PHOTO CREDIT: NICK DOLDING—GETTY IMAGES
Corbett O’Connor has contracted the coronavirus three times. The first infection was in April 2020, the second a year later, and the third in the fall of 2022.
But until now, the New York native is feeling better. His longest-running symptom—brain fog—has finally gone, and he’s doing well in his new remote role in the construction management industry.
O’Connor said: “It’s been almost a year since I was last infected with the new crown virus. Now, through both physical and mental treatment, I am starting to feel that I am free from the aftereffects.”
Some studies estimate that brain fog may affect as many as 70% of patients infected with COVID-19. Today, doctors are still trying to understand brain fog and trying various treatments that might bring relief to patients who experience brain fog months after contracting the new coronavirus. Studies have shown that compared with people who have not been infected with the new crown virus, those who have been infected with the new crown virus have a significantly higher rate of brain fog – even if they do not notice it – and these symptoms can be seen after 6 months to 9 months. just disappeared.
Theories about what causes brain fog are still debated, and treatments vary widely. In the summer of 2022, O’Connor sought treatment with Dr. Raphael Kellman, an internist and functional medicine physician at the Kellman Wellness Center in New York City. Kellman’s approach to treatment is based on the idea that these symptoms are triggered by inflammation in the brain.
“Brain fog is a very prominent problem,” Kelman said. “People have memory loss and distractedness when they are doing things. The first problem is actually chronic inflammation. At this time, the immune system is still working, and the brain is still in a state of constant hyperinflammation.”
Physicians at the University of Pittsburgh Medical Center opened the Post-COVID-19 Recovery Clinic in November 2020, taking a variety of different approaches to treating patients. They point out that the cause of brain fog in patients infected with the new crown has not yet been determined. Doctors have instead focused on treating the more than 500 patients suffering from the aftermath of COVID-19.
“Probably the most common complaint among patients is decreased exercise tolerance, sometimes accompanied by shortness of breath,” said Carla Yoney, a senior practicing physician at the University of Pittsburgh’s Post-COVID Rehabilitation Clinic. “Secondly, the most common symptoms are probably brain fog and fatigue.”
Those with symptoms of brain fog are often referred to a speech therapist for cognitive rehabilitation. There, patients undergo a series of brain exercises week after week to get the brain functioning normally again.
“We’re focused on symptom management. The bottom line is we can’t even speculate whether brain fog is inflammation until we have enough comprehensive data,” Yoni said.
Brain Fog Symptoms of COVID-19
O’Connor first noticed something was wrong when he returned to work. Suddenly, at the end of the day, the only thing he could do was go home and sleep. Simpler tasks took longer to complete, and colleagues noticed that O’Connor was missing things.
“It’s just something relatively simple, like I’m missing someone in an email discussion, or someone is going to say, ‘Did you forget to send an attachment?'” he said. “It’s embarrassing.”
Outside of work, O’Connor realized that his chess skills were declining. He often plays chess with his son, but after being infected with the new crown virus, if O’Connor wants to win a game, he needs the opponent to handicap.
Brain fog is defined as short-term memory loss and difficulty concentrating, doctors say. Some people may also experience confusion. As the name suggests, like a driver driving through thick fog, patients often feel they have to expend more time and energy to accomplish the same task.
Kelman said: “Memory decline, can’t remember names, confusion, inability to concentrate, etc.” When patients come to him, they usually think that contracting the new crown means that related symptoms have appeared, but he pointed out that many Patients struggle with disease without realizing what is causing their symptoms.
“Some people realize they’ve got symptoms from COVID, and some people haven’t made that connection,” he said. “Sometimes they have an autoimmune disease, so it’s not sure if the brain fog is COVID-19 or not.” Yes, but usually can be determined by the timeline.”
In short, there is a lot of overlap between covid-19 and autoimmune diseases, Kelman said. He sees this as a complex set of issues, and again, the symptom may or may not be diagnosed as a covid-19 sequelae, depending on how well the patient understands their symptoms.
“Sometimes it’s typical for people to complain of slower processing or more forgetfulness and difficulty concentrating,” said Dr. Eric Weng, president and chief medical officer of Wave Neuroscience in Newport Beach, Calif. symptom.”
What Causes COVID-19 Brain Fog
Some doctors believe that brain fog is the result of inflammation in the brain. Brain fog occurs in patients when the body is overloaded to fend off viruses such as the new coronavirus. It’s unclear why some people develop brain fog and others don’t, but many patients with symptoms of brain fog are thought to have inflammation.
Kellman noted that there are tests available to determine whether there is inflammation in the brain, but many of these tests are expensive and unnecessary. Some tests look for interleukins and cytokines, small proteins in the blood produced by the immune system that cause inflammation.
Instead, many doctors treat brain fog as inflammation, a treatment that affects the microbiome in the gut and contributes to autoimmune disease, he said.
“There are fundamental issues, and if you address those fundamental issues, they can get better — they can get better — you just have to know what’s going on,” Kelman said.
It’s unclear what the cause was, Yoni said. Instead, patients are able to go to the clinic to seek treatment for COVID-19 sequelae, which doctors define as symptoms that persist for more than two months after the first onset of COVID-19. During this time, patients who complain of brain fog first have thyroid and B12 levels tested at the clinic to confirm that symptoms, such as feelings of fatigue, are not caused by another underlying problem. Those with symptoms of brain fog may undergo cognitive testing to see if a deficit is the cause. Many patients also undergo MRIs, but Yoni said that so far, those with symptoms of brain fog have shown no signs of brain damage.
“The good news is that when patients come in, based on red flags and symptoms, we sometimes order head imaging before they come to neurology,” Yoni said. “I didn’t see any structural changes in the patient’s brain. At the moment the CT and MRI of the brain are normal, which reassures people, but I can’t generalize and say the functional scan is also normal. .”
Functional scans may further reveal how brain fog manifests in the brain, Yoni explained.
Treatment for brain fog after COVID-19
O’Connor sought treatment between his second and third COVID-19 bouts in the summer of 2021 after he saw an email from his son’s doctor in which he listed some Symptoms of COVID-19 sequelae.
Kelman put him on a Chinese herbal compound and health tablets designed to reduce inflammation.
There is evidence that infrared light can also help reduce inflammation, Kelman said.
Kelman said patients who received his regimen showed improvement within weeks.
“It does work,” O’Connor said.
Eric Ong took a different approach to the treatment, which he developed after researching how well it worked for chemotherapy patients suffering from “chemo brain”, which causes similar symptoms of brain fog . He was able to detect inflammation in the patient’s brain with an electroencephalogram (EEG).
Transcranial magnetic stimulation (TMS) uses a magnetic field to stimulate these nerve cells and help them regain function.
“In our experience, when neurons slow down, they just need some stimulation,” Weng said.
Kelman believes that treatment can improve brain fog over time, but doesn’t believe patients can overcome symptoms by retraining their brains on their own.
“Reducing stress helps, but in my experience, it’s not enough,” he said.
Eric Ong points out that good sleep hygiene is important, and that mindfulness and meditation can sometimes be beneficial. Plus, engaging in daily activities has been shown to improve brain health, too.
He added: “People who exercised for 30 minutes three to four times a week were able to restore brain function more quickly than sedentary people.”
But it is also not advisable to hope that the condition will go away on its own over time.
Kelman also said: “Brain inflammation can lead to chronic problems, including early dementia, and there is already a link between COVID-19 and dementia.”
So while he sees the urgency of the situation and the seriousness of the situation, he said patients should not be discouraged.
“People should be hopeful because we have treatments,” Dr. Kelman said.
Yoni says her patients are typically referred to a speech-language pathologist for cognitive therapy lasting four to 12 weeks. After the weekly sessions, patients are tested again and compared to their initial baseline test results to see if they are improving. These patients said the exercises during treatment helped them improve their memory and focus.
The clinic will soon launch a clinical trial that will compare the efficacy of cognitive therapy with three months of Adderall (the smart drug: Adderall, a prescription drug for ADHD that uses amphetamine as its main ingredient— —Annotation) efficacy of therapy.
At the same time, Yoni said that for some people, the symptoms of the after-effects of the new crown can resolve on their own. But patients who seek treatment at clinics often have symptoms that have persisted for a year or more. (Fortune Chinese website)
Translator: Zhong Huiyan-Wang Fang
Corbett O’Connor has contracted COVID three times, beginning with his first bout in April of 2020. A year passed before his second case, and his third was in the fall of 2022.
But it’s only now that the New Yorker is feeling better. His longest lasting symptom—brain fog—is finally clearing up and he’s performing well at his new remote position in construction management.
“I’m coming up on a year out since the last time I had COVID and I’m just now really starting to mentally and physically feel like I’m getting beyond this,” he says.
Doctors are still trying to understand brain fog, which some studies estimate may affect up to 70% of COVID patients, and experimenting with treatments that may improve symptoms for those dealing with it months out from their illness. Studies show those who have had COVID demonstrate measurable increases in brain fog compared to their counterparts—even if they didn’t notice it—but also that those symptoms cleared up around six to nine months later.
Theories on what causes the feeling of brain fog are still up for debate, and treatments vary widely. O’Connor sought treatment from Dr. Raphael Kellman, an internist and functional medicine physician at Kellman Wellness Center in New York, last summer. Kellman treats patients based on the idea that inflammation of the brain causes these symptoms.
“Brain fog is a very prominent issue, recall, feeling out of it, and the number one issue is chronic inflammation,” Kellman says. “The immune system has just not shut off and it’s in a constant hyperinflammatory state.”
Doctors at the University of Pittsburgh Medical Center have taken a different approach with their Post-COVID-19 Recovery Clinic, launched in November of 2020. They say the cause of brain fog in COVID patients has not been determined with conclusive evidence. Doctors have instead focused on treating the symptoms in more than 500 patients with long-haul COVID.
“Probably the most common complaints we see patients for are for decreased exercise tolerance, sometimes with a shortness of breath,” says Karla Yoney, a Senior Advanced Practice Provider for the UPMC Post-COVID-19 Recovery Clinic. “Brain fog is probably second most common as well as fatigue.”
Those with brain fog are typically referred to speech therapists for cognitive rehab where patients go through a battery of brain exercises week after week to get things working smoothly again.
“We’re focusing on symptom management,” says Yoney. “Bottom line is we can’t even really speculate if it’s inflammation until we have enough data across the board.”
Long COVID brain fog symptoms
O’Connor first noticed something wasn’t right when he returned to work. Suddenly, all he could manage to do was put in a full day before coming home and heading to bed. Simple tasks took longer, and colleagues noticed he was missing things here and there.
“It was relatively simple things, like I’d leave somebody off of an email thread or someone would say ‘do you know forget to attach a document?” he says. “It was embarrassing.”
Outside of work, he realized his chess game was suffering. He often plays with his son but after contracting COVID, he needed a handicap if he wanted a shot at winning a game.
Doctors say brain fog is defined by short-term memory loss and trouble concentrating. Some might feel confused as well. Like the name suggests, patients often feel as if they’re having to take more time and effort for the same tasks the way a driver might when navigating a heavy fog on the roads.
“Memory, name recall, confusion, trouble concentrating, etc,” Kellman says. When patients come to him they’ve often identified COVID as marking the start of their symptoms, but he believes there are many patients out there struggling without realizing what kicked off their symptoms.
“Some realize they developed this after COVID and some don’t make that connection,” he says. “Sometimes they have an autoimmune disease and you don’t know if it developed from the COVID, but usually you can see the timeline.”
In short, there’s a lot of overlap between long COVID and autoimmune disorders, Kellman says. He looks at it as a web of issues, and depending on what the patient knows about their own symptoms it may or may not be diagnosed as long COVID.
“Sometimes people complain about processing speeds or being more forgetful, trouble with focus and attention and concentration—these are kind of the hallmark symptoms,” says Dr. Erik Won, president and chief medical officer at Wave Neuroscience in Newport Beach, California.
What causes Long COVID brain fog
Some doctors agree brain fog is the result of inflammation of the brain, which happens when the body works in overdrive to fend off viruses such as COVID. It’s unclear why some experience brain fog and others don’t, but many patients complaining of the symptoms are assumed to have inflammation.
There are ways to test for certain, but many of these tests are costly and unnecessary, says Kellman. Some tests look for interleukins and cytokines, small proteins in the blood produced by the immune system which causes inflammation.
Instead, many doctors opt to treat brain fog as inflammation, which can also affect the microbiome in the gut and lead to autoimmune disorders, Kellman says.
“So these are the underlying issues and if you address these people can get better—and they do—you just have to know what’s going on,” he says.
Yoney says the causes are still not clear. Instead, patients can self refer to the clinic for long haul COVID symptoms, which they define as symptoms lasting for more than two months after an initial bout of COVID. Patients who complain of brain fog during this time period are first tested at the clinic for thyroid and B12 levels to confirm that feelings of fatigue, for example, are not part of another underlying issue. From there, those with brain fog might undergo some cognitive tests to confirm deficiencies. Many patients undergo an MRI, but so far Yoney says those with brain fog do not show signs of damage.
“The good news is when patients come in, depending on red flags and symptoms, we’ll sometimes order head imaging before they get to neurology,” Yoney says. “I have not found structural changes. These are normal head CTs and brain MRIs , which is reassuring for the population, but I can’t speak to functional scans.”
Yoney explains that functional scans might reveal more about how brain fog manifests in the brain.
Long COVID brain fog treatments
O’Connor sought treatment in the summer of 2021, between his second and third bout of COVID, after seeing an email from his son’s doctor listing some symptoms of long haul COVID.
Kellman started him on a course of herbal compounds and supplements aimed at reducing his inflammation.
Dr. Kellman says there is some evidence that infrared light can help reduce inflammation as well.
Patients on his regimen have seen improvement in a matter of weeks, he says.
“I definitely saw results,” O’Connor says.
Won performs a different kind of treatment on his patients, one developed after studying its effectiveness in chemo patients suffering from “chemo brain,” which causes similar feelings of brain fog. He can test for evidence of inflammation with an electroencephalogram, or EEG.
Transcranial magnetic stimulation (TMS) uses magnetic fields to stimulate those nerve cells, restoring function.
“When neurons slow down, in our experience, they just need some stimulation,” Won says.
Kellman believes time and treatment can help combat brain fog, but doesn’t believe there’s a way to retrain the brain on your own to overcome the symptoms.
“Stress reduction helps, but in my experience it’s not sufficient,” he says.
Won says good sleep hygiene is important, and mindfulness and meditation can sometimes help as well. Plus daily activity is proven to improve brain health.
“Thirty minutes of activity three to four times a week can help restore function faster than someone who is sedentary,” he adds.
But hoping that the condition resolves with time isn’t advised either.
“Brain inflammation can lead to chronic problems, including early dementia, and there is already a link between COVID and dementia,” Kellman adds.
So while he views the condition as both urgent and serious, he says patients shouldn’t feel discouraged.
“People should feel hopeful because there is treatment,” Dr. Kellman says.
Yoney says her patients are typically referred to a speech pathologist for cognitive therapy lasting between 4 and 12 weeks. After those weekly sessions, patients are tested again and compared to their initial baseline testing to show that improvement. These patients exes therapy have improved things like memory recall and their ability to focus.
The clinic will soon launch a clinical trial comparing the effects of cognitive therapy to a 3-month treatment of Adderall to compare the effects of each.
In the meantime, Yoney says that for some, long-haul COVID symptoms can resolve on their own. But patients who seek out care at the clinic have typically been dealing with symptoms for a year or more.
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