Cerebral fog after COVID-19 – what is it and how to deal with it? [WE EXPLAIN]

They forget words and information, do not know how to do something they could have done with their eyes closed, suffer from headaches and olfactory disorders, feel alienated, learn and work slower, and are constantly tired. Up to half of those recovering can experience brain fog symptoms. The scale of the occurrence of the phenomenon has already led to giving the syndrome its own name for these characteristic symptoms. Bożena Adamkiewicz, MD, a neurologist who works with patients after a home course of COVID-19, talks about what the povid fog is, where it comes from and how to deal with it.

1. Up to half of the healed may suffer from the so-called brain fog after undergoing COVID-19
2. The symptoms of pocovid fog are not only problems with memory and concentration, but also fatigue, difficulty formulating thoughts, anxiety
3. The neurologist explains what tests you need to do and what can help
4. You can find more such stories on the TvoiLokony home page

Paulina Wójtowicz, MedTvoiLokony: What is brain fog?

Bożena Adamkiewicz, MD, PhD: To begin with, “brain fog” is not a medical term. It is a popular, non-scientific term for a set of symptoms such as: headaches, cognitive disorders, concentration and memory disorders, and a sense of alienation. In the case of ailments after COVID-19, it also means long-term fatigue, a problem with divided attention or an olfactory disorder that lasts longer than three months and in which the ENT cause has been excluded.

In many cases, patients seem to be completely healthy, functioning properly and only they notice that something has changed, for example, they cannot recall something quickly, they have something on the tip of their tongue, they work slower, but they did not have it before. According to the literature, from 30 to 50 percent suffer from this type of disorder. patients who have had SARS-CoV-2 virus infection, not necessarily severe.

The editorial board recommends: The healers are not healthy. The doctor tells them what is wrong with them most often

Patients did not report such problems before the pandemic?

Of course, there were frequent problems with memory and concentration, but mostly older patients reported them. Occasionally, the reason for visiting a neurologist were olfactory hallucinations, which so far have been associated mainly with hook seizures in epilepsy, while weakened sense of smell was the first symptom of Parkinson’s disease. Generalized brain damage can occur in the course of many diseases, the symptoms of the so-called brain fog are experienced, among others, by oncological patients after chemotherapy. It is uncharacteristic for convalescents that these discomforts last much longer than the symptoms of infection.

Why do such disturbances occur?

Theories are different. It is believed that the direct role of the virus is not as important as it might seem. An interesting study was conducted analyzing the autopsy brains of people who died after infection with SARS-CoV-2. Among other things, it was checked how much virus was actually in them. It turned out that in the brains of people who complained about pocovid fog during their lifetime, there was not so much RNA material or virus proteins. There was a clear disproportion between the concentration of the coronavirus and the severity of the disorder.

1. See also: The brains of patients who died from COVID-19 were examined. What was found in them?

What is the conclusion?

For example, there may be an excessive inflammatory reaction. Examination of the cerebrospinal fluids of these patients showed high levels of cytokines, which would indicate an autoimmune background. This would suggest a dysregulation of the immune system, a situation where the body begins to produce antibodies against its own structures. This mechanism is known in neurology, but it has been assumed that it may also be important in connection with SARS-CoV-2 infection.

In addition, another study found small and large infarcts, many of which were hemorrhagic, in autopsy materials from patients who died from COVID-19. Activation of microglia with the presence of microglial nodules with accompanying neuronophagy has also been demonstrated. These changes were most visible within the brain stem. Researchers also observed a rare accumulation of T cells in perivascular areas or in brain tissue.

Who goes to the neurological clinic as part of the «STOP-COVID» program?

Among people with a mild course of COVID-19 infection who are referred to us by GPs, cardiologists or pulmonologists, the vast majority are patients suffering mainly from anxiety and depressive syndromes, which they did not have before the infection.

How are they diagnosed?

First of all, we perform neuroimaging and EEG examinations, if they have abnormalities in the neurological examination, sometimes a lumbar puncture. In some cases, magnetic resonance imaging shows changes, mostly vascular, which are insignificant, but most often the brain image is normal, as are the electroencephalography records, i.e. the bioelectrical activity of the brain. It often happens that in patients with normal test results, during psychological tests, including the assessment of cognitive functions, and if necessary, as a result of psychiatric examination, apart from concentration disorders and chronic fatigue syndrome, anxiety disorders and / or or depressive. Then we propose appropriate treatment to such a patient.

Anxiety as a result of a pandemic?

Yes, in part. The pandemic lasts a long time and to some extent, such permanent stress associated with it makes patients more sensitive not only to infections, but also to life failures, and they can react to them with such a strong anxiety-depressive syndrome.

Today we are afraid of everything: vaccinations, the consequences of the disease, what the world and our lives will look like after the pandemic, we are worried about whether we will ever have a rest, whether our children will be healthy, and so on. Added to this is the limitation of contacts with the family, the lack of meetings with friends, which, after all, reduce mental tension. Anxiety is ubiquitous and certainly – in addition to the role of comorbidities – it contributes to the fact that we go through COVID-19 harder and we feel more ailments after the disease. It is also often the case that the course of the disease itself is mild, but the infection is a drop that spills the cup, it exceeds our tolerance limits.

How long does it take for the symptoms of pocovid fog to pass?

It is a very individual matter. I have patients who have recovered from them after a month, but there are also some who are relieved of the disorders after three, four or five months. And in fact, the literature talks about the duration of fog after COVID-19. However, there are case reports where such cognitive dysfunctions last longer. However, it seems to me that these patients simply reveal diseases that they would have developed anyway.

COVID-19 is accelerating them?

Hard to say. This requires observational studies, comparing groups of people who were infected with those who were not, and then assessing the incidence of different diseases, including degenerative, demyelinating, and vascular diseases in both groups. Then it will be possible to assess whether people who have suffered COVID-19 actually suffer from a significantly more frequent disease. It is worth remembering that we are still a population that has its own risk factors for the development of vascular, degenerative, dementia and many other diseases. The pandemic has brought about one additional disease, but the rest still affect us, and we can’t put everything under one denominator. Not everything is related to covid.

Read the second part of the interview to find out what can help with brain fog:

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