Long covid and the symptoms of “brain fog”.
There is a symptom, or one remainder of her Covid-19 hangover-like or depression-like: it’s a disorder of the brain’s executive functions that makes basic cognitive tasks unreasonably difficult. If, after an illness with Covid-19, you cannot, for example, understand what a simple SMS says, this is a rare, but real, phenomenon that can last for many months after contracting the virus. Patients with Long Covid they find they can’t handle tasks as simple as filling out forms, while their memory fades and everyday tasks—food shopping, meal preparation, cleaning—become painfully difficult. Their inner world—the daydreaming, the planning, the imagination—seems to fade into an all-enveloping fog. Some patients have lived this way for more than 900 days, while the remaining long-term symptoms subsided.
Of the many possible symptoms of long-term Covid, the brain fog “is by far one of the most disabling and destructive,” says Emma Lands, an expert in primary care at the University of Oxford. It’s also one of the most misunderstood: it wasn’t even listed as a possible symptom of COVID when the coronavirus pandemic began. But over time we found that 20-30% of patients report “brain fog” three months after their initial infection, and these were not people who had needed hospital treatment. Also, this symptom of Long Covid concerns the elderly as much as the young in the prime of their mental life.
Brain fog patients say it’s unlike anything we already know. It is “thicker” than the clouded thinking that accompanies a hangover, stress or fatigue. It is not a psychosomatic delusion: it involves real changes in brain structure and chemistry. And despite its nebulous name, brain fog is not an umbrella term for every possible mental health problem. At its core is almost always a disorder of “executive function,” that is, the set of mental abilities that include focusing attention, keeping information in mind, and blocking out distractions. These skills are so fundamental that when they break down, much of a person’s cognitive edifice collapses. Anything that involves concentration, multitasking, and planning—that is, almost anything important—becomes a pain. It makes conscious decision-making processes those simple decisions that in healthy people are made unconsciously and automatically. Does the brain often lose focus mid-sentence, leading to hesitation, asking the question out loud? “What was I saying now? Oh yes…”
Brain fog can interfere with driving, because the person forgets the destination or the route to take. Some could not even read, because understanding a series of words becomes very difficult. Difficult and time-consuming are the programming, the management of technological devices such as e.g. a dishwasher. Memory suffers, but in a different way than in degenerative diseases like Alzheimer’s. The memories are there, but with executive function dysfunction, the brain doesn’t select the important things to store or retrieve that information efficiently. The person can remember facts from scientific papers, but not events. When he thinks about his loved ones or his old life, everything seems far away. Some feel as if they are floating in a void.
Fortunately, most people with brain fog are not that severely affected and gradually get better. But even when they recover enough to work, they find that their minds are less agile than before. Especially people with sensitive tasks ―eg. surgeons and researchers in laboratories― feel they have lost their dexterity. Some clinicians argue that Covid can cause cognitive impairment. Relevant investigations have already begun. However, patients need help with “brain fog” now. There are no cures: most approaches focus on helping people manage their symptoms with better sleep, good nutrition and other general lifestyle changes. Breathing and relaxation techniques can also help with bad outbursts, and speech therapy can help those who have trouble finding words. Some over-the-counter medications, such as antihistamines, can relieve inflammatory symptoms, while stimulants can enhance concentration.
Some people suddenly return to their former state, while others, even after two years, see no improvement. Between these extremes lies perhaps the largest group of patients—those whose brain fog has thinned but not disappeared: they can maintain a relatively normal life, but only by making the necessary adjustments.