By President Daniel R. Wilson, MD, Ph.D.
America is experiencing yet another spike in daily COVID-19 cases. Along with the immediate dangers of contracting the virus, the medical community continues to release studies on new findings of side effects that show COVID-19 can cause long-lasting damage.
As a neuropsychiatrist, I am interested in whether those who contract COVID-19 experience cognitive fogginess or memory loss. These are classic neuropsychiatric issues. Hampshire et al (medRxiv October) in an online study of 84,000 ‘recovered’ COVID patients, found a link between COVID-19 infection and cognitive deficiencies in both mild and severe cases. More specifically, they report “… significant cognitive deficits when controlling for age, gender, education level, income, racial-ethnic group and pre-existing medical disorders. They were of substantial effect size for people who had been hospitalised, but also for mild but biologically confirmed cases who reported no breathing difficulty. Finer grained analyses of performance support the hypothesis that COVID-19 has a multi-system impact on human cognition.”
They note people recovering from COVID-19 could suffer from consequences as severe as mental decline equivalent to the brain aging a decade.
While this is just one study, and it shows that most of those who contract the virus will not suffer clear signs of cognitive loss, the study serves as a staunch reminder of just how little the scientific community understands about the capabilities of COVID-19. When the virus first gained notoriety in the medical community, it was clear that it was more than the average respiratory illness. There was direct evidence that the virus affected the lungs, the heart, and the brain. When news came that losing the sense of smell was a symptom, it became clear that the virus impacts the nervous system. The more cases that accumulate, the more data suggests that COVID-19 can cause moderate or severe neurological, cognitive, psychological, and psychiatric symptoms.
Determining the commonality of neurological side effects becomes even more muddled when you consider that the medical community only has reference to people who experienced symptoms severe enough to cause hospitalization. It is currently impossible to calculate just how many people who had COVID-19 but were either asymptomatic or well enough to avoid hospitalization, will experience a deterioration of their cognitive health. We do not yet have all the pieces to the puzzle. However, there’s enough evidence where trusted publications like the Journal of Alzheimer’s Disease are providing estimates that 30% to 50% of hospitalized patients have neurological issues.
Again, these neurological issues are documented while a patient is hospitalized. Everything from headaches or dizziness to confusion and strokes have been documented. What is difficult to understand is how cognitive issues are usually more severe in sicker patients, but there remain exceptions to the rule. A study from Oxford recently noted that of 43 patients examined for severe neurological complications as a result of COVID-19; several showed only mild respiratory symptoms. With so much information to sift through, the medical community must do everything they can to process the information quickly to better treat the effected patients. In addition to examining the latest trends, it is also beneficial to look back at lessons learned from the pandemics of the past.
What history has shown is that neurological issues linked to pandemics can occur in the present as well as years into the future. For instance, it is well documented that 1918’s influenza pandemic caused issues for people years later. The same can be said for more recent pandemics like the MERS outbreak of 2012. The medical community must brace for the likelihood that patients may need care for neurological issues long after the pandemic. There are plenty of treatment strategies designed to treat neurological issues, but there aren’t established options for patients who are suffering from neurological issues as a result of COVID-19. History shows that intervention may make it possible for doctors to help their patients restore brain functionality.
The medical community must continue to prepare for the challenges seen and unseen ahead. Cognitive deterioration can cause countless hardships in a person’s life. No one deserves to have their ability to perform their daily responsibilities stripped away from them by a terrible disease like COVID-19. It is also essential to look at the big picture. Damage to cognitive abilities can also lead to other symptoms such as apathy or depression. A well-rounded approach to treatment will only grow more crucial in the weeks, months, and years ahead.
Along with being the President of Western University of Health and Sciences, Daniel R. Wilson has directed neuropsychiatry at McLean Hospital & Harvard Medical School in Boston. He is also the former president of the American Neuropsychiatric Association.
