The One COVID Symptom No One is Talking About
The COVID pandemic has altered our world on a scale that few events have ever done so before. Healthcare systems were crippled by the millions of infections, hospitalizations and deaths caused by this virus. Tens of millions of people suffered financial hardships as the global economy experienced its worst downturn since the Great Depression. Countless individuals were and continue to be psychologically and emotionally traumatized by the fear of becoming infected and the social isolation imposed by mandated quarantines. Implementation of effective vaccine programs have brightened our outlook on the future, yet our understanding of the longer-term consequences resulting from this pandemic remains in the earliest stages. Nowhere is this truer than with respect to the long-term impact COVID will have upon brain health. As a neurologist who has engaged in dementia research for several years, I see this as one of the greatest challenges that lies ahead.
What are the Major Symptoms of COVID and How Long Do they Last
The initial presentation of COVID is defined by symptoms commonly associated with other types of viral infections. Fevers and chills, cough, headaches, fatigue, body aches, and shortness of breath can occur between 2-14 days after initial exposure to the virus.
A loss in the sense of smell or taste has been reported in 30% to 80% of all COVID cases and often presents as the initial symptom of infection. Similar to the flu, the severity of COVID symptoms can range from none (also called asymptomatic) to severe. Older adults, young children, and infants, as well as those with coexisting medical conditions like asthma, emphysema, and diabetes are at increased risk for experiencing a more severe illness.
COVID-related symptoms typically last 1-2 weeks after which most people experience a complete recovery. Unfortunately, some will experience complications during their recovery from the infection. Pneumonia, strokes and heart attacks, widespread inflammation involving the heart, brain, and muscles, multi-organ failure, and blood clots have all been reported. Additionally, many individuals will experience a persistence of symptoms that may last for weeks or months after infection which we now refer to as long COVID.
What Are the Signs You Have Long COVID
While most cases of COVID resolve without any lasting effects, some people will experience a persistence in COVID-related symptoms for 4 or more weeks after being infected. Still others who seemingly experience a complete recovery will develop recurrent or even new COVID-related symptoms several weeks thereafter. Long COVID, also referred to as long-haul COVID or chronic COVID, is the term used to describe the persistence or recurrence of post-COVID infection symptoms. Commonly reported long COVID symptoms include shortness of breath, feelings of fatigue that worsen with physical or mental exertion, sleep difficulties, mood changes, GI upset, and difficulties with concentration otherwise referred to as "brain fog". While more data is needed to better understand the cause of long COVID, research has shown that severe infection, hospitalization, advanced age, and coexisting conditions such as diabetes and asthma greatly increase the risk for its development. While less common, long COVID symptoms such as brain fog and fatigue have also been observed in lower risk groups including otherwise healthy children.
This is the One COVID Symptom No One is Talking About
As we have become more aware of the impact that COVID has on the brain, research is beginning to uncover the possible mechanisms by which COVID-related cognitive impairment and even dementia may occur. COVID frequently infects the central nervous system. Anosmia, or the loss in the ability to smell, occurs during the earliest stages of infection and is a prime example of this. Persistent anosmia has been associated with an increased risk for cognitive impairment, and may reflect the presence of significant cellular damage in other infected portions of the brain. Delirium, which involves the rapid onset of confusion and memory impairment, is associated with widespread inflammation caused by some viral infections and has been reported to occur in up to 30% of seniors hospitalized with COVID-19.
Early data also suggests that people experiencing COVID-induced delirium may be at increased risk for the development of Alzheimer's disease. Decreases in blood flow to the brain caused by blood clots, inflammation of the blood vessels supplying the brain, and the deposit of a protein closely associated with Alzheimer's disease called phosphorylated tau have all been observed in COVID patients and have been suggested as possible causes for COVID-related cognitive impairment. Clearly, more research is needed to fully understand how COVID causes cognitive impairment and its connection with dementia.
What are the Symptoms of COVID-Related Dementia
The symptoms of COVID-related cognitive impairment are similar to those observed in the early stages of Alzheimer's disease. Missing appointments or having difficulty recalling items on a shopping list may arise due to short-term memory loss. Impairments in language skills may lead to difficulties in finding the right word to say or write. Executive functioning, which involves the cognitive processes needed for multitasking and problem solving, can also be impaired after a COVID infection.
Successful completion of common tasks such as following a recipe, planning a family event or handling personal finances becomes difficult when executive functioning is impaired. It is also important to note that the severity of COVID-related cognitive impairment may be much greater in individuals suffering with mild cognitive impairment or dementia prior to contracting the infection.
What You Should Do if You Notice These Signs
Regardless of the suspected cause, evaluation by the patient's primary care physician should be sought when concerns regarding cognitive impairment arise. Simple, non-invasive memory screening tests can be performed to evaluate cognitive function. While these tests cannot identify the specific cause of cognitive impairment, they can help identify those who require further evaluation and specialist referral. It is also important to remember that many symptoms associated with long-COVID including "brain fog" can improve over time.
Avoid overexerting yourself and resume activities such as exercise gradually. Allowing your brain to recover from the illness by getting enough sleep is also very important. Focus on improving your sleep hygiene by maintaining a set sleep schedule, reducing caffeinated drinks, limiting daytime naps and unplugging from your electronic devices and TV at bedtime. Improving your sleep hygiene is especially important if you feel unrefreshed despite being in bed a normal amount of hours.
How You Can Stay Safe
The best way to reduce your chances of getting long COVID is to avoid getting infected. While not a guarantee against contracting the illness, available COVID vaccines have been proven to reduce the chances of getting COVID disease. As importantly, research has shown that vaccinations greatly reduce the chances of severe infection, hospitalization and the development of long COVID even when breakthrough cases occur. Get vaccinated if you haven't already done so, and make sure your protection against the infection remains high by receiving vaccine boosters as recommended by the CDC. Also make sure to get COVID tested if you develop any signs of infection and follow quarantine guidelines to protect others from contracting the illness.
The FInal Word From the Doctor
For years dementia research has been directed at gaining a better understanding of its various causes in the hopes that such efforts would lead to the discovery of effective treatments. Alzheimer's research epitomizes these efforts, as the discovery of specific proteins associated with this condition has spurred the development of new targeted therapies currently under study. As a result of these efforts, there is now hope that we will not only have effective treatments for Alzheimer's disease in the near future but as importantly ways to prevent its onset. More research is needed if we are to have similar gains in our fight against COVID, and the success of these efforts will depend upon the countless number of volunteers who participate in clinical research trials. Be a part of the solution by getting involved in COVID research. Information regarding ongoing COVID-related research trials and the location of research centers performing these studies can be found at ClinicalTrials.gov. And to protect your life and the lives of others, don't visit any of these 35 Places You're Most Likely to Catch COVID.
Dr. Egilius L.H. Spierings, a neurologist and Medical Director at MedVadis Research in Boston.
