Brain Fog, Fatigue, Other Symptoms Often Persist for COVID-19 ‘Long Haulers’
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It’s estimated that more than half of the U.S. population has been infected by the coronavirus, and that one in five of those individuals have at least one COVID-19 symptom months after their infection. These so-called ‘‘long haulers” are the subjects of ongoing studies, including some by MGH researchers.
For many people who recover from even a relatively mild COVID-19 infection, the symptoms don’t completely disappear. The Centers for Disease Control and Prevention reported recently that around 20 percent of people who test positive for the SARS-CoV-2 virus (COVID-19) continue to report symptoms months after their first positive test.
Several studies, including one recently published in the Annals of Clinical and Translational Neurology, suggest that a majority of COVID “long haulers” report at least one neurological symptom as late as 18 months after symptom onset. In a separate investigation, Zeina Chemali, MD, director of Neuropsychiatry Clinics and Training at Massachusetts General Hospital (MGH) and medical director of the McCance Center for Brain Health at MGH, and colleagues from MGH conducted a 15-month study of 87 confirmed and 13 suspected long haulers who had symptoms at least six month after COVID-19 infection. The findings, published in the Journal of Clinical Neuroscience, noted that some of the most prevalent symptoms of long COVID include “brain fog” (memory problems, confusion, trouble concentrating), headaches, sleep problems, fatigue, and prolonged periods of anxiety and/or depression.
“Commonly, patients with long COVID present with ‘brain fog’, a vague description including lack of sleep, anxiety, depression and a history of headache or migraine combined with trouble with attention and word-finding difficulties, as well as executive dysfunction,” Dr. Chemali says. “In the patients we treated with long COVID who presented with brain fog we found that the root cause of this commonly used term is often multifactorial.”
Who Is Most at Risk?
The number of individuals being treated at MGH’s long haulers clinic has grown significantly. As of June 2022, about 200 patients had been referred to the RECOVER study, a National Institutes of Health study meant to understand why COVID-19 affects certain people differently and why some people are more likely than others to become long haulers.
Dr. Chemali notes that while these questions are still largely unanswered, there has been research to suggest that individuals with high blood pressure, asthma, or metabolic disorders may be at higher risk. There is also evidence to suggest that women and people with a history of migraine, mild traumatic brain injury, anxiety or depression also may be at risk.
“Everyone is still grappling with understanding long COVID,” Dr. Chemali says, adding that similar symptoms are found in patients with other post-viral diseases, post-traumatic brain injury, concussive syndrome, or the complicated and not fully understood chronic fatigue syndrome.
What You Can Do
As researchers continue to explore the mysteries of COVID-19, including ways to better treat the virus and manage symptoms, some clues are emerging. “From a neurocircuitry point of view, we see that frontal networks are the most vulnerable in the post-COVID-19 phase,” Dr. Chemali says.
The frontal networks connect the frontal lobes to other regions of the brain. The frontal lobes are responsible for higher cognitive functions, such as memory, problem solving, emotions, impulse control, social interaction, and motor function.
Dr. Chemali explains that while there are no medications or procedures guaranteed to halt the effects of long COVID, there are some steps individuals can take that may be helpful. She suggests, for example, supporting healthy neurocircuitry by getting sufficient quality sleep. If you struggle with insomnia, obstructive sleep apnea, or other sleep disorders, tell your doctor or consider seeing a sleep specialist.
If headaches or chronic pain affect your sleep and waking hours, talk with your physician about treatment options. Likewise, seeing a therapist for anxiety or depression may have multiple benefits, both psychologically and physically.
A healthy diet and regular exercise—to the extent that you can be physically active—can also help support your recovery.
If you are interested in participating in the RECOVER study, consider joining a study site in your area. Researchers are looking for people who have had COVID-19 and those who have so far evaded the virus. Adults and children of all ages are encouraged to participate. Lab samples, such as blood and urine, will be collected, and some imaging will be done, along with simple physical examinations.
To learn more about the research, visit: studies.recovercovid.org.
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