Cognitive Problems in Long COVID: Understanding and Managing the Impact
Long COVID, characterized by persistent symptoms lasting more than 12 weeks following acute COVID-19 infection, has affected a significant number of individuals worldwide. One of the most common and debilitating symptoms experienced by long COVID patients is cognitive impairment. In this article, we will explore the impact of cognitive problems in long COVID and provide a practical guide for general practitioners (GPs) to help them approach this issue.
The Prevalence of Cognitive Problems in Long COVID
As of March 2023, approximately 1.879 million individuals in the UK had self-assessed as having long COVID. Among these individuals, around 42% reported symptoms lasting two years or more, indicating a decline in new cases but a persistence of those with ongoing symptoms. Studies have shown that up to a third of long COVID patients experience persistent symptoms of cognitive impairment, although estimates vary due to methodological differences.
Understanding the Nature of Cognitive Impairment
Cognitive performance encompasses various functional domains, ranging from basic sensory processes to executive functioning and cognitive control. Long COVID patients commonly report problems with memory, attention, concentration, and executive processing. Other domains, such as visuospatial processing and language, may also be affected. Many patients experience deficits in multiple domains, which may or may not correlate with self-reported symptoms. Additionally, systemic symptoms like fatigue, insomnia, and “brain fog” are frequently reported and often worsen with physical fatigue.
The Causes of Cognitive Problems in Long COVID
The underlying causes of cognitive impairment in long COVID are still uncertain. Mechanistic studies have suggested viral infection in the brain, immune or inflammatory pathways leading to neuronal destruction or impairment, dysregulated autonomic function, and microvascular damage caused by endothelial dysfunction and inflammation. Other factors such as poor sleep, diet, reduced activity levels, and low exposure to natural light may also contribute to cognitive problems.
Assessing Cognitive Function in Long COVID
There is no specific test to diagnose or assess the severity of cognitive impairment in long COVID. However, several instruments are being developed to provide a general assessment of cognition. Brain imaging tests are not routinely recommended for cognitive problems following COVID-19, but they may be indicated in some cases to rule out other neurological conditions. Neuropsychometric testing may also be helpful after six months if cognitive function is not improving.
Managing Cognitive Problems in Long COVID
Patients with cognitive problems in long COVID can benefit from self-management strategies to reduce cognitive load and improve functioning. These strategies include controlling environmental stimuli, making and using lists, establishing routines, breaking down activities into smaller components, and pacing oneself to avoid crashes. Physical and occupational therapists can provide support for day-to-day functioning, but rehabilitation should incorporate pacing and personalized approaches to avoid exacerbating symptoms.
The Role of Primary Care Teams
GPs play a crucial role in supporting patients with cognitive symptoms in long COVID. Providing a supportive and empathic environment can significantly impact patients’ well-being, even if physical symptoms cannot be alleviated. GPs should also ensure optimal management of comorbid conditions and refer patients to specialist services when necessary. Longitudinal support and encouragement are essential for patients with persistent cognitive impairment.
The Future of Cognitive Impairment in Long COVID
Retrospective studies suggest that most individuals with persistent symptoms following mild COVID-19 infection, including cognitive dysfunction, recover within 12 months. However, patients with severe or progressive impairment may require specialized care and rehabilitation services. Ongoing research studies are investigating therapeutic agents and interventions for cognitive symptoms in long COVID.
Conclusion
Cognitive problems are a common and distressing symptom experienced by individuals with long COVID. Understanding the nature of cognitive impairment, assessing cognitive function, and implementing self-management strategies are crucial for managing this condition. GPs play a vital role in providing support and guidance to patients with cognitive symptoms, ensuring optimal management of comorbid conditions, and referring patients to specialist services when necessary. Ongoing research is needed to further understand and address cognitive problems in long COVID.
