After two full years have passed since the COVID-19 pandemic began, we are hearing more about the potential long-term effects of the virus, both mentally and physically. COVID-19 spares no organ system. The short- and long-term symptoms are widespread and seem to vary significantly from patient to patient. While the virus is known for attacking the respiratory and cardiovascular systems, it’s also becoming known for attacking the nervous system. This begs the question of whether or not COVID-19 could cause neurological problems in the long term.
Below, we take a closer look at how COVID-19 could cause neurological problems in patients, including both acute and potential long-term consequences, as well as what this means for patient monitoring and rehabilitation.
When examining neurological manifestations in patients admitted with confirmed COVID-19 infections, doctors within an extensive hospital network in Chicago, Illinois, found that 40.2% of patients with COVID-19 presented with neurological problems at the onset, and more than 30% of those patients showed signs of impaired cognitive function. They found that the most frequent neurologic manifestations were myalgias (44.8%), headaches (37.7%), encephalopathy (31.8%), dizziness (29.7%), dysgeusia (15.9%), and anosmia (11.4%), with encephalopathy being independently associated with worse functional outcomes and higher mortality within 30 days of hospitalization.
Many patients are concerned and are asking their doctors if COVID-19 could cause neurological problems. Here is what we know so far about the acute and potential long-term consequences of COVID-19.
Most individuals who are infected with the SARS-CoV-2 virus will experience no or mild to moderate neurological symptoms. However, most patients who are hospitalized as a result of COVID infection will likely present with neurological manifestations.
Several neurological symptoms have been reported with acute COVID-19, including loss of taste and smell, headaches, muscle aches, delirium, brain inflammation, and stroke. It also has been known to cause seizures or major strokes in rare cases. As the virus does not appear to extensively infect brain cells, these symptoms are currently believed to be caused by immune activation, neuroinflammation, and damage to blood vessels in the brain.
While inflammation typically plays a helpful role in our bodies, acting as a defense system against pathogens, it can also cause immense harm. Some experts believe that the more severe cases of COVID-19 may develop from an overactive inflammatory response to the virus. Coronaviruses directly bind to ACE-2 receptors in respiratory epithelial cells, causing an event known as a “cytokine storm,” leading to widespread inflammation in COVID-19 patients and ultimately leading to multiple organ damage.
Our understanding of the long-term neurological consequences of COVID-19 is still very limited, but it is clear that COVID can damage the brain; however, how COVID damages the brain is still up for debate. Current research suggests this damage can occur from direct infection (encephalitis), a lack of oxygen to the brain, and strokes.
One of the most common symptoms reported in long COVID patients is “brain fog,” which is essentially an umbrella term used to describe long-term cognitive symptoms associated with COVID that are similar to symptoms of Mild Cognitive Impairment, including short-term memory loss, poor attention span and difficulty concentrating, slow thinking, and confusion. Currently, researchers believe these cognitive symptoms may be a byproduct of the inflammatory processes within the brain.
Emerging and ongoing research surrounding neurological problems caused by COVID-19 has important implications for healthcare providers. Providers should incorporate tools to measure and monitor neurological changes in COVID patients, particularly those at high risk of developing neurological manifestations. Cognitive and functional aspects of brain function should be regularly assessed and monitored over time for patients experiencing long COVID symptoms. This will give rise to tailored treatment and rehabilitation, and consequently, better health outcomes.
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