Dr. Matthew Kennedy, Co-Founder & Chief Medical Officer, Neurovine
Long-haulers across the world are familiar with the impact of long COVID on their daily life, including confusion and unanswered questions about treatment options. Now, recent research is shedding light on whether or not long COVID is a neurological disease and how that can improve available treatments.
When patients first started experiencing long COVID, doctors focused primarily on physical symptoms and dismissed neurological ones. This was traumatizing for early sufferers, who were invalidated by their experiences and often told it was all in their heads.
The medical community is now recognizing the neurological side of long COVID and is building a holistic view of the disease. Understanding the brain-nervous system relationship is showing how COVID-19 has an equal pulmonary and neurological impact, which is helping address patient needs and inform treatments.
In this blog post, we’ll explore what this means for long-haulers, what treatment options are available, and how this is shaping future understanding of long COVID.
What is Long COVID Syndrome?
Long COVID syndrome is a long-term condition where individuals continue to experience symptoms that endure more than 12 weeks after the initial COVID-19 diagnosis. These individuals are often referred to as long-haulers. Socioeconomically disadvantaged people, women, older people, and those with existing autoimmune disorders are at the greatest risk of getting long COVID.
Long-haulers often experience fatigue, brain fog, and difficulty concentrating or remembering things, among other symptoms. Long COVID is also known in the medical field as post-acute sequelae of COVID-19, or PASC.
Neurological Symptoms of Long COVID
While symptoms of long COVID are expansive and varied from person to person, the most common ones are:
- Nerve damage including damage to the peripheral nervous system
- Brain fog (difficulties concentrating, thinking, or recalling words, confusion, forgetfulness, etc.)
- Changes in mood
- Confusion/cognitive disorientation
- Memory issues
- Anxiety and depression
- PTSD
- Fevers and chills
- Trouble breathing/lung damage
- Suicidal/thoughts of self-harm
- Headaches
- Trouble sleeping
- Loss of taste and smell
- Fatigue
- Joint and muscle pain
What Are the Long-term Neurological Effects of COVID-19?
For long-haulers, the impact of COVID-19 extends into neurological symptoms not to ignore. The most difficult and prominent symptoms are difficulty sleeping, mood, brain fog, anxiety, depression, and more. Even the physical symptoms of long COVID are reflective of COVID-19’s effect on the brain-nervous system relationship.
Some patients suffering from long COVID can develop a reduction in grey matter thickness and even a reduction in global brain size. This directly affects memory and brain function due to the areas of the brain that get most impacted – the frontal cortex and limbic system. This also explains why many long-haulers experience anxiety and depression.
Individuals with long COVID often experience dips in energy after completing activities or find certain activities exacerbate their symptoms. This can be attributed to damage to the autonomous nervous system, which controls basic functions like breathing and digestion on autopilot. When the autonomous nervous system no longer works, scientists call this phenomenon dysautonomia.
A recent study conducted by the NIH investigates possible reasons behind the neurological impact of COVID. When the body is infected with COVID-19, its immune response results in inflammation and other factors which can damage the brain. Antibodies misidentify cells that are part of the blood-brain barrier as a threat and attack. The blood-brain barrier is key in protecting the brain from harmful substances. When it’s compromised, proteins leak into the brain from the bloodstream, which can harm the brain.
This response from the body’s antibodies activates endothelial cells. This causes platelets to adhere to blood vessel walls, which results in blood clots, leakage, and damage to several organs as well as the brain, leading to cognitive problems. The immune system then responds, repairing the damage, which can actually cause further neurological damage through inflammatory effects.
Long COVID’s effect on the brain can also be attributed to the fact that individuals with neurological symptoms often have inflammation in the central nervous system from their immune system’s response to COVID-19. Macrophages (a type of white blood cell that are part of the immune system’s defense against COVID-19), can often be imprecise and cause large amounts of damage.
There is also evidence that there could be an autoimmune response that causes antibodies to attack not only the COVID-19 virus but also misidentified body cells, which means the immune response continues long after the virus is gone, creating prolonged damage. This can be attributed to viral proteins that linger in the body and offers an explanation behind long COVID’s effect on the brain, especially with a recent study showing that the COVID virus can live in the brain for up to 8 months.
More research and studies are further investigating the impact of long COVID on the brain. More and more, it’s looking like long COVID is an umbrella term with several individual diseases lying underneath it.
WHAT IS THE TREATMENT FOR COVID NEUROLOGICAL SYMPTOMS?
This new information on the body’s immune response to COVID-19 and the resulting widespread inflammation is now helping inform treatments. Researchers are now testing different treatments for patient groups such as using anti-inflammatory drugs and rehabilitation.
There are several ways to begin treating long COVID’s neurological impact. They can include:
- Drug treatment – Doctors can prescribe medication like Adderall to address brain fog and concentration difficulties.
- Healthy diet - Eating brain foods, and reducing alcohol and caffeine consumption.
- Adequate sleep – Sleep is important for rest and recovery and improves your cognitive health. Doctors recommend 7-8 hours of sleep every night.
- Physical therapy and light physical activity - Doctors recommend not pushing yourself too hard, while also not being sedentary. Consistent, sustainable amounts of activity can be a great way to help symptoms.
- Cognitive pacing - Several patients see improvement when they slowly adjust to normal life and get rid of combinations of treatments. Cognitive pacing is an effective method for working within your energy capacity and letting it grow naturally.
- Start with the 3 P’s of Pacing: PLAN, PRIORITIZE, PACE:
- Plan: Observe trends in your energy and emotional response after activities and identify triggers. You may want to work with your GP or therapist to help create a plan. Take time to identify energizing activities and make sure to incorporate that into your daily routine.
- Prioritize: Make a schedule every day. Focus on categorizing activities into Necessary, Should, and Want. You’ll want to prioritize your needs and start off with half a day of rest. Try your best to avoid overstimulation, which can make some symptoms of long COVID worse.
- Pace: Modify your activities to make them easier. You can do this by breaking them up into smaller parts. Pad your activity with rest periods for 30-40 min, and make sure to keep track of how you feel after each one. Using this information, you can ramp up or scale down accordingly.
- Support groups and therapy – Finding emotional support and connecting with a therapist and/or long-hauler support groups can help validate your experiences and provide a source of community.
- Meditation and Mindfulness – This is an effective way to help treat anxiety and depressive symptoms. Mindfulness and meditation alter brain structure and activate parts of the brain associated with focus, mood, and cognition.
FINDING THE RIGHT TREATMENT OPTION FOR YOU
There's still a lot still unknown about long COVID to determine whether or not it’s a neurological disorder. It’s a nuanced disease with many factors impacting its symptoms and its effect on individuals. While there’s no silver bullet to address long COVID as a whole, recent research has still been extremely helpful in aiding long-haulers and informing current and future treatment options.
Want to learn more about how mindfulness and meditation can help support your long COVID recovery? Read how mindfulness and meditation can help your mental health here.
To learn more about supporting your neurological health, check out the blogs on The Virtual Vine.
ADDITIONAL RESOURCES:
- Coronavirus and the Nervous System
- Long COVID Now Looks like a Neurological Disease, Helping Doctors to Focus Treatments
- What is Covid-19 Brain Fog & How Can You Recover?
- Long COVID or Functional Neurological Disorder?
- Cognitive Pacing: A Step-by-Step Path to Improving Your Brain Health
- Dr. Matthew Kennedy's Top Five Foods for Brain Health
- A Deep Dive into Depression and Brain Structure
- Your Guide To Better Sleep and Brain Health
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