What are the management options for post-COVID-19 (Coronavirus Disease 2019) cognitive impairment, specifically brain fog?

From the Guidelines

To manage post-COVID-19 cognitive impairment, specifically brain fog, cognitive pacing and postconcussion syndrome protocols are recommended, as they have been found to be effective in managing similar symptoms in ME/CFS and postconcussion syndrome literature 1. The current evidence suggests that cognitive impairment in post-COVID-19 patients is a significant concern, with studies showing that it can occur in up to 22% of patients at 12 weeks after infection, and may increase over time 1. The mechanisms underlying cognitive impairment in post-COVID-19 patients are thought to include neuroinflammation, damage to blood vessels, and injury to neurons, with studies finding Alzheimer disease-like signaling, widespread neuroinflammation, and abnormal cerebrospinal fluid findings in patients with long COVID 1. In terms of treatment options, the evidence suggests that a combination of lifestyle modifications and cognitive strategies may be effective in managing brain fog, including:

• Getting adequate sleep (7-9 hours nightly)
• Engaging in regular moderate exercise, such as walking or swimming, for 30 minutes daily
• Maintaining a balanced diet rich in omega-3 fatty acids, antioxidants, and B vitamins
• Staying hydrated with 8-10 glasses of water daily
• Practicing cognitive exercises, such as puzzles, reading, or learning new skills, to rebuild neural pathways
• Using stress management techniques, including meditation, deep breathing, or yoga, for 10-15 minutes daily to reduce inflammation
• Organizing tasks with lists and reminders, and breaking complex activities into smaller steps Additionally, some studies suggest that certain medications, such as low-dose aripiprazole, may be effective in managing fatigue, unrefreshing sleep, and brain fog in patients with ME/CFS, although more research is needed to confirm their efficacy in post-COVID-19 patients 1. It is essential to note that while these treatment options may be effective in managing brain fog, they should be used under the guidance of a healthcare provider, as some may have potential side effects or interact with other medications. Overall, the evidence suggests that a comprehensive approach, incorporating lifestyle modifications, cognitive strategies, and potentially medication, may be the most effective way to manage post-COVID-19 cognitive impairment, specifically brain fog.

From the Research

Management Options for Post-COVID-19 Cognitive Impairment

• Constraint-Induced Cognitive Therapy (CICT) has shown promise in reducing brain fog and improving instrumental activities of daily living (IADL) performance in adults with Long COVID 2.
• A multidisciplinary approach to brain fog and related persisting symptoms post COVID-19, including treatment recommendations that encompass cognition, mood disorders, sleep disorders, and neuroinflammation, may be beneficial 3.
• Intervention modalities for brain fog caused by long-COVID, such as noninvasive brain stimulation, hyperbaric oxygen therapy, and the use of Palmitoylethanolamide and Luteolin (PEA-LUT), have shown improvement in cognitive ability and brain perfusion 4.
• Neurofeedback treatment methods, including an original neurofeedback treatment method using a Z-score neurofeedback technique, may be effective in improving cognitive functions, such as processing speed and executive functions, including attention, planning, organization, problem-solving, and performance 5.
• Spontaneous recovery from post-COVID-19 brain fog is also possible, with some patients experiencing gradual improvement in cognitive function over time without the use of medications 6.

Treatment Recommendations

• CICT may be a viable treatment option for reducing brain fog and improving IADL performance in adults with Long COVID 2.
• A multidisciplinary approach to brain fog and related persisting symptoms post COVID-19 may be beneficial in addressing the complex needs of patients with Long COVID 3.
• Noninvasive brain stimulation, hyperbaric oxygen therapy, and the use of PEA-LUT may be considered as potential treatment options for brain fog caused by long-COVID 4.
• Neurofeedback treatment methods may be effective in improving cognitive functions in patients with brain fog 5.
• Monitoring and follow-up may be necessary to assess the progression of brain fog and the effectiveness of treatment options 6.