Cognitive impairment is a common sign of COVID-19 and many people who suffer from persistent symptoms after the end of their infection report a “brain fog.” This can first show up as a difficulty to understand something you are reading or performing everyday tasks like cooking or planning your grocery list. It may shrink down someone’s creativity as daydreaming or imagination may become a struggle.
Long COVID still needs extensive studies to establish clear mechanisms and even reach an official definition. However, brain fog easily gets discarded compared to other symptoms like immune dysfunction or gastrointestinal issues. Brain fog can nevertheless be one of the most disabling long COVID symptoms even if most people dealing with it do not exhibit sharp physical symptoms like reduced lung or cardiovascular function.
Another concern with the brain fog associated with long COVID is how it can affect people of any age. People with brain fog often report how this issue goes deeper than quick and minimal episodes of clouded thinking due to stress or fatigue.
Brain Fog and Executive Dysfunction
Some misconceptions about brain fog interfere with understanding how it affects people with long COVID. Brain fog does not cover all sorts of mental health issues. It impacts executive function and cognitive abilities such as focus, memory, and multitasking. These mental skills are foundational to someone’s cognitive process. When long COVID brain fog happens, skills that were taken for granted and unconscious functions, become challenges and require conscious efforts with varying success.
Brain fog can be mild to severe and even people who recover over time often report continuous struggles, even if milder than at the onset of long COVID. Other individuals may sustain an impaired executive function that prevents them from performing their professional occupation or daily tasks.
Brain Fog and Medical Legitimacy
Brain fog is a diagnostic criterium for myalgic encephalomyelitis (chronic fatigue syndrome) and people who have HIV, fibromyalgia, or other chronic conditions can experience it. Cancer patients may also deal with “chemo brain,” which shares symptoms with brain fog.
However, people reporting brain fog for years did not mean the issue was taken seriously or considered worth investigating. Some have argued that the term itself is a problem because it makes brain fog sounds like a mild inconvenience that goes away on its own, discarding the many reports of lasting cognitive impairment and executive dysfunction.
The stigma attached to brain fog can also lead people to make efforts to appear without cognitive issues in their professional life or even during medical appointments. The unpredictability of brain fog can even have people seem like they have their full mental capacity because they did not experience executive dysfunction at the time of a health checkup.
Lacking Research and Diagnostic Tools
One of the existing protocols physicians have is the Montreal Cognitive Assessment. However, this tool aims to diagnose severe mental issues in elderly individuals who have dementia. People with severe brain fog may still pass the test with little to no difficulty. Even other protocols that compare someone’s cognitive abilities to a normal baseline may not effectively reflect brain fog as someone who previously had a high executive function may still fall within the acceptable range. This could lead to the dismissal of their brain fog issues once again.
Discrediting patients’ symptoms is not new or specific to those with long COVID, including brain fog, especially when patients are women or from a minority group. There is a dire need for research on brain fog and the creation of appropriate evaluation tools.
Some medical imaging technology like brain MRI and scans have started to shed some light on regions affected in people with long COVID brain fog. Further studies must happen to confirm initial observations but the early reports of changes in areas supporting memory and execution functions offer some possible explanations.
Possible Causes for Long COVID Brain Fog
A current hypothesis is that neuro-inflammation is the primary cause of brain fog in long COVID patients. Studies have shown that COVID can sometimes cause an infection of the central nervous system, but this development is not widespread. Although more research is necessary, neuro-inflammation could explain the wide range of issues caused by brain fog and it could mean that the condition is reversible.
Other possible explanations for the emergence of brain fog could be that the initial COVID infection triggers certain chronic conditions like chronic fatigue syndrome or multiple sclerosis, or dormant viruses like the Epstein-Barr one. The impact on the brain could result in executive dysfunction associated with brain fog.
Limited Treatment Options
Although medical research can further our understanding of brain fog and help design more effective diagnostic methods, people who are experiencing it right now need help. Symptom management is the most common approach at this time.
Lifestyle habits are common options to recover from brain fog like a consistent sleep routine and a balanced diet. Someone’s recovery changes are uncertain as some people may unexpectedly recover without specific efforts while others may continue to struggle despite mild to moderate improvement.
Common health advice to engage in regular physical activity may backfire because many people with long COVID are prone to post-exertional malaise like patients with chronic pain syndrome. Learning how to manage their energy to avoid crashing and needing additional recovery time from a simple task can make a positive difference.
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