Fatigue and headaches were the most common symptoms reported by individuals who had been infected with COVID-19 for an average of four months or more, researchers report.
Myalgia, cough, changes in smell and taste, fever, chills, and nasal congestion continued.
“Our results support growing evidence of chronic neuropsychiatric symptoms after COVID-19 infection,” Georgia Medical University researchers write in the journal. science direct.
“In the early days of the pandemic, there were many symptoms that we didn’t know how to judge, but now it’s clear that the COVID syndrome has been going on for a long time and that many people are affected.” said Dr. Elizabeth Rutkowski of MCG. Neurologist and corresponding author of the study.
The published study is a report on preliminary findings from the first visit of the first 200 patients enrolled in the COVID-19 Neurological and Molecular Prospective Cohort Study (CONGA) in Georgia, testing for COVID-19. were recruited on average about 125 days after testing positive in virus.
CONGA was established at the MCG early in the 2020 pandemic to examine the severity and longevity of neurological problems and began enrolling participants in March 2020. The ultimate goal is for him to recruit 500 people in five years.
Of the first 200 participants, 80% reported neurological symptoms with fatigue, the most common symptom reported by 68.5%, and 66.5% reported headaches that followed. Just over half reported changes in smell (54.5%) and taste (54%), nearly half (47%) of participants met criteria for mild cognitive impairment, 30% had vocabulary impairment, and 32% had working memory impairment. showed.
Twenty-one percent reported confusion, and hypertension was the most common medical condition reported by participants in addition to battling COVID-19.
None of the participants reported stroke, speech-related muscle weakness or loss of control, and coordination problems were some of the lesser-reported symptoms.
Twenty-five percent met criteria for depression and were associated with those who had a history of diabetes, obesity, sleep apnea, or depression. was associated with 18% who met.
While the findings so far are not surprising and are consistent with what other researchers have found, Rutkowski found that symptoms reported by participants did not match those shown by objective tests. The fact that there are many things is amazing. And it was both ways.
For example, the majority of participants reported changes in taste and smell, but objective tests of both these senses did not always match what they reported. A higher percentage of those who did not report actually had evidence of impairment based on objective measures, write the researchers. Rutkowski says it could be a change in the quality of taste and smell rather than a pure performance impairment.
“They eat chicken sandwiches and they have weird flavors like smoke and candles, but our taste strips are trying to express specific tastes like salty and sweet,” says Rutkowski. Others, for example, may rely more on these sensations, even when preparing food, and may be more inclined to notice even the slightest change, she says.
In any case, their data and others suggest a persistent loss of taste and smell after COVID-19, write Rutkowski and her colleagues.
Many previous reports have been based on this type of self-report, and the discrepancies they found indicate that the approach may not reflect objective dysfunction, the researchers wrote. ing.
Cognitive tests, on the other hand, can overestimate disability in disadvantaged people, they report.
Initial registrants were predominantly female, with 35.5% male. Their average age he was 44.6, nearly 40% were black, and 7% had been hospitalized for her COVID-19. Black participants were generally disproportionately affected, researchers say.
Seventy-five percent of black participants and 23.4% of white participants met criteria for mild cognitive impairment. This finding may indicate that cognitive tests assess different ethnic groups differently. And socioeconomic, psychosocial (issues such as family problems, depression, and sexual abuse) and physical health factors can disproportionately affect blacks in general, researchers say. wrote. It could also mean that cognitive tests may overestimate clinical impairment in disadvantaged populations, they write.
Black and Hispanic individuals are thought to be twice as likely to be hospitalized with COVID-19, and ethnic and racial minorities are more likely to live in areas with high infection rates. Genetics is also a factor likely to increase the risk of increased effects from COVID, just as it increases the risk of more severe hypertension and heart disease earlier in life.
CONGA’s focus is to better understand how the increased risks and impacts of COVID-19 will affect blacks, who make up approximately 33% of the state’s population.
The reason fatigue appears to be such a major factor among people infected with COVID-19 is that levels of inflammation, the body’s natural response to infection, remain elevated in some individuals. For example, blood samples taken at the first visit and at follow-up showed that several markers of inflammation were elevated and remained elevated in some patients.
These and other findings indicate that persistent inflammation contributes to some of the symptoms, such as fatigue, even though antibodies to the virus itself may wane. He notes that patients with multiple sclerosis and rheumatoid arthritis are considered autoimmune diseases, resulting in high levels of inflammation and fatigue being the most prominent symptom.
“They feel shortness of breath, body fatigue, go to wash the dishes, feel heart palpitations, have to sit down quickly, feel muscle pain as if they had run more than a mile.
“There’s probably some degree of neurological fatigue, too, because the patient is dazed. It hurts to think, to read even one email, it just wipes the brain. they say,” she says. Some studies have shown that even mild to moderate disease causes a reduction in brain volume.
These multi-system ongoing concerns are why some medical facilities have set up lengthy COVID clinics where doctors with expertise in the myriad of issues they are going through come together to see each patient.
CONGA participants who reported more symptoms and problems were more likely to have depression and anxiety.
Such problems, like mild cognitive and vocabulary deficits, may reflect the long-term isolation that COVID-19 has brought to many individuals, Rutkowski said.
“You’re not doing things that you normally do, like hanging out with friends, that bring joy to most people,” says Rutkowski. You may be dealing with loss, loss of job.”
For CONGA, participants self-report their symptoms and answer questions about general health conditions such as smoking, alcohol consumption, exercise, and known pre-existing medical conditions. However, you will also undergo an extensive neurological examination to look at basics such as mental status, reflexes, and motor function. They also undergo established tests to assess cognitive function with age-adjusted outcomes. They also do extensive at-home tests where they are asked to identify smells and whether they taste sweet, sour, bitter, salty, soupy, or tasteless. We are doing blood analysis to look for indicators of lingering infection, such as inflammatory markers and oxidative stress.
Neuropsychiatric symptoms are observed during the acute phase of infection, but there is a need to accurately characterize how symptoms evolve over time, the researchers wrote.
Especially in some individuals, the symptoms are definitely prolonged. Even people who were previously high-functioning but typically worked 80 hours a week and exercised every day may find themselves only able to be active for about an hour a day and spend the rest in bed, he says. says.
Investigators ask why and how they want answers, and Rutkowski says she can’t answer all of their questions yet, but she’s sure they’re not alone or “crazy.” can be conveyed with
One of the best things anyone can do to move forward is to stay diligent about avoiding infection, including getting vaccinated and boosted, to protect your brain and body from long COVID symptoms. and help protect others from infection, says Rutkowski. There is evidence that the higher the number of infections, the higher the risk of developing the problem.
Rutkowski noted that their findings may have been somewhat skewed toward higher rates of ongoing symptoms, as the proportion of individuals with concerns about ongoing problems was likely higher. doing.
SARS-CoV-2, believed to have first infected in late 2019, is a member of the larger group of coronaviruses and has been the cause of upper respiratory tract infections like the common cold for years. It is
At least part of the reason SARS-CoV-2 is thought to have such a widespread impact is because the virus is known to attach to angiotensin-converting enzyme-2, or ACE2, which circulates in the body. It’s because ACE2 plays an important role in functions such as regulation of blood pressure and inflammation. It is found in neurons, nose, mouth, lungs, cells lining blood vessels, heart, kidneys, and gastrointestinal tract. Viruses attach directly to ACE2 receptors on the cell surface. The ACE2 receptor acts like a door for the virus to enter.
Since the beginning of COVID-19, both experience and research have documented immediate neurological complications such as loss of taste and smell, brain infections, headaches, and, less commonly, seizures, stroke, nerve damage or death. showing the impact. Over time, there is growing evidence that problems such as loss of taste and smell can become chronic, as well as problems such as brain fog, exhaustion, depression, anxiety and insomnia. Permanent conditions, including these and others, are now called “long-term Covid.”
This research was supported by funding from the National Institute of Neurological Disorders and Stroke Research and philanthropic support from the TR Reddy Family Fund.
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