From the Guidelines
COVID-19 can cause various mental health changes after infection, including brain fog, memory problems, anxiety, depression, and cognitive difficulties, with cognitive impairment being a major feature that can persist for at least 2 years, as reported in a study of over 1.3 million people who had COVID-19 1. These post-COVID mentation changes, sometimes called "COVID brain fog," typically improve within a few months but may persist longer in some individuals.
Key Findings
- Cognitive impairments in long COVID are debilitating, at the same magnitude as intoxication at the UK drink driving limit or 10 years of cognitive ageing, and may increase over time 1.
- Activation of the kynurenine pathway, particularly the presence of the metabolites quinolinic acid, 3-hydroxyanthranilic acid and kynurenine, has been identified in long COVID, and is associated with cognitive impairment 1.
- A report of more than 1.3 million people who had COVID-19 showed mental health conditions such as anxiety and depression returned to normal over time, but increased risks of cognitive impairment (brain fog), seizures, dementia, psychosis and other neurocognitive conditions persisted for at least 2 years 1.
Treatment and Management
Treatment focuses on managing symptoms through:
- Cognitive rehabilitation exercises
- Adequate rest
- Proper nutrition
- Staying physically active Medications aren't specifically approved for post-COVID cognitive issues, but doctors may prescribe treatments for specific symptoms like:
- Antidepressants (such as sertraline 50-100mg daily or escitalopram 10-20mg daily) for depression or anxiety
- Cognitive behavioral therapy can help manage psychological symptoms Patients should:
- Maintain a consistent sleep schedule
- Engage in regular moderate exercise like walking 30 minutes daily
- Follow a balanced diet rich in omega-3 fatty acids and antioxidants These recommendations help because they support overall brain health and recovery.
Mechanism of Post-COVID Cognitive Changes
The exact mechanism of post-COVID cognitive changes isn't fully understood but likely involves:
- Inflammation
- Immune system effects
- Possibly direct viral impact on brain tissue If symptoms persist beyond 3-6 months or significantly impact daily functioning, patients should seek specialized medical evaluation. Some studies suggest that long COVID is associated with all ages and acute phase disease severities, with the highest percentage of diagnoses between the ages of 36 and 50 years, and most long COVID cases are in non-hospitalized patients with a mild acute illness 1. However, the most recent and highest quality study, published in 2023 in Nature Reviews Microbiology, provides the most comprehensive understanding of the post-COVID-19 mentation changes 1.
From the Research
Post-COVID-19 Mentation Changes
The post-COVID-19 mentation changes are characterized by various cognitive and emotional disturbances. Some of the key changes include:
- Cognitive impairment, such as difficulties in concentration and memory deficits 2, 3, 4
- Depression and anxiety, with a high prevalence of mild to moderate depression 2, 4, 5
- Fatigue, which is one of the most frequent post-COVID-19 complaints 3, 4
- Sleep disturbances and anhedonia 5
- Decline in information processing speed and memory 2
Factors Influencing Post-COVID-19 Mentation Changes
Several factors can influence the severity and nature of post-COVID-19 mentation changes, including:
- Gender, with men and women showing different patterns of cognitive impairment 2
- Severity of previous COVID-19 disease, with more severe disease associated with greater cognitive decline 2
- Previous psychiatric conditions, which can increase the risk of developing post-COVID-19 syndrome 3
- Somatization, which can contribute to cognitive deficits and fatigue 3
Treatment and Management
Various treatments and management strategies are being explored to address post-COVID-19 mentation changes, including:
- e-Health interventions, which can provide accessible and tailored support for patients 6
- Pharmacological treatments, such as vortioxetine, which has been shown to improve physical and cognitive symptoms in patients with post-COVID-19 major depressive episodes 5
- Cognitive training and psychological support, which can help patients manage their symptoms and improve their quality of life 4