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Covid and Cognition 1




I have been unable to work as a GP since March 2012 when I caught acute Covid-19.

For the first 8 months thisk was due to the symptoms I had in the first 4 weeks that never really abated - fever, shortness of breath on exertion, chest pain, dizziness on standing and overwhelming fatigue. I still suffer from these but less severely. Over the course of the year I have been diagnosed with pneumonia, post viral asthma (?!) microvascular angina, POTS, breathing pattern disorder, Long Covid, peripheral neuropathy and hypothyroidism. I have addressed these symptoms with medication and lifestyle adjustments. Things like drinking 3 litres of water a day, adding salt to everything, compression garments, a shower stool, sitting down to prepare dinner, breathing exercises, no coffee, no alcohol, gluten free, and so many supplements….


However it was what was happening to my brain that was the most concerning for me. At 9 months into my illness I wrote a couple of posts exploring this. One called Brain Fog where I detail my confusion, lack of focus, loss of memory, problems word finding and slow recall. I have always described this as “a dementia that I am aware of”. Sometimes when I am really concentrating I actually feel discomfort in my brain followed by overwhelming fatigue. The other post, Executive Dysfunction, detailed my problems with attention, concentration, planning, problem solving and multitasking.


Whilst I could deal, to some extent, with the physical aspects of my illness I didn’t know what to do about healing my brain- where do I start with that??

I had looked up a lot about POTS and its links with cognitive dysfunction. This is thought to be due to reduced cerebral perfusion on sitting/ standing or possibly a autoimmune reaction but I felt it went deeper than this. I felt my brain had been damaged during the first months of the acute infection when I was confused, feverish and hypoxic.


I spoke to my GP who referred me to psychiatry as he wasn’t sure what else to do as there are no neuropsychiatry departments locally. Over a five minute phone call the locum psychiatrist said he had only heard of anxiety and depression post Covid-19 and didn’t know how to help me. So he said he would refer me to Old People’s Mental Health (! I'm 48) presumably to assess me for dementia. I never heard a thing from them.

I found out I could only be seen by for a neuro cognitive assessment locally if I had had a stroke or significant brain injury. This still sticks in my throat even now.

So I was back to advocating for myself (again). I wrote to an autonomic neurologist working at the top neurological hospital - Queen’s Square, London - explaining my situation. Again no response.

So I asked my GP to refer me there formally. Same result - been waiting 5 months. Referrals are supposed to be answered in less than 8 weeks FYI.


In the mean time I have done every study available on Covid-19 and cognition!! Firstly for my own validation and secondly so that if I could confirm the problem existed maybe I could get some help with it. Answer to that hopeful wish = fat chance.


I have memory issues so bad that in my Occupational Health interview this March I couldn’t remember when I started working at my practice, where I worked before (only 2 years ago) or ANY of the names of doctors I worked with currently. They did come back to me but about 3 hours after my interview.

He signed me off for another 3 months.


So it’s been 14 months since the initial infection. My Long Covid clinic did ask around locally for me. No one is interested in seeing me with regards to this. They have taken a punt and sent off a referral to a neurologist anyway. Fingers crossed. In the mean time some clever bod on the UK Doctors Long Covid group enrolled about 15 of us into another cognition trial with Mount Sinai Hospital in the USA. Three times a week for 30 minutes I am doing a variety of cognitive tests for an eight week period. It's interesting because the tests imply that if you practice you'll improve. For me the tests I couldn't do in week one I still can't do in week 7.


In being my own advocate I always come back to saying “would you be happy if this was happening to you?” I mean I am currently facing losing my job due to my disability and yet NO ONE has assessed me for disability.


Anyway rant over. I came across a recent webinar called “Covid and Cognition” run by the University of Cambridge and given by Lucy Cheke, an Experimental Psychologist. It was excellent and very validating. It seems the research is slowly seeping out now on how an acute Covid-19 infection DOES affect people’s memories/cognition/executive planning and I am going to bring this research to you in bite size pieces.


PS it's not been easy! I am REALLY struggling reading neuroscience research papers. I read about 5 minutes, can’t make head or tail of what they’re trying to stay, my brain implodes and have to have a lie down to recover.


The first paper is “Cognitive deficits in people who have recovered from COVID-19 relative to controls: An N=84,285 online study” by Hampshire et al.

The paper is heavy going but really interesting so I have included a reference for you to read in its entirety below, if you so wish. Of course the critics didn't like it because you had to self report your symptoms and the researchers included people without a positive PCR test ( shameful) but overall they suggested it was an interesting study and more research into this was needed.


Why did they do the research?

Case studies have revealed neurological problems in severely affected COVID-19 patients. However, there is little information regarding the nature and broader prevalence of cognitive problems post-infection or across the full spread of severity.


What did they do?

They analysed cognitive test data from 84,285 Great British Intelligence Test participants who completed a questionnaire regarding suspected and PCR confirmed COVID-19 infection. They then went on to do a series of cognitive tests.




What did they find?


  • People who had recovered from Covid-19 including those no longer reporting symptoms, exhibited significant cognitive deficits when controlling for age, gender, education level, income, racial-ethnic group and pre-existing medical disorders.

  • The cognitive deficits were of substantial effect size for people who had been hospitalised. Interestingly both ventilated and non-ventilated patients had similar deficits for attention. There was also significant deficits also for mild but PCR confirmed cases who reported no breathing difficulty.

  • Finer grained analyses support the hypothesis that COVID-19 has a multi-system impact on human cognition.

Here are my results at 4 months:

In the spiders web is a heavier grey line - 50% of the population are below this (inside the centre of the spiders web) and 50% of the population are above this line. We can take the 50th percentile as "average" for the population.

So this is showing for me that my memory - medium term, short term, and working memory is hovering near the 50th percentile. My verbal reasoning, verbal comprehension and attention is also reduced. Now as I did not do this test before I was ill with Covid-19 I have nothing to compare it to but given my academic qualifications and profession I can hypothesise that this is well below par for me. And it fits with what I am noticing - pill boxes, tick charts, phone alarms and post it notes as memory prompts just to get through the day.

And this is my result at 9 months in - essentially worse!!


I repeated the test at 12 months and it is a very similar picture with short term memory and planning at the 50th centile , and medium term and working memory at the 60th centile. Attention and verbal reasoning had improved to the 80th centile.



Their conclusion

There is evidence that COVID-19 may cause long term health changes past acute symptoms, termed ‘long COVID’. Our analyses of detailed cognitive assessment and questionnaire data from tens thousands of datasets, collected in collaboration with BBC2 Horizon, align with the view that

there are:

  • chronic cognitive consequences of having COVID-19.

  • individuals who recovered from suspected or confirmed COVID-19 perform worse on cognitive tests in multiple domains than would be expected given their detailed age and demographic profiles.

  • these deficits are in a positive correlation with symptom severity and is evident amongst those without hospital treatment.

  • these results should act as a clarion call for more detailed research investigating the basis of cognitive deficits in people who have survived SARS-COV-2 infection.


Comment on the paper by Dr David Strain

“Cognitive decline after severe infection is well recognised. The mechanisms for this are many-fold, through inflammation, oxidative stress (i.e. the body detects something is wrong and tries to do something about it, but overshoots and ends up damaging itself), lack of perfusion into the microcirculation (the smallest blood vessels that do most of the oxygen delivery and waste product removal), and hypoxia – reduced oxygen into the blood. This persists for at least five years and may be a lifelong step down in function. One manifestation that we see regularly in hospital is delirium during the acute infection. (Delirium is an acute and fluctuant alteration in mental function during an infection). COVID was associated with a degree of delirium that was substantially higher than we have seen in other similar viral illnesses. It also persisted much longer than previous experience would have predicted. Delirium is at one end of the spectrum of a virus affecting the brain. Knowing that this was much higher, it makes sense that all of the effects on brain function were more common, and this paper does talk about a ‘dose dependency’ type of effect (i.e. the more severe the original illness, the more the brain appears to be affected).

“With regards to the ‘long COVID’ symptoms, brain fog – which is effectively an individual not being able to function where they were previously – is the most common symptom that people are talking about in our study as well as being common in patients presenting to the long COVID services. This paper will certainly resonate with all of those affected. As to whether this is more common or more severe than in other post viral illnesses, it’s difficult to say, as the extremes are more likely to get referred or participate in these trials.”


References

The Great British Intelligence Test

https://www.bbc.co.uk/programmes/articles/5tFHwWMgg9VbrHT9kvGlFqd/the-great-british-intelligence-test

Cognitive deficits in people who have recovered from COVID-19 relative to controls: An N=84,285 online study

https://www.medrxiv.org/content/10.1101/2020.10.20.20215863v1

Cambridge Neuroscience - Lucy Cheke - Covid and Cognition

https://www.youtube.com/watch?v=QFxooG97ugA&t=1912s


Expert reaction to preprint suggesting patients who recovered from COVID-19 could suffer serious cognitive decline

https://www.sciencemediacentre.org/expert-reaction-to-preprint-suggesting-patients-who-recovered-from-covid-19-could-suffer-serious-cognitive-decline/

Brain Fog

https://www.rosecottagedoc.co.uk/post/brain-fog


Executive Dysfunction

https://www.rosecottagedoc.co.uk/post/executive-dysfunction-and-covid-19


Brain Fog Update

https://www.rosecottagedoc.co.uk/post/brain-fog-research-update

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