En español | As many as 1 in 3 COVID-19 survivors experience a mental health or neurological disorder within six months of a coronavirus infection, according to a large study published this week in The Lancet Psychiatry. These latest findings add to a growing body of evidence that show COVID-19 can have serious and potentially long-lasting effects on the brain.
Researchers analyzed data from more than 236,000 patients diagnosed with COVID-19 and found that about 34 percent were diagnosed with a neurological or mental health disorder following their bout with the coronavirus. For nearly 13 percent of these patients, it was their first time receiving such a diagnosis.
Out of a total of 14 brain disorders, mood and anxiety disorders were among the most common conditions the researchers saw, followed by substance use disorders and insomnia. Neurological complications were rarer, with 2.1 percent of patients reporting ischemic stroke, 0.7 percent reporting dementia and 0.6 percent reporting brain hemorrhage. The risk for both mental health and neurological disorders was greatest in patients who were severely ill with COVID-19, and especially for those who were in intensive care.
The researchers also compared the group of COVID-19 survivors with populations of patients diagnosed with influenza and other respiratory tract infections, and they found a significantly greater risk for neurological or psychiatric conditions among the COVID cohort than the other two groups.
Neal Parikh, a neurologist and assistant professor at NewYork-Presbyterian/Weill Cornell Medicine who was not involved in the study, calls the report's findings “attention-worthy.” A number of previous studies have linked COVID-19 to brain health issues, but he says “it's surprising to see the whole spectrum of neuropsychiatric illnesses that increased after COVID."
It also provides a sense of validation for those experiencing one or more brain-related symptoms after a coronavirus infection. “Especially somebody who's experiencing mental health symptoms, they may take solace in knowing that this is not uncommon after COVID-19, that they're not alone in experiencing those symptoms, and that they should really be seeking help for that,” Parikh says.
Unclear how the coronavirus attacks the brain
Scientists are still unclear about how, exactly, COVID-19 affects the brain. One theory is inflammation. A recent study conducted by the National Institutes of Health (NIH) found blood vessel damage in the brains of deceased COVID-19 patients, likely caused by the body's inflammatory response to the virus. Other research suggests the virus can directly invade the brain and its cells. Ronald Petersen, a neurologist at Mayo Clinic, says it could be a combination of factors. “From a medical perspective, a scientific perspective, it's still a bit up in the air,” he adds.
Low levels of oxygen and the virus’ effect on the body's blood-clotting system have also been studied as potential explanations.
While the study's findings are significant, Petersen says there's no need for unnecessary alarm. Just because you've had a coronavirus infection doesn't mean “you're destined to develop neurologic or psychiatric problems,” he points out.
That said, if you start to exhibit new or unusual symptoms that persist or reoccur after having COVID-19, “it might merit at least an inquiry with your personal physician to see if, in fact, there's something brewing.” Petersen notes the study also serves as a reminder for health care providers to keep COVID-19 “on their radar screen” as a possible contributing factor to serious neurological conditions, such as stroke.
Doctors brace for influx of patients with brain-related symptoms
With the total number of COVID-19 cases continuing to climb in the U.S., Sara Manning Peskin, a neurologist at Penn Medicine who works with people experiencing post-COVID-19 brain fog, predicts the health system will start to see an “influx” of patients noticing brain-related symptoms after COVID-19. To that, the study's authors write that health services “need to be configured, and resourced, to deal with this anticipated need."
Several hospitals and health systems have set up clinics to help treat people who experience lingering effects of COVID-19 — and some specifically treat neurological issues. “There's a big demand for the clinics because patients are having these experiences and nobody knows what to do,” Manning Peskin says.
The NIH's National Institute of Neurological Disorders and Stroke (NINDS) has also launched a database to keep track all of the neurological symptoms and outcomes health care providers throughout the U.S. see in coronavirus patients.
To date, there is no specific intervention that prevents COVID-19-related brain issues. That is why NewYork-Presbyterian's Parikh says it's important to “remain vigilant” and to continue with proven mitigation efforts — wear a mask in public, keep a distance of at least 6 feet from others, wash your hands often, avoid crowds and poorly ventilated spaces, and get a vaccine when it's available to you.
As for next steps, experts agree that more research is needed to better understand COVID-19 and the brain — and especially any long-term complications that could arise from a coronavirus infection.
"I think [the study published in The Lancet Psychiatry] is really good proof that there's an association,” Manning Peskin says. “Everyone's just wondering what's actually causing it, and then the next step is treating it.”
10 Ways to Protect Your Brain Health During COVID-19
In its latest report, AARP's Global Council on Brain Health recommends 10 steps older adults can take to protect their brain health during the pandemic.
- Consider getting the vaccine as soon as you are able
- Stay physically active
- Maintain a balanced diet
- Stay socially connected
- Maintain a regular sleep schedule
- Stimulate your brain
- Don't put off necessary medical appointments
- Take care of your mental health
- Pay attention to signs of sudden confusion
- Monitor changes in brain health
Source: COVID-19 and Brain Health: The Global Council on Brain Health’s Recommendations on What to Do Now