Brain fog caused by long Covid is real. These doctors have advice for managing it

One of the ways long COVID presents itself, commonly known as “brain fog,” is particularly devastating to those suffering with it, say doctors.

The New York Times recently reported that, according to the U.S. Census Bureau, more Americans say they have problems with memory, making decisions and other cognitive issues than at any time in the last 15 years.

It’s as common as other long COVID symptoms and continues to appear in adults in their 30s and 40s and has been reported to keep people out of work.

“If you can take the example of an engineer who works with computers and has to process the information and write down the data and do all kinds of mental calculations and make decisions, they cannot do that because they cannot process the information,” said Dr. Naheed Van de Walle, a rehabilitation physician with Hartford HealthCare. 

“I had a patient who had to give up the practice of law because of these brain fog symptoms,” she said. “And I have patients who are physicians who obviously have a lot of problems if they have brain fog. So it affects everyone basically, even if you’re not working.” 

Related: UConn study to test cognition training games to improve Covid-related ‘brain fog’

Van de Walle said she has not seen the issue as much in older people.

“I don’t see that. I see younger people, mostly between I would say 30s to 60s, and some patients are in their 20s,” she said. “And I don’t see that high an incidence in older people. So I think that’s something that we have to revisit and look at it, because it’s not really true that it’s always older people in their 80s.”

Brain fog, which is a loss of cognitive ability, “is very debilitating,” Van de Walle said.

It includes “memory deficits, word-finding problems, processing information. Short-term memory is the most devastating and I see that in my patients who are 30-something. It’s not all the people. These are very productive people. They’re working, and they are completely devastated by this symptom,” she said.

Van de Walle said scientists believe the cause of brain fog may be a loss of serotonin caused by the coronavirus, including a decrease of the precursor of serotonin in the gut. The loss of serotonin leads to impaired communication between the brain and the vagus nerve, which controls bodily functions such as digestion, heart rate and the immune system, she said.

This can lead to reduced function in the brain, mainly the hippocampus, she said.

Van de Walle said people with brain fog often find that their complaints aren’t taken seriously.

“One thing they will say is, thank you so much for listening to us and acknowledging our symptoms, because we’ve been dismissed so many times by so many different providers that they feel so invalidated. They don’t feel validated at all. And these symptoms are real,” she said.

She said brain fog can occur with other diseases as well, including fibromyalgia, depression, chronic fatigue syndrome and general cognitive decline.

Dr. Lindsay McAlpine, who runs Yale Neurology’s NeuroCOVID-19 Clinic, said brain fog can be associated with chronic fatigue syndrome or postural orthostatic tachycardia syndrome, knowns as POTS, which causes an increased heart rate after getting up from a sitting or lying position.

Patients with those issues make up a good portion of those McAlpine sees in her clinic, she said.

“I’ve seen a lot of very high-functioning people, busy moms who used to do 10 things at once, who now … can’t do that, have to prioritize,” McAlpine said.

Others will say, “I had this conversation with my wife yesterday and she gets so frustrated with me. I just totally don’t remember the conversation at all today,” she said. “The severity really ranges very widely, interestingly. Some people, most people are able to work through it and they just have to adapt and they’re frustrated.”

Others had to change jobs or retire, she said.

While brain fog can’t be cured, and can last from 12 weeks to as long as six months or even years, Van de Walle does teach her patients how to manage it.

First, she sends them to a speech pathologist.

“Speech pathologists are very well trained to do cognitive screening,” she said. “So if it’s mild brain fog symptoms, I will send them to a speech pathologist to see what are the deficiencies. They can do specific tests. These are standardized tests to see where the problem is and then give them recommendations, remedial techniques.”

She also tells her patients not to multitask.

“You’re going to cause more confusion and more problems and will not be able to complete any task,” she said. “So always do one thing at a time.”

She also advises people to pace themselves.

“Give themselves extra time, take breaks, computer breaks, and not to try to finish everything in one stretch, which is sometimes hard for younger patients to do who are very enthusiastic and work very hard, but they have to remind themselves to take breaks, so they can come back, let the brain rest a little bit and then go back to what they’re doing,” she said.

Hydration is important, as is avoiding physical fatigue, Van de Walle said.

McAlpine said she makes sure she’s not missing some other cause because “long COVID to me is the diagnosis of exclusion.” 

“And then, one of the main things I focus on is sleep. So what we’re finding is that individuals with long COVID are much more sensitive to sleep loss and sleep deprivation and sleep interruption.”

Anyone with sleep issues is given a sleep study. Exercise is also recommended for patients who are able to do it because it improves brain health. 

“And then making sure we’re not missing other things like … migraine disorders,” McAlpine said. “Migraines have an effect on function, making sure we’re treating new mood disorders after COVID or mood issues, because anxiety and depression has a huge effect on cognitive function.”

It’s a holistic approach, she said, which also includes medications such as guanfacine and N-acetyl cysteine “and patients respond well to that.” 

Ed Stannard can be reached at estannard@courant.com.