Neurocognitive and psychoneurological effects of COVID-19

COVID-19 is recognized as a respiratory virus that primarily damages the airways and causes coughing, shortness of breath, desaturation of oxygen and pneumonia, but it can also affect other organs and systems in the body, including the nervous system. Influence.¹ Mechanisms of damage to the brain and nervous system include chronic inflammation, alterations in blood-brain barrier integrity, hypoxia, and coagulopathy leading to thrombus formation.^{2, 3} Long-lived COVID-19 and terms like “long-term infected” and “post-coronavirus syndrome” have been used to describe symptoms lasting more than 12 weeks that cannot be explained by another symptom.^Four Some people who have had COVID-19 for a long time report ongoing or persistent symptoms that they experienced during their initial infection, while others did not experience them during their initial infection. Some people report continuous new onset of symptoms, or remissions and relapses of symptoms.^Five Commonly reported neurocognitive and neuropsychiatric symptoms of prolonged COVID-19 include fatigue, sleep disturbances, headacheattention/concentration difficulties, memory impairment, anxiety and depression, and post-traumatic stress disorder (PTSD) symptoms.⁶ Some studies have identified specific risks for developing long-term COVID-19, such as hospitalization for COVID-19, female sex, obesity, aging, and the presence of five or more symptoms during the acute phase of the disease. Although we have identified factors, other studies have reported few associations with these. Severity of acute illness followed by prolonged onset of COVID-19.^5,7

Since the World Health Organization declared the novel coronavirus disease (COVID-19) a pandemic in early March 2020, nearly 107 million cases have been reported in the United States, with more than 6 million people infected with COVID-19. hospitalized due to virus.⁸ About 30% of people diagnosed with COVID-19 develop long-term infections, according to data from household pulse surveys initiated by the Census Bureau early in the pandemic.⁹ As we now know, long-standing COVID-19 patients frequently report neurocognitive and neuropsychiatric symptoms.

research

Mazza and colleagues tested 402 adults who were diagnosed with COVID-19 about a month after they were discharged from the hospital.^Ten They screened for psychiatric symptoms using clinical interviews and a series of self-reported questionnaires. Their analysis found that a significant proportion of participants self-reported psychopathological ranges for PTSD (28%), depression (31%), and anxiety (42%). Sleeping disorder (40%). A significant proportion of long-term COVID-19 sufferers also report persistent cognitive deficits such as forgetfulness, difficulty concentrating, and difficulty thinking.¹¹

Using a self-report questionnaire on COVID-19 and a web-based version of the UK Intelligence Scale, Hampshire et al. We investigated the relevance of¹² Their analysis found that people who recovered from COVID-19 displayed significant deficits compared to controls in many cognitive domains, including attention, working memory, problem-solving, and emotional processing. shown. Significant cognitive impairment was seen in both hospitalized and non-hospitalized patients with COVID-19.

Studies show that long-term COVID-19 neurocognitive and neuropsychiatric symptoms impact mental, emotional, and cognitive health, as well as self-care (dressing, bathing, etc.), driving, and living. It has also been shown to affect performance. to get back to work.^9,13

Similarities to concussion/mTBI

Similarities can be seen in the neurocognitive and neuropsychiatric symptoms of long-term COVID-19 and concussion/mild traumatic brain injury (mTBI), approaches to effectively manage concussion/mTBI may provide some insight into treatment.¹⁴ Effective management includes early detection and treatment, education about the condition, and optimistic expectations about recovery and outcome. The variability in reported symptoms and duration of symptoms necessitates a symptom-focused, individualized approach. Ask questions about how the symptoms affect the patient’s life (i.e., ‘Which aspects of your symptoms affect your life the most?’, ‘What would you like to return to?’ “What would you do if you didn’t have these symptoms?”) What would you do today? ), and has also been shown to provide information on how to deal with manifesting symptoms (i.e., headaches, sleep disturbances, mood changes, etc.).

For individuals with physical, cognitive and psychiatric symptoms, a multidisciplinary team approach with coordination by a case manager may be required. The core interdisciplinary team includes physician specialties (physical therapy, psychiatry, neurology, etc.), occupational therapy (improving activities of daily living and monitoring when to return to work or driving), physical therapy ( management of pain, balance problems, vestibular problems). ), language/language pathology (treatment of cognitive and language disorders), counseling (mood disorders, Sleeping disorder,Such).

summary

In conclusion, many people infected with COVID-19 may continue to have symptoms after recovering from their initial viral infection and seek treatment from mental health and rehabilitation providers. Persistent symptoms include neurocognitive and neuropsychiatric symptoms that can interfere with meaningful daily activities and roles. Given the overlapping symptoms of concussion/mTBI and long-term coronavirus, best practices and evidence-based techniques for concussion/mTBI treatment can be used to manage symptoms and reduce the adverse effects of long-term coronavirus. You can provide information on your approach.

Dr. Seal He is the Regional Director of Clinical Services for the Center for Neuroskills, which operates rehabilitation programs after acute brain injury in California and Texas. He is licensed in Texas as a Chemical Addiction Counselor and as a Psychological Associate in independent practice. He also holds clinical appointments in the Department of Rehabilitation Sciences at the University of Texas Medical School (UTMB) in Galveston.

References

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2. Lahiri D, Ardila A. The COVID-19 Pandemic: From a Neurological Perspective. Creus. 2020;12(4):e7899.

3. Aghagoli G, Marin BG, Katchur NJ, et al. Neurological involvement and potential mechanisms in COVID-19: A review. neurocrit care. 2021;34(3):1062-1071.

4. Gas E. Covid-19: What do we know about “long-term Covid-19”? BMJ. 2020;370:m2815.

5. Get N. long covid: how to define and manage. BMJMore. 2020;370:m3489.

6. Crook H, Raza S, Nowell J, et al. Long-term novel coronavirus mechanisms, risk factors, and management. BMJ. 2021;374:n1648.

7. Sykes DL, Holdsworth L, Jawad N, et al. Post-COVID-19 symptom burden: What is prolonged COVID-19 and how should it be managed? lung. 2021;199(2):113-119.

8. Long-term COVID-19 or post-COVID-19 situations. Centers for Disease Control and Prevention. December 16, 2022. Accessed June 9, 2023. https://www.cdc.gov/coronavirus/2019-ncov/long-term-Effects/

9. The long novel coronavirus. Household Pulse Survey, 2022-2023. National Center for Health Statistics. https://www.cdc.gov/nchs/covid19/pulse/long-covid.htm

10. Mazza MG, Lorenzo RD, Conte C, et al. Anxiety and depression in COVID-19 survivors: the role of inflammatory and clinical predictors. behavioral immunity of the brain. 2020;89:594-600.

11. Russ V, Beal R, Seefecker AJ, et al. Neurological Outcomes and Quality of Life Three Months After COVID-19: A Prospective Observational Cohort Study. Euro J New Roll. 2021;28(10):3348-3359.

12. Hampshire A, Trender W, Chamberlain SR, et al. Cognitive impairment in people who have recovered from COVID-19. EC Clinical Medicine. 2021;39:101044.

13. Kumar S, Weldhaus A, Marholtra T. Neuropsychiatric and cognitive sequelae of COVID-19. front psycho. 2021; 12:577529.

[ PubMed ]14. Junn C, Bell KR, Shenouda C, Hoffman JM. Symptoms of concussion and comorbidities. Kerr gout rep. 2015;19(9):46.