Brain fog among Covid patients: What could be the fact?

Long-standing COVID-19 infection outcomes like cognitive & functional, and acute neurological complexities are less discussed, presented, and documented substantially.

Long COVID neuropsychiatric symptoms

It includes breathing & gastrointestinal difficulties, sleep disturbances, frequent headaches, anxiety episodes, depressed feelings, attention impairment & loss of memory.

In inappropriately handled long-lasting hospitalized patients warning consequences of chronic stage causes mental challenges & “brain fog”.

Long COVID care demands the development of patient-centered preventive measures, rehabilitation techniques & clinical management procedures. Simultaneously detailed analysis and understanding of the prevalence, risk factors, and pathophysiology of brain fog is crucial.

Neuroimaging & electroencephalography (EEG)

In post-acute sequelae, COVID-19 patients, structural & functional abnormalities of frontal, temporal, and limbic areas develop.

Olfactory network structural changes including prefrontal structures, corpus callosum and insula involvement, temporal lobe, basal ganglia, brainstem, and cerebellum are the most reported. 

Covid survivors and brain fog

The cognitive disturbance duration depends on the severity of cognitive damage.

Brain fog is a descriptive terminology & is explained by the patients as a diverse bunch of intellectual function-related complications comprising trouble in thinking, remembering, and reasoning that interferes with daily functioning and instigates neuropsychological dysfunctions.

As per the World Health Organization (WHO), brain fog is defined as an informal term for a common complaint of intellectual functions among patients with post-acute COVID-19. Impairment of cognitive function, confusion, short-term memory loss, dizziness, and inability to concentrate come under brain fog.

It is a common characteristic in healing or recovering patients affecting their higher cognitive or “executive” function.

Brain fog requires serious attention from medical practitioners in employing its instructive & protective procedures.

Brain Fog related mechanism

Virus-induced long-standing & neurodegeneration cognitive impairment denotes the hippocampal distribution of microglial activation, systemic inflammation & sepsis.

Severe acute intensive care patients of COVID-19 develop hypoxia, vascular nerve cell injury & endothelial dysfunction associated with microvascular damage. Concomitantly immunological dysregulation, chronic inflammation & peripheral organ dysfunction occur. Cerebral white matter becomes vulnerable to ischaemic injury, cerebral hypoperfusion, amyloid-beta rapid accumulation, and TAR DNA binding protein-43 pathology.

There are also chances of systemic inflammatory injury & abnormalities, blood-brain barrier permeability increase & disturbance in tight junction proteins associated with brain parenchyma.

Cognition controlling the hippocampus, temporal lobe, and thalamus gets affected by thrombotic and inflammatory cascade leading to capillary occlusion, and ischemia.

Risk factors for brain fog

• Inflammatory markers (IL-6 & TNF-alpha) increase & abnormal cerebrospinal fluid level
• Females, elderly & asthmatic people
• COVID-19 infection severity & medication side effects
• Hypertension, sleep apnea, depression, anxiety, mild traumatic brain injury
• Poor lifestyle habits, smoking, drinking alcohol & obesity

Conclusion

Inspection, follow-up & appropriate clinical facilities are needed to deal with the long COVID-19 cognitive impairment. Right nutritional requirements along with correct brain fog treatment are needed, to normalize neural information, and oxidative stress & slow cognitive decline progression.

Suitable intervention strategies, scientific community-based future studies & trials can reduce long-lasting COVID-19-related cognitive diminishing symptoms & their effects.

References

1. SN Comprehensive Clinical Medicine (2023) 5:9

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