Is There Effective Treatment for COVID Brain Fog?

Summary: Yes, there is effective treatment for COVD brain fog. While COVID brain fog – i.e. cognitive issues related to infection with SARS-CoV-2 – can appear in anyone who gets COVID, it’s most common among people who report long COVID.

Key Points:

• The latest data shows that almost everyone over age 16 in the U.S. has antibodies from SARS-CoV-2 either from infection or vaccination.
• Data shows about 3/4^ths of the U.S. population has ever had COVID.
• Close to 10% of people who’ve had COVID report long COVID, i.e. COVID that lasts longer than three months.
• Among people with long COVID, around half report cognitive problems, i.e. COVID brain fog.

What is Long COVID?

Here’s the most comprehensive definition of Long Covid to date, provided by the National Academies of Sciences, Engineering, and Medicine (NASEM):

“Long Covid is an infection-associated chronic condition that occurs after SARS-CoV-2 infection and is present for at least 3 months as a continuous, relapsing and remitting, or progressive disease state that affects one or more organ systems.”

Experts indicate long COVID can appear in many ways, and any organ system in the human body can be affected. Primary known symptoms include the following:

Common Symptoms of Long Covid

• Shortness of breath
• Cough
• Persistent/chronic fatigue
• Feeling awful – energy, body, thoughts/feelings – after any exertion
• Difficulty concentrating
• Memory changes
• Chronic/recurring headache
• Lightheadedness
• Elevated heart rate
• Insomnia
• Problems with taste or smell
• Bloating
• Constipation
• Diarrhea

Long COVID is associated with increased risk of development of a variety of chronic physical and behavioral health conditions, including but not limited to:

Diagnosable Conditions Associated With Long Covid

• Interstitial lung disease and hypoxemia
• Cardiovascular disease and arrhythmias
• Cognitive impairment
• Mood disorders
• Anxiety
• Migraine
• Stroke
• Blood clots
• Chronic kidney disease
• Postural orthostatic tachycardia syndrome
  • Range of cardiovascular and other symptoms
• Dysautonomia: impairment in systems associated with the autonomic nervous system:
  • Blood pressure
  • Heart rate
  • Brain fog
  • Sexual dysfunction
  • Dizziness
  • Mood swings
  • Problems with vision
• Myalgic encephalomyelitis–chronic fatigue syndrome (ME/CFS)
• Mast-cell activation syndrome (MAS)
• Fibromyalgia
• Connective-tissue diseases
• Hyperlipidemia
• Diabetes
• Autoimmune disorders including:
  • Lupus
  • Rheumatoid arthritis
  • Sjögren’s syndrome.

These bulleted lists should help people understand that long COVID is real, and can cause serious disruption across virtually all areas of life.

How People Experience Long COVID, Why Treatment for COVID Brain Fog is Important

The most common features of long COVID include:

Features of Long COVID

• May appear after asymptomatic, mild, or severe SARS-CoV-2 infection.
• May appear alongside initial infection
• Onset may occur weeks or months after apparent full recovery
• Can affect children
• Can affect adults
• Factors that do not prevent long covid:
  • Overall health at initial infection
  • Socioeconomic status
  • Age
  • Sex
  • Sexual orientation
  • Race
  • Ethnic group
  • Geographic location
• May exacerbate preexisting problems
• Can appear as mild, moderate, or severe
• Can resolve in months, can persist for years
• Diagnosis determined by clinical observation:
  • There is no blood test for long covid

In addition, experts indicate long covid can:

• Impair work performance, causing:
  • Loss of hours
  • Loss of income
  • Chronic absenteeism
• Impair academic achievement, causing:
  • Loss of learning days
  • Declining grades
  • Chronic absenteeism
• Reduce ability to care for self
• Reduce ability to maintain family responsibilities/caregiving
• Degrade overall physical, psychological and emotional wellbeing
• Degrade psychological wellbeing of family members and/or caregivers

Now Let’s extract the cognitive, psychological, and emotional symptom of long covid:

• Cognitive impairment, i.e. problems with:
  • Memory
  • Learning
  • Decision-making
  • Clarity of thought
  • Problem solving
• Mood disorders, i.e. depression
• Anxiety

Here’s how the experts at Yale University Medicine describe COVID brain fog:

“Brain fog isn’t an official medical diagnosis; rather, it’s a colloquial term for a range of significant, persistent neurocognitive impairments that cause such symptoms as sluggish thinking, difficulty processing information, forgetfulness, and an inability to focus, pay attention, or concentrate. With Long COVID, the exact combination of brain fog symptoms varies from one person to the next.”

With all that information in mind, let’s take a look at a recent study conducted on treatment for COVID brain fog. It’s critical to realize that COVID brain fog can affect each person in different way, which means researchers needed to design a study to account for these individual differences.

The Study: Assessing Treatment for Covid Brain Fog, i.e. Covid-Related Cognitive Impairment

Th authors of the paper “Cognitive Rehabilitation and Functional Outcomes in Long COVID–Related Cognitive Impairment” posed this research question:

“Does cognitive rehabilitation (CR) improve goal attainment, cognitive, and clinical outcomes in people with cognitive impairment as a part of long COVID?”

To address this question, researchers recruited 78 adults with a clinical diagnosis of long covid, and separated them into two groups:

• One group received standard treatment (treatment-as-usual) for long covid (TAU): 40 patients
• One group received ten weeks of weekly sessions of cognitive rehabilitation therapy (CR) via telehealth:

Cognitive rehabilitation therapy (CR) is an effective, evidence-based treatment designed to improve and/or restore deficits in memory, attention, organization, judgment, processing speed, and executive function associated with stroke, brain injury, or other neurological diseases or conditions.

• Patients selected three functional goals for treatment using the Bangor Goal Setting Interview (BGSI)
• Sessions focused on patient-selected goals
• The selection of goals by each patient allowed providers to prioritize treatment to match patient needs.

Each participant completed a variety of assessments for different factors associated with cognitive impairment from long COVID. Patients completed assessments at baseline, 3 months after initiation of treatment, and 6 months after initiation of treatment.

During the study, participants chose three (3) goals as benchmarks for improvement. For example, a work-related goal may have looked like this:

“I will work on sales reports for 30 minutes, twice a week, without taking a break.”

Therapists and patients addressed identified goals in order of priority, dedicating three (3) sessions to each goal. During the last session of treatment – the 10^th of 10 – for COVID brain fog, providers and patients reviewed treatment gains, identified effective individualized strategies, and devised plans and exercises for maintaining cognitive gains long-term.

Researchers prioritized the following primary outcome:

• Significant improvement in self-reported goal attainment scores as measured by the BGSI.

Let’s take a look at what they found about treatment for COVID brain fog, i.e. cognitive impairment associated with long COVID.

Can Treatment for COVID Brain Fog Work?

Spoiler alert: yes. If you have brain fog from COVID, whether its typical COVID or long COVID, you can receive treatment to improve cognitive deficits caused by COVID.

First, we’ll share the average improvement on scores associated with specific cognitive goals identified by the patients in the study. Note: for the BGSI results, a higher score reflects greater improvement on self-identified goals.

Functional Cognitive Goals: Effect of Treatment for COVID Brain Fog

This data shows the impact of CR at three and six months on the three benchmark items defined by each patient as their most important goals for treatment for COVID brain fog on the Bangor Goal Setting Interview (BGSI).

At 3 months:

• Cognitive rehabilitation therapy (CR) group:
  • BGSI score: 7.84
• Treatment-as-usual (TAU) group:
  • BGSI score: 4.97
• Adjusted mean difference (AMD): 2.88
• Treatment effect:
  • Large: 1.57

At 6 months:

• Cognitive rehabilitation therapy (CR) group:
  • BGSI score remained stable: 7.46
  • Significant adjusted mean difference (AMD) persisted: 1.72
  • Treatment effect remained large: 0.91
• Treatment-as-usual (TAU) group:
  • BGSI score increased: 5.74

Those results show that compared to no CR, patients who received CR showed significantly greater improvement on cognitive functions they identified as priorities.

Now let’s look at the secondary outcomes assessed by the treatment team.

Impact of Treatment for COVID Brain Fog on Additional Outcomes

Goal satisfaction at 3 months:

• Cognitive rehabilitation therapy (CR) group showed more improvement than treatment-as-usual (TAU) group:
  • BGSI difference: 2.87

Goal satisfaction at 6 months:

• Cognitive rehabilitation therapy (CR) group showed more improvement than treatment-as-usual (TAU) group:
  • BGSI difference: 1.53

Cognitive outcomes measured 3 months after treatment initiation:

• Cognitive rehabilitation therapy (CR) group showed more improvement than treatment-as-usual (TAU) group for:
  • Executive function
  • Number/letter sequencing
  • Mean difference: 1.52

Cognitive outcomes measured 6 months after treatment initiation:

• Cognitive rehabilitation therapy (CR) group showed more improvement than treatment-as-usual (TAU) group for:
  • Executive function
  • Number/letter sequencing
  • BGSI difference: 0.93
• Cognitive rehabilitation therapy (CR) group showed more improvement than treatment-as-usual (TAU) group for processing speed:
  • Mean difference: 1.90

These results show that people with cognitive impairment associated with COVD or long COVID can experience improved and/or restored cognition by engaging in cognitive rehabilitation therapy (CR). In this study, CR had no effect on the presence or symptoms of anxiety or mood disorders.

How This Research Helps

Here’s how the study authors characterize the results above:

“In this random controlled study, cognitive rehabilitation (CR) improved self-reported goal-specific functional outcomes in long COVID. These effects were clinically meaningful and sustained at 6 months. Together, these findings provide the first class II evidence for a goal-based cognitive rehabilitation intervention for this population and support its use in routine care.”

Since COVID is a relatively new disease in humans, it’s no surprise we’re learning more about it every day. In the months after the pandemic began, no one knew about long COVID, for obvious reasons: humans hadn’t had it long. In addition, reports of COVID brain fog were only beginning to trickle in: that was something humans had not had yet, either.

Now, six years later, we have data. We know long COVID is real. We know COVID brain fog is real. Importantly, we know the cumulative physical and emotional impact of long COVID can cause serious and significant dysfunction and disability. And more importantly, we know that cognitive rehabilitation therapy (CR), a type of treatment designed for recovery from various brain injuries, can help significantly improve cognitive deficits caused by long COVID.

In other words, there is effective treatment for COVID brain fog, and we don’t have to reinvent the wheel. The existing protocol for cognitive rehabilitation therapy (CR) is effective, and can help people meet their short- and long-term cognitive goals.