Long COVID and the brain

Since the start of the COVID-19 pandemic, researchers have worked at lightning speed to develop tests, vaccines and treatments. Despite all these breakthroughs, there’s still a lot we don’t know about this disease, and in particular its long-term effects, otherwise known as long-term COVID.

Fatigue is the most common symptom of long-term COVID, but many people report persistent neurological and psychological symptoms. The effects it has on the brain are some of the biggest unknowns and attract a lot of interest from researchers.

The start of long COVID

Long COVID was largely defined by means of the people who experience it on social media about their symptoms. At the start of the pandemic, people were not warned about the possibilities of long-term COVID because so much was unknown about the new virus.

When the first wave recovered, many previously healthy people described symptoms that persisted or appeared weeks after infection. After fatigue, neurological symptoms such as confusion, poor concentration and memory and brain fog were common.

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One study indicates that the long-term cognitive problems in prolonged COVID may be due to inflammation, as measured by CRP. The liver makes CRP or c-reaction protein in response to inflammation.

Previous studies have linked high CRP and inflammation to long-term cognitive decline and changes in memory, attention, self-control and verbal fluency, but more research is needed on how CRP compares to long-term COVID.

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Silent Strokes

Strokes are common in people recovered from COVIDespecially those over 70.

Silent strokes can also occur, and they usually affect white matter that facilitates communication between parts of the brain and plays a role in attention and other cognitive functions. If someone with COVID experiences a silent stroke, it can significantly affect their brain and they may not even realize that something has happened.

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Alzheimer’s disease

Some studies suggest that COVID survivors are at greater risk for neurological diseases, especially Alzheimer’s disease. Researchers aren’t sure how COVID causes this, but they suspect it could be due to inflammation, encephalitis, organ dysfunction, or changes in the vascular system in the brain.

They theorize that COVID aggravates a pre-existing neurological condition or causes a new one, but more research and monitoring of COVID survivors is needed.

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COVID in the brain

COVID can also directly affect the brain. Researchers know that the virus affects the olfactory muscosa, the tissue at the top of the nasal cavity, because loss of smell is a common symptom of COVID. Some researchers speculate that the virus could get into the brain through this tissue. The virus may also be able to cross the blood-brain barrier because of the inflammation and instability it causes in the body.

If COVID can penetrate the brainstem, long-term neurological symptoms are likely.

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Mental health

Long COVID probably will too take a significant toll about mental health† Little is known about long-term COVID, so there is a lot of uncertainty for people experiencing it and few concrete answers. These things combined with potential loss of income, difficulty getting benefits and general skepticism about long-term COVID can lead to feelings of isolation and depression.

Woman with mental health problems sits desperately on the floor and cries and her dog is next to her ArtistGNDphotography / Getty Images

Difficulties in diagnosing long-term COVID

Researchers have many theories about long-term COVID and the brain, but diagnosis is challenging. Doctors can’t confirm causes of long-term neurological and psychiatric symptoms of COVID if the things suspected of causing it to be not detectable in the brains of COVID survivors.

No lab test or imaging test can provide objective results, so diagnosis depends on the subjective reporting of the person experiencing symptoms. Doctors can rule out other things, but there’s no way to confirm COVID for long.

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Risk factors for long-term COVID

studies show that some people are more prone to developing long-term COVID than others. Women are more than twice as likely to get it than men, and many people who experience long-term COVID symptoms have pre-existing autoimmune conditions, suggesting a possible link.

People with a history of depression, anxiety, or mood disorders were also more vulnerable to developing long-term COVID. Some studies indicate that people who multi-system disease are more likely to develop long-term COVID.

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Prevalence of long-term COVID

Long COVID is an essential part of ongoing COVID treatment and research for many reasons, including the fact that it affects so many survivors. Research shows that 87 percent of people hospitalized with COVID have symptoms 60 days after onset of the illness, and about 4.5 percent of people have mild symptoms that last longer than eight weeks.

Other studies claim that as many as half of unhospitalized COVID patients have at least one symptom that lasts an average of four months. Considering how many people COVID has infected worldwide, millions of people could experience COVID and its effects on the brain for a long time.

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Future research

Diagnosing long-term COVID is complex, and researchers are trying to develop more definitive diagnostic criteria. The national institutes of health have committed to research into long-term COVID.

The goals include determining the underlying cause of long-term symptoms, why some people get it and others don’t, and whether COVID infection can cause changes in the body that lead to chronic heart or brain disease.

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