COVID Brain Fog is Common But Not Well Understood
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Have you had COVID-19 and then experienced problems with thinking, memory, or staying on track with the things you need to do?
Perhaps you’ve made commitments and then forgotten them. Or you find yourself searching for words far more often than before you had the illness.
If so, then you are among the millions who report experiencing COVID “brain fog,” a much-discussed term these days. Although the research into COVID brain fog is scanty, researchers in England have gathered data on the problem and have shared some preliminary findings with the press.
Foggy thinking ranks among the top two COVID symptoms.
“The number one symptom that people commonly complain about after they’ve had COVID is extreme fatigue. The number two symptom is ‘brain fog,’ for lack of a better term,” says James E. Galvin, M.D., M.P.H., director of the University of Miami Miller School of Medicine’s Comprehensive Center for Brain Health. Dr. Galvin specializes in memory and cognitive disorders. He notes that “brain fog’ is not a medical diagnosis.
With any significant illness, people often complain that they don’t feel as sharp as they did before.
“But most illnesses don’t occur in the context of a worldwide pandemic,” Dr. Galvin says. “The extent of COVID’s reach, with millions of people affected, has made brain fog due to COVID an issue we see so often.”
Brain fog needs to be better understood.
“We don’t know much yet about this issue, although there’s lots of research going on to explore it,” Dr. Galvin said. “But we do know that it exists, and people are suffering from it.”
In a British study, memory problems after COVID proved to be common but not universal. On some questionnaire items, as many as 50% of the participants said they had difficulties. Meanwhile, a small percentage of those surveyed felt that their memories had improved.
Two problems stood out.
“One was forgetting when something had happened. The other issue was searching for a word on ‘the tip of their tongue,’” said Dr. Galvin.
The British study, in addition to offering details on how many people have experienced memory lapses, also shows some possible reasons for those lapses. It will also provide guidance on protecting yourself and your loved ones from COVID brain fog to the extent possible.
Memory allows us to retain information even as time passes.
What we experience, learn, know, and remember provides the framework through which we make sense of the world and act in it.
“We rely on our memories so heavily that you cannot overstate how much memory matters,” says Dr. Galvin.
The British researchers studying COVID brain fog used the Everyday Memory Questionnaire, which includes seven items that capture a person’s ability to retrieve memories.
- Having to check whether the person had done something
- Forgetting when it was that something happened
- Forgetting that they had been told something yesterday
- Finding that a word was ‘on the tip of their tongue’
- Completely forgetting to do things that they had said they would do
- Forgetting important details of what they had done
- Failing to tell somebody something important
Four items addressed “attentional tracking issues.”
- When talking to someone, forgetting what they had just said
- When reading a paper, being unable to follow the story
- Getting the details mixed up
- Repeating to someone what they had just told them
Two items were not categorized.
- Starting to read something they’d read before
- Forgetting where things are normally kept
Loneliness and boredom are bad for your brain.
Many study participants reported that their lives during lockdown grew dull as they stayed home day after day and week after week.
“If one day feels just like the days before it and the ones after it, you can see that forgetting when things happen might be the result,” said Dr. Galvin.
“Events become a blur.”
Also, trouble finding the “right word” might reflect less time spent being social, according to the British researchers.
“COVID disrupted our social interactions to such a great extent,” Dr. Galvin says. “Removing that kind of in-person contact from people has really affected the way they are able to stay mentally sharp and socially engaged.”
A high level of social connections plays a key role in keeping the brain at a high level of overall health, he says.
The nature of a person’s COVID confinement mattered.
One intriguing finding from the study is that when people went into lockdown, the spaciousness of their homes mattered in terms of how badly they suffered from brain fog.
Those who experienced the tightest sorts of confinement, with little space to move about, seemed to suffer worse memory problems than people who had more room to move about and who did get about more physically.
The COVID virus does not seem to infect brain cells.
A few viruses, such as herpes, can directly infect brain cells, or neurons. Most viruses are unable to cause direct infections within the brain because of the shielding effects of the blood brain barrier. This barrier consists of a layer of special cells around the brain that admits substances that will support the brain and blocks those that will cause harm.
“COVID does not appear to directly infect neurons. What it seems to do is to bring on vascular and inflammatory changes that can impede how well the cells can function.” Dr. Galvin says. “So, the symptoms that people call ‘brain fog’ may be due to secondary effects of the virus on brain function.”
Although the science is not yet clear, it seems that the COVID virus causes microscopic blood vessels to swell, which can limit blood and oxygen reaching the brain.
“There’s also the issue of a person’s lungs not functioning as well as they usually do during a COVID infection. When the lungs aren’t working at full capacity, the brain receives less oxygen, which also affects thinking and memory,” Dr. Galvin explains.
To avoid developing COVID brain fog, avoid catching COVID.
“Decide on your own personal protection plan,” Dr. Galvin advises. He views masks as the first, most basic form of protection and wears one often.
“Consider getting vaccinated if you haven’t done so already, and encourage the people you’re close to get vaccinated as well,” he says. If you have been vaccinated, then follow up with the latest booster. Visit vaccines.gov to easily find a nearby site for a first vaccination or to a booster.
If you do catch COVID, take Paxlovid if it’s appropriate.
“Paxlovid is really the first oral antiviral drug that has proven to work quite well at keeping people out of the hospital and preventing deaths,” says Dr. Galvin.
Paxlovid consists of two antiviral drugs combined in one pill, and it is FDA-approved for use for some people but not for everyone. The medication reduces the risk of severe illness or death by almost 90% among unvaccinated people age 12 and older who weigh at least 88 pounds and are at high risk for serious disease.
“If you get COVID and qualify for Paxlovid, get started on it as soon as possible. Starting the medication quickly can minimize the illness’ immediate and lingering effects, including memory issues,” says Dr. Galvin.
Paxlovid treatment needs to begin as soon as possible after a positive COVID test and within the first five days of the illness’ onset for a person to reap the drug’s benefits. Starting treatment is advantageous with most antiviral drugs.
You can take simple steps to deal with your foggy brain.
“Some simple strategies can help you deal with brain fog and perform better. They involve treating your brain gently while it allows your brain to recover,” Dr. Galvin says. Try these approaches:
- Plan and prioritize – “Identify your most important tasks and tackle those first to conserve your mental energy,” he says. Postpone or even drop certain to-do list items that aren’t so important.
- Pace yourself and rest – Many people are most energetic and clearest in the morning. “Use your best hours to do the things that you find most challenging,” Dr. Galvin says. Take frequent rest breaks every 30 or 45 minutes.
- Rotate tasks: “If you have a mentally tiring job to do, like your taxes, take some breaks to do a different kind of task that’s easier. Maybe take out the trash or pull some weeds,” Dr. Galvin suggests. The variety can wake up your brain for the harder jobs, and so can a jolt of daylight.
- Ask for help: Can a relative, friend, or co-worker help with some of your tasks? If so, let them know.
Get up, get out, and be social.
“Once you have passed through the acute phase of the illness, start to increase your activities to stay mentally and physically fit,” Dr. Galvin says.
He explains that the fitter you are mentally and physically, the more likely you are to stave off some of the symptoms of brain fog.
Seeing people supports brain health.
“COVID has changed the way we live; whether you have had it or not, it has changed society,” reflects Dr. Galvin.
“Whether you are being locked down or fighting lockdown, it has disrupted social interactions to a great extent.” And social interactions play a fundamental, essential role in our physical, mental, and emotional well-being.
Before COVID, we never thought about going out to do errands such as grocery shopping.
“Now, whether you wear a mask or not, you’re wondering about the person walking past you or the one behind the deli counter – ‘Does that person have COVID?’” he says.
“Human beings are social creatures. We experience being isolated as a punishment; when a child misbehaves, their parents will send them to their room,” Dr. Galvin says.
COVID, meanwhile, has led many of us to avoid people to avoid contagion.
Isolation creates distress, which harms health.
“Having few social ties or mostly weak ties has been linked to some of the basic biological problems, such as inflammation and a less effective immune system,” Dr. Galvin says.
These disturbed physical processes set the stage for severe illness or death from COVID, other infections, and a host of chronic conditions, including cancer and heart disease.
This sets us up for a higher background level of worry and anxiety that we had before COVID. “Less socialization and all these stressful feelings, day in and day out, are not good for your brain either,” he explains. “It’s not surprising that there are more complaints about anxiety, depression, and memory lapses.”
Socialize as safely as possible.
Yes, avoiding infection with COVID-19 is desirable. But cutting back too much on your social life can degrade your health in many ways. The key is to strive for a reasonable balance.
“Be particularly cautious about new environments where you don’t know the situation around you,” Dr. Galvin says.
For instance, before you accept an invitation to a social event, ask the host some questions.
- How many people how will be there?
- How crowded will it be?
- Does the host know if they’re mostly or all vaccinated or not?
- Will it be indoors or outdoors, or will there be options to be either inside or outside?
We all need to decide how to continue to be social.
“We have to get back to seeing people and doing the leisure activities we enjoy,” Dr. Galvin says. “This is how we move forward and create a new normal.”
Milly Dawson is a contributing writer for UHealth’s news service.