WHO & Alzheimer’s Assoc. launch global study on persistent COVID symptoms
There’s something eerily familiar about the symptoms being reported for long haulers suffering months after a COVID-19 diagnosis. Many of the long-term issues, such as fatigue, myalgia (muscle pain), insomnia, and now cognitive deficits, are reminiscent of what used to be called Post Viral Fatigue, renamed as Myalgic Encephalomyelitis (ME), and currently known as Chronic Fatigue Syndrome (CFS).
So, what’s going on with these lingering symptoms? And is inflammation behind the long-term effects of COVID?
A quick breakdown of the cognitive consequences of long-haul COVID-19
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Before we dig into potential causes, let’s look at a recent study from Italy that found cognitive effects of COVID-19 in hospitalized patients some six months after diagnosis:1
- In this latest study, a preprint (meaning, it’s not yet been peer-reviewed), researchers in Italy looked at the long-term effects of COVID-19 on the nervous system.
- They found that more than a third (37.4 percent) of patients with serious enough disease to be hospitalized had neurological symptoms six months after initial diagnosis with COVID.
- These were people without nervous system disease prior to infection with SARS-CoV2.
The patients included in this study were hospitalized in Italy between February and April 2020, with a standard neurologic symptom check conducted alongside a neurologic examination six months later. These assessments looked at the health and function of nerves and reflexes, as well as certain cognitive and muscular functions.
The most common long-term manifestations in the long haulers were:
- Fatigue (34.1 percent)
- Cognitive deficits (such as memory problems: 30.8 percent)
- Sleep disorders (including insomnia: 30.8 percent)
- Myalgia (muscle pain: 29.6 percent)
- Depression and anxiety symptoms (26 percent)
- Blurring or visual disturbances (19.5 percent)
- Paresthesia (migraines and nausea: 18.3 percent)
- Hyposmia/dysgeusia (loss of sense of smell or taste: 16.5 percent)
Other reported symptoms and signs included:
- Urinary dysfunction (14 percent)
- Confusion/dizziness (13 percent)
- Dizziness/hypotension (12.2 percent)
- Gait disturbances (10.7 percent)
- Postural instability or falls (8.5 percent)
In earlier research, which we’ve discussed before, some 87 percent of patients hospitalized for COVID-19 report still suffering from at least one symptom 60 days after discharge from the hospital. The most common lingering symptoms were fatigue and shortness of breath, which were also most notable in an analysis of hospitalized and non-hospitalized patients at three-month follow-up.
The biggest risk factors for long-haul neurologic symptoms
The patients included in this latest study were more likely to have neurological symptoms if they had a more severe case of COVID-19, as well as if they were older and had pre-existing conditions. There were, however, patients included in the study who were younger and previously healthy.
- Patients with more severe COVID-19 reported a higher number of symptoms six months later.
- They also had more memory complaints and visual disturbances, even after accounting for their age and pre-existing conditions.
The patients who had memory problems tended to be older and to have received oxygen therapy in the hospital. The patients who had a neurologic exam where abnormalities were observed tended to have stayed longer in the hospital, been older, have had a worse case of COVID-19, and have reported more neurologic symptoms themselves, as well as having pre-COVID-19 health issues.
There were some limitations to this study that should be noted. For instance, the study was quite small and took place at only one medical center, meaning the results are hard to extrapolate to a wider population. The study excluded patients who developed neurologic disease during their COVID-19 illness (the acute phase when they were hospitalized). The researchers also had to rely on medical records regarding neurologic symptoms as patients did not undergo a thorough neurologic assessment when admitted for COVID-19.
What’s next for COVID-19 and cognitive health?
The growing link between COVID-19 and long-term cognitive effects has prompted the Alzheimer’s Association, the World Health Organization, and other health organizations to launch a global prospective study into the issue.2
This worldwide group of researchers will look at more than 22 million cases of COVID-19, evaluating people at six, nine, and 18 months. It will also look at those already enrolled in international studies, adding new assessments to the studies’ protocols.
One major aim of this huge undertaking is to figure out why COVID-19 seems to result in long-term neurologic effects in some patients.
To that end, the researchers looked back at the longer-term impacts of the 1918 flu epidemic, which also led to a raft of neurologic issues in survivors.3 These included movement disorders, profound sleep disturbances, and even psychotic illness. Other research suggests that even more common viruses, such as herpes simplex virus 1 (HSV-1), have links to Alzheimer’s disease and cognitive decline.4
So, what accompanies most neurodegenerative disorders and also accompanies COVID-19? In short, inflammation. So much so that many researchers worldwide are now focusing on tracking the effects of COVID-19 on inflammatory processes, in part to see how this affects the nervous system and cognitive health.
Adding weight to the link between COVID-19, inflammation, and cognitive decline is a body of evidence showing that a variety of other pathogens, including the bacteria that causes Lyme disease (Borrelia burgdorferi), Candida glabrata, and Chlamydophila pneumoniae, all trigger a pro-inflammatory response in brain tissue that can cause progressive neurodegeneration and dementia.5
In the case of COVID-19, delirium is a common, if not the only, presenting symptom of infection with SARS-CoV2 in some patients, especially in seniors, and it is linked to higher mortality rates.2 Delirium may be related to direct viral invasion of brain tissue, or to neuroinflammatory responses to the virus. Immune system responses and other complications — such as lack of oxygen to brain tissue (because of COVID-19’s effects on the lungs), as well as side effects from drugs and even organ failure — can also contribute to delirium in COVID-19.
Given the connection between inflammation and COVID-19, what can we do to minimize risk if we do get infected?
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COVID care to reduce risk of cognitive symptoms: 9 essential steps
For some people, SARS‐CoV‐2 infection can cause massive cytokine storms, where immune system cells are released in huge numbers, triggering inflammation and tissue damage. In the brain, this can mean that neurons die, and neural pathways are disrupted. In patients with existing cognitive issues, the effects of out-of-control inflammation may propel faster neurodegeneration.
Even in those without pre-existing neurological problems, COVID-19 can compromise the blood-brain barrier and kickstart a lifelong process that causes severe debility.6 Getting a handle on inflammation can help to maintain a healthy blood-brain barrier.
This may look like:
1. Taking actions to better manage blood glucose regulation — with a high-fiber, low-sugar diet, plus exercise.
2. Getting regular exercise (ideally, outdoors, with other people, at a distance).
3. Ensuring a healthy sleep pattern and good-quality sleep.
4. Including good sources of anti-inflammatory omega-3s from algal oil, nuts and seeds, and wild, oily fish.
5. Reducing red and all processed meat consumption (acid-forming).
6. Reducing processed food consumption (acid-forming).
7. Cutting out/down on alcohol (acid-forming).
8. Eating a predominantly plant-based, antioxidant-rich diet (alkalizing).
9. Including healthy fermented foods to support good gut health and the gut-brain axis.
It’s also worth noting that one of the most likely routes by which SARS-CoV2 gets into brain tissue is the gut-brain axis.7 This means that gastrointestinal symptoms of COVID-19 may precede neurologic symptoms and, hopefully, that there’s a chance that maintaining good gut health could help minimize the risk of cognitive symptoms.
- 1. Pilotto, Andrea. COVID-19 severity impacts on long-term neurological manifestation after hospitalisation. medRxiv 2020.12.27.20248903; doi: https://doi.org/10.1101/2020.12.27.20248903.
- 2. de Erausquin GA, Snyder H, Carrillo M, Hosseini AA, Brugha TS, Seshadri S; CNS SARS-CoV-2 Consortium. The chronic neuropsychiatric sequelae of COVID-19: The need for a prospective study of viral impact on brain functioning. Alzheimers Dement. 2021 Jan 5. doi: 10.1002/alz.12255. Epub ahead of print. PMID: 33399270.
- 3. Foley PB. Encephalitis lethargica and the influenza virus. II. The influenza pandemic of 1918/19 and encephalitis lethargica: epidemiology and symptoms. J Neural Transm (Vienna). 2009;116(10):1295-1308. doi:10.1007/s00702-009-0295-9.
- 4. Cairns DM, Rouleau N, Parker RN, Walsh KG, Gehrke L, Kaplan DL. A 3D human brain-like tissue model of herpes-induced Alzheimer’s disease. Sci Adv. 2020;6(19):eaay8828. Published 2020 May 6. doi:10.1126/sciadv.aay8828.
- 5. Fülöp T, Itzhaki RF, Balin BJ, Miklossy J, Barron AE. Role of Microbes in the Development of Alzheimer’s Disease: State of the Art – An International Symposium Presented at the 2017 IAGG Congress in San Francisco. Front Genet. 2018 Sep 10;9:362. doi: 10.3389/fgene.2018.00362. PMID: 30250480; PMCID: PMC6139345.
- 6. Bhaskar S, Sinha A, Banach M, et al. Cytokine Storm in COVID-19-Immunopathological Mechanisms, Clinical Considerations, and Therapeutic Approaches: The REPROGRAM Consortium Position Paper. Front Immunol. 2020;11:1648. Published 2020 Jul 10. doi:10.3389/fimmu.2020.01648.
- 7. Bostancıklıoğlu M. Temporal Correlation Between Neurological and Gastrointestinal Symptoms of SARS-CoV-2. Inflamm Bowel Dis. 2020 Jul 17;26(8):e89-e91. doi: 10.1093/ibd/izaa131. PMID: 32440692; PMCID: PMC7313997.