID showed neurologic manifestations at the outset, and more than 30% of those had damaged cognition. Sometimes the neurological manifestations could be devastating and could even lead to death.

Although, new research is now recommending that there might be long-term neurologic aftereffects in those who survive COVID infections, including more than 7 million Americans and another 27 million people all over the world. Especially troubling is increasing evidence that there might be mild — but very real — brain damage which happens in many survivors, causing pervasive yet subtle cognitive, behavioral, and psychological complications.

How COVID Harms the Brain

COVID could cause damage to the brain directly by encephalitis, which might have devastating or subtle aftereffects. In one British study of twelve patients with encephalitis, 1 made a full recovery, ten made a partial recovery, and 1 died. This study also discovered that a number of patients with COVID suffered strokes.

In fact, COVID disease is a risk factor for strokes. A group of Canadian primary care physicians discovered that individuals over 70 years of age were in particular high risk for stroke associated to COVID disease, but even young individuals are 7 times more likely to have a stroke from this coronavirus versus a normal flu virus.

Autopsy data from COVID patients in Finland indicates that another major cause of brain injury or damage is lack of oxygen. Especially worrisome is that many of the patients who were autopsied did not display any signs of brain injury during the course of their COVID disease still all had brain damage. In 1 patient there was loss of taste, and in 2 there was “minimal respiratory distress,” but none of these patients were thought to have any brain damage when alive.

Major Cognitive Effects of COVID

In survivors of intensive care unit (ICU) stays because of acute respiratory failure or shock from any cause, one-third of people display such a profound degree of cognitive impairment that performance on neuropsychological testing is comparable to those with moderate traumatic brain damage. In everyday life, such cognitive effects on memory, attention, and executive function could lead to complications handling medications, managing finances, understanding written materials, and even carrying on discussions with friends and family.

Generally observed long-term psychological effects of intensive care unit (ICU) stays include anxiety, depression, and post-traumatic stress disorder (PTSD). Effects because COVID intensive care unit (ICU) stays are expected to be identical, a prediction which has already been confirmed by the studies in Britain, Canada, and Finland reviewed above.

Subtle Cognitive Effects of COVID

It is clear that COVID could cause brain damage by direct infection or encephalitis, by strokes, and by lack of oxygen. It is also clear that when patients experience serious disease requiring an intensive care unit (ICU) stay, brain damage is highly likely to happen, and its effects are generally obvious. But what if the COVID disease is not that serious? Can brain damage still happen?

A Chinese group of primary care physicians and scientists examined various aspects of cognitive function in 29 individuals who were thought to have completely cured from COVID disease. They found continuous impairment in sustained attention and the ability to attend to crucial information for as long as it is relevant.

Long-Term Cognitive Effects of COVID Disease

Why would sustained attention be continuously impaired in individuals who were thought to have completely cured from COVID? The Chinese group thought it may be linked to underlying inflammatory processes. But it is equally likely that patients with COVID suffered silent strokes or lack of oxygen which damaged their brains. As discussed above, strokes because of COVID are normal, especially in those over the age of 70.

We know that silent strokes frequently happen, and are a risk factor for both large strokes and dementia. Silent strokes generally affect the brain’s white matter, the wiring between brain cells which enables different parts of the brain to communicate with each other. This wiring is important for attention, and when it is damaged, sustained attention is impaired.

The bottom line

There is one unpreventable conclusion from these studies: COVID disease frequently leads to brain damage especially in those over the age of 70. While sometimes the brain damage is obvious and leads to major cognitive impairment, more frequently the damage is benign, leading to complications with sustained attention.

However, many people who have cured from COVID could resume their daily lives without difficulty even if they have some deficits in attention there are a number of people who might experience difficulty now or later. One recently published paper from a group of German and American primary care physicians concluded that the combination of direct effects of the virus, systemic swelling, strokes, and damage to body organs (for example lungs and liver) can even make COVID survivors at high risk for Alzheimer’s disease in the future.

Individuals whose professions involve medical care, legal advice, financial planning, or leadership including political leaders might require to be carefully assessed with formal neuropsychological testing, including measures of sustained attention, to make sure that their cognition has not been compromised.