Alarmingly Many Non-Hospitalized COVID-19 Patients Will Exhibit Brain Fog For Weeks Or Months After Infection According To University of Oxford Study
: A new study by researchers from the University of Oxford has found that many non-hospitalized COVID-19 patients will exhibit brain fog for weeks or months after SARS-CoV-2 infection.
The study team intended to explore the lived experience of ‘brain fog
’ ie the wide variety of neurocognitive symptoms that can follow COVID-19 infection.
Out of a study group of 50 participants, 84% of participants were female and 60% were White British ethnicity. Most had never been hospitalized for COVID-19.
Qualitative analysis revealed the following themes: mixed views on the appropriateness of the term ‘brain fog’; rich descriptions of the experience of neurocognitive impairments (especially executive function, attention, memory and language), accounts of how the illness fluctuated and in some but not all cases, resolved over time; the profound psychosocial impact of the condition on relationships, personal and professional identity; self-perceptions of guilt, shame and stigma; strategies used for self-management; challenges accessing and navigating the healthcare system; and participants’ search for physical mechanisms to explain their symptoms.
These qualitative findings complement research into the epidemiology and underlying pathophysiological mechanisms for neurological symptoms after COVID-19. Services for such patients should include: an ongoing therapeutic relationship with a clinician who engages with the illness in its personal, social and occupational context as well as specialist services that are accessible, easily navigable, comprehensive, and interdisciplinary.
The study findings were published on a preprint server and are currently being peer reviewed. https://www.medrxiv.org/content/10.1101/2021.08.07.21261740v1
Numerous individuals infected with the SARS-CoV-2 have experienced persistent health issues.
A detailed survey conducted in Britain revealed that approximately one in every five experiences prolonged COVID-19 disease symptoms five weeks post-infection. Also, one in seven people reported persistent symptoms even after twelve weeks. https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/conditionsanddiseases/bulletins/prevalenceofongoingsymptomsfollowingcoronaviruscovid19infectionintheuk/1april2021
In addition, one in ten people was found to remain sick even one year after the COVID-19 infection. This group of individuals is said to be suffering from "long COVID." https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/conditionsanddiseases/datasets/alldatarelatingtoprevalenceofongoingsymptomsfollowingcoronaviruscovid19infectionintheuk
viduals suffering from long COVID experience a reduction in their ability to carry out certain everyday activities or return to work many weeks after the initial COVID-19 diagnosis.
Medical researchers have defined long COVID as a condition of post-acute COVID-19 syndrome, where symptoms persist between 4 and 12 weeks post-infection. It also includes chronic COVID-19 disease, where symptoms are retained beyond 12 weeks.
Patients who suffer from long COVID often complain of wide-ranging fluctuating symptoms, such as fatigue, chest pain, breathlessness, autonomic nervous system disruption and cognitive dysfunction.
Although the underlying pathophysiology behind the above-stated long COVID symptoms remains unclear, medical researchers have explained the probable reasons that result in these conditions. They stated that persistent viremia, deconditioning, relapse or reinfection, inflammatory immune reactions, and several psychological factors are potential contributors to long COVID.
Past studies reported that almost a quarter of a million COVID-19 recovered patients, both hospitalized and non-hospitalized, had succumbed to certain neurological and psychiatric conditions. However, severely infected patients are most prone to these conditions.
About 25% of patients experienced disturbing moods, such as anxiety. Some patients also report experiencing serious problems like psychosis.
Many other neurocognitive symptoms experienced by this group include cerebrovascular events, insomnia, dementia, encephalitis, and disorders of peripheral nerves, nerve roots, or plexus.
Furthermore, previous surveys associated with non-hospitalized long COVID patients reported short-term memory, attention disorders and a general befuddled state of mind, which has been called "brain fog."
Despite the fact that adolescents and children are considered at low risk of COVID-19 infection, recent research highlighted that brain fog was also found in this group.
Medical researchers have identified various possible pathophysiologies for brain fog, such as direct neuroinvasion, neuronal injury or toxicity, glial activation, viral persistence and chronic inflammation, microvascular injury, Lewy body production, and activation of autoimmune mechanisms.
Past studies related to bioimaging had revealed a differential loss of grey matter, in COVID-19 patients, in several key regions of the brain. As a result, individuals suffering from such cognitive impairments face immense difficulties in their daily activities, such as making decisions, communicating, and maintaining social relationships.
The current study focused on three main areas, i.e., a) neurocognitive symptoms experienced by adults with long COVID, b) impact of long COVID symptoms on these individuals, and c) how do these individuals handle the situation?
Further, the researchers of this study also aimed to reveal the mechanism behind psycho-cognitive processes and the pathological effects behind long COVID.
For the research, a total of 50 participants were recruited, among which 23 were recruited from a previous qualitative study associated with lived experience of long COVID patients, and 27 participants were recruited from online support groups with persistent neurological problems following COVID-19 infection.
84% of the participants were female and 60% belonged to White British ethnicity. All the participants were invited to describe their cognitive symptoms, and researchers followed them up via email, 4-6 months later.
The study team audiotaped, transcribed, anonymized the data, and coded using the qualitative data analysis computer software, NVIVO. These data were analyzed by an interdisciplinary team, whose expertise extends across clinical neuroscience, general practice, and the sociology of chronic illness. The interpretation was subsequently evaluated by three people who experienced brain fog.
Interestingly the qualitative analysis revealed mixed views on the description of the term "brain fog." However, the study team obtained detailed descriptions of the experiences of the participants related to neurocognitive impairments, i.e., disorders associated with attention, memory, and language and executive functions. They reported on the fluctuations in the symptoms. Some of the participants revealed that they recovered from all these symptoms over time.
The study team also established the interaction between cognitive and physical symptoms, along with the psychosocial impact on professional and personal activities. The participants used several strategies to mitigate the effects of brain fog, e.g., communication strategies; however, these strategies had only minimal success.
Importantly these qualitative findings add to the research about the epidemiology and pathophysiology underlying symptoms caused by COVID-19. These patients should be provided with the following services: an ongoing therapeutic relationship with a clinician who engages with the illness within its personal, social, and occupational context, as well as access to specialist services that are comprehensive, interdisciplinary, and easily navigable.
The study team did however highlight limitations to the study including the fact that the samples were entirely UK-based. Further, researchers could not include samples from different demographics, minority ethnic groups, and the diversity in occupational classes was also not well captured. Lastly, the participants mainly were infected during the first wave of the COVID-19 pandemic, and long COVID has changed substantially since then.
The study team concluded, "In dealing with COVID-19, it is crucial that health policy begins to shift from acute disaster response to managing a chronic crisis. This study has brought neuroscientists and qualitative researchers to align the subjective illness experience as directly described by patients with the objective disease models that underpin therapeutic options for ongoing 'brain fog' experienced by long COVID patients. The profoundly disabling, persistent impacts in some people revealed here adds weight to arguments that we need to prevent COVID -19 to reduce the long-term burden of this disease on patients, the health service, and the wider economy. Moreover, it is crucial to mitigate the impact for those already affected through a better understanding of the pathophysiological mechanisms of this neurotrophic virus and further exploration of the best approaches to support cognitive, psychological, and occupational restoration."
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