Preliminary research with neuropsychologic assessment shows that people with COVID-19 exhibit deficits in several cognitive domains. 4 Another study reported poor concentration and attention, poor memory, executive functioning deficits, and brain fog at least 28 days after COVID-19. 16Ī recent article explored self reports of cognitive symptoms, including persistent memory loss (34%) and concentration deficits (28%), 110 days after people were discharged from a hospital ward vs an intensive care unit (ICU), and no significant differences were found regarding reported cognitive symptoms between the 2 groups. 15 Some preliminary research suggests risk factors for developing long COVID, and early research suggests that increased age, specific symptoms in the first week of infection, higher body mass index (BMI), and female sex carry a higher risk of persistent symptoms.
14 A hypothesis regarding etiology of cognitive decline is that the virus may enter the brain via nasal passages and the olfactory bulb to directly invade the hippocampus. 12,13 Chronic symptoms are also suggestive of postural orthostatic tachycardia syndrome (POTS). Symptoms may be attributed to mitochondrial dysfunction and metabolic changes however, the pathophysiology is often unknown. Symptoms may be similar to myalgic encephalomyelitis or chronic fatigue syndrome (ME/CFS) and autonomic dysfunction. The underlying pathophysiology of long COVID is unclear. There may be other lingering symptoms, including fatigue, body aches, inability to exercise, headache, and difficulty sleeping. 5 Brain fog is used to describe a sense that thinking is slowed, concentration is fuzzy, and mental abilities are not as sharp as they once were. 2 The terms post-acute sequelae of SARS-CoV-2 (PASC), COVID syndrome, long COVID, and long haulers have all been used to describe people who report persistent cognitive, psychologic, and somatic symptoms after COVID-19. 1-11 As many as 75% of people who were hospitalized with COVID-19 report persistent symptoms even 6 months later. Many people report cognitive symptoms in the weeks and months following diagnosis of COVID-19 (Table). Cognitive Symptoms Reported After COVID-19 There are several important limitations of cognitive screening tests in this context that are discussed at the end of the article. Physicians may choose cognitive screening as an efficient way to evaluate those reporting cognitive issues, and these may inform both treatment recommendations and decisions of whether to refer a patient for more comprehensive neuropsychologic testing. This article aims to provide a preliminary approach to screening cognitive symptoms after COVID-19. We anticipate that physicians will have patients who present with brain fog, a not uncommon symptom in this population.
Although this research is being done, it is occurring primarily in tertiary medical centers and teaching hospitals, and much of the information has not yet entered clinical practice. A timeline for when maximal medical improvement can be expected remains to be determined. For individuals who are experiencing persistent symptoms after infection, we must define current best practices, recognizing that our understanding is evolving. This review addresses reported symptoms weeks or months after infection, how and when neurologists and other physicians might be able to assess these, and whether cognitive screening will inform ability to return to work and treatment recommendations. Many who have cognitive complaints have normal neurologic and physical examinations, lab results, and neuroimaging. 1 Although cognitive symptoms can occur secondary to systemic disease, and a small number of individuals have had meningoencephalitis and vascular events (eg, stroke) during COVID-19, some do not present with any known objective evidence of neurologic insult. Approximately a third of people with COVID-19 report neurologic symptoms. There is an emerging body of literature indicating that a subset of people who experienced SARS-CoV-2 infection have neurocognitive symptoms for weeks or even months afterwards.
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