Brain fog after COVID-19: how to treat memory and concentration disorders?

How can we treat the "brain fog" (brain fog) that some patients experience after surviving COVID-19? At the outset, it is worth clarifying what is meant by the term "brain fog." The term is used to describe a range of symptoms concerning cognitive impairment of varying severity.

Although brain fog is not a symptom that occurs only after COVID-19 (it can occur in Hashimoto's disease, for example), it has been officially identified as a symptom of what is known as long-COVID, or long COVID-19, also known as the "tail of the disease." Thus, this is the recovery period in which people, after experiencing symptoms of an infection, experience many persistent symptoms during the recovery period for weeks or months after becoming ill.

Brain fog can be distressing for a patient, as it can affect our daily functioning. In my practice, I have dealt with many people struggling with brain fog problems for up to 12 months after having the disease. I will never forget a young girl, a student, who told during a medical appointment how she spent half a day looking for her smartphone, which, as it later turned out, for unknown reasons, she had previously hidden in the refrigerator. Many people complain that single words escape them, they can't recall the name of an object, the name of a person they've known for years, or they call the TV - a stove, although in a moment they catch themselves on what they just said strangely. Brain fog can range in severity from mild concentration impairment to moments when my patients did not understand simple commands given to them by a supervisor or lecturer. The second of the "stronger" examples from my practice was a girl who, in a remote class, when talking to her teacher, had the impression that the teacher was speaking to her in a foreign language from which she could not understand anything. I also had among my patients several accounting ladies who caught themselves at one point not understanding what they had just generated in the program they were using. Unfortunately, such symptoms are often accompanied by anxiety, which is related to the risk of not doing well at university or losing one's job as a result of cognitive decline. People-fearful of the symptoms they experience-often become depressed, which can further exacerbate brain fog symptoms.

Fortunately, all of my patients, thanks to the treatment given, have returned to their previous intellectual performance.

In order to effectively help patients, it is extremely important to understand the causes and mechanisms in which symptoms of cognitive dysfunction arise after SARS coronavirus CoV-2 infection. Unfortunately, at present, the exact causes and mechanisms of brain fog after COVID-19 are not fully understood. Yet we already know quite a bit and enough to make effective attempts to treat the disorder.

Some researchers suggest that brain fog can be caused by inflammation of the nerves, damage to the microcirculation in the central nervous system, a mild form of encephalitis, or even loss of gray matter, or brainstem dysfunction.

Interestingly, there are other theories as well. For example, one study found that brain fog after COVID-19 could be caused by an immune system response, even without the presence of the virus, but which the virus initiated. However, further research is needed to fully understand the mechanisms underlying brain fog after COVID-19.

While brain fog after COVID-19 can be a persistent symptom for some people, especially those previously suffering from various forms of dementia, the good news is that the vast majority of patients recover completely within 6 to 9 months.

How to deal with a patient showing symptoms of brain fog?

There are some very simple strategies that all patients can use to deal with brain fog on their own. In fact, it has been shown that simply doing aerobic exercise, eating healthy meals, especially those based on the Mediterranean diet, avoiding alcohol and drugs, and getting enough sleep can all help and can speed up recovery and the resolution of annoying and impeding daily symptoms. In addition, protecting cognitive reserve and avoiding additional stressors can help combat brain fog . So taking care of such a patient and making him feel safe seems extremely important. In my practice, I try to use a variety of neuroprotective drugs, as well as those whose primary mechanism of action is to bind to the polar group of phospholipid membranes of cells, which initiates the process of restoration of the membrane structure through the formation of mobile drug molecules and phospholipids.

I support these medications with additional supplementation with 3 omega acids, lecithin, B vitamins and sometimes herbal preparations, which is likely to accelerate the recovery processes even more efficiently and improve the stability of cell membranes in the central nervous system. For this process to be effective, a healthy diet that provides the right amounts of all nutrients, including minerals and vitamins, is essential. It is also not without an adequate amount of sleep, during which the regeneration of our body, and especially the CNS, takes place. Exclusion of stress-as far as we are able-eliminates the adverse effects of excess of certain hormones on our brain.

Remember that for those with persistent symptoms, it is necessary to see a doctor, preferably a neurologist specialist, who will provide appropriate help, including appropriate drug treatment.

It is important to remember and reiterate to our patients that recovery and complete cessation of brain fog after COVID-19 is possible, and with the passage of time and appropriate strategies prescribed by the doctor, people can usually fully regain cognitive function and enjoy life as before.

There are methods available to treat brain fog after COVID-19, so as to help patients get rid of the unpleasant symptoms associated with cognitive impairment more quickly. One way is the cognitive impairment drugs I mentioned earlier, which can help improve memory, attention and other cognitive functions. A recent case study published by researchers at the Yale School of Medicine showed promising results from such brain fog treatment. However, the likelihood of full recovery in patients with pre-existing dementia or mild cognitive impairment, as I mentioned earlier, may be lower.

Another treatment option that can be used is anxiety and PTSD therapy, which can help address underlying emotional and psychological issues that also contribute to the persistence of brain fog. PTSD, or post-traumatic stress disorder, is categorized as an anxiety disorder. In the case of our patients, it develops in people exposed to a traumatic stressor, which can be a situation of imminent threat to life or health as a result of COVID-19, or the death of a loved one in this case as a result of COVID-19 and the fear of the disease.

Well-chosen antidepressants can also be used to treat mood and sleep disorders associated with brain fog. The results of a study by Taube et al. suggest that therapy may be partially effective using small doses of antidepressants at first, followed by gradually increasing doses of antidepressants in combination with nonpharmacological therapies.

In addition, as previously mentioned - lifestyle changes involving aerobic exercise, eating meals based on a Mediterranean diet, avoiding alcohol and drugs, and getting enough sleep can also significantly help to permanently resolve brain fog symptoms.

While there are currently no approved proven and 100% effective, and therefore universally recommended, treatment options for post-COVID-19 brain fog, we do know that early intervention can help patients cope with the condition. According to Dr. Arnsten, protecting cognitive reserve and avoiding additional stressors can be helpful in the fight against brain fog. In addition, it can also be beneficial to offer practical advice on how to counteract brain fog and help patients with functioning related to cognitively impaired relationships with other people. It is important for health care professionals to work with patients to develop the best treatment approaches that take into account their individual needs.

Lifestyle changes to reduce the severity of symptoms Brain fog?

Brain fog as previously mentioned is a common symptom experienced by patients in recovery from COVID-19. While there is no established treatment for the cognitive side effects that the disease can cause, fortunately there are lifestyle changes that can be made to reduce the existing cognitive impairment that brain fog causes.

There is no need to immediately reach for expensive drugs or supplements, often with unproven efficacy, especially without consulting a doctor.

To begin with, it is enough to implement exercise and physical activity to improve cognitive function and reduce the severity of brain fog. Patients should start exercising carefully and slowly, initially with two to three minutes of exercise a few times a day and gradually increase the level of physical activity slowly, day by day. Cognitive stimulation and brain training under the care of a team of people trained to do so can further help treat brain fog. Treatment of cognitive side effects after COVID-19 includes breathing exercises combined with physical and cognitive therapy, which can help many patients recover completely.

While patients with pre-existing dementia or mild cognitive impairment are less likely to fully recover, cognitive stimulation and brain training can still be beneficial in this group of patients. Therefore, despite the poor prognosis, it is important not to give up, but to start appropriate measures as soon as possible.

Patients should be engaged in activities such as reading, doing puzzles and memory games. Such activities help stimulate their cognitive functions and slowly lift the symptoms of brain fog.

A doctor caring for a COVID-19 patient should know that brain fog can persist for weeks, months or even longer after COVID-19, even when other symptoms have subsided.

Some clinicians are attempting to treat patients with low-dose medications, mi such as stimulants or antidepressants, to alleviate brain fog symptoms. Researchers have also found that inflammation in the CNS may contribute to brain fog in COVID-19 patients, and some evidence suggests that regular infrared light therapy may help reduce inflammation. In general, brain fog after COVID-19 can be treated through lifestyle changes and medical interventions, and patients should seek medical help if symptoms persist despite their self-administered measures.

Some neurologists, since brain fog occurring as a sequela after COVID-19 is a relatively new phenomenon, are still researching effective ways to treat the condition. One of the drugs being investigated in the context of treating brain fog after COVID-19 is methylphenidate. Methylphenidate is a drug used to treat ADHD in children. Studies conducted on small groups of patients suggest that methylphenidate may help improve cognitive function in people with brain fog after COVID-19. However, further studies are needed to confirm the efficacy and safety of methylphenidate in treating brain fog. It is important to always consult a doctor before starting treatment with any drug, especially methylphenidate. The drugs used to treat ADHD in children are designed to treat other disorders, and their use in treating brain fog after COVID-19 requires further research and approval by relevant institutions involved in drug registration processes, among others.

Some doctors see an opportunity to treat "brain fog" with low-dose naltrexone therapy (LDN therapy). This is a treatment that involves taking a low dose of naltrexone, usually from 1 target to 4.5 mg per day. Naltrexone is an opioid antagonist, with high doses of 50-100 mg/day used to treat opioid and alcohol dependence. However, when the drug is used in low doses, its anti-inflammatory properties have been confirmed, which appears likely to be beneficial in treating a variety of conditions, including chronic pain, autoimmune diseases and even post-COVID-19 brain fog.LDN's anti-inflammatory properties may also help reduce inflammation in the brain, which can contribute to cognitive impairment, an exponent of brain fog. LDN's mechanism of action involves increasing levels of opioid growth factor (OGF), an endorphin involved in cell growth and immunity, which may help reduce inflammation and improve immune function. LDN therapy has shown potential benefit in treating brain fog after recovery from COVID-19, and one pilot study suggests that LDN therapy may be beneficial in reducing chronic inflammation in patients with post-Covid symptoms. However, further studies are needed to confirm the efficacy of low doses of naltrexone for brain fog therapy.

Can diet be helpful in treating brain fog?

One strategy for treating brain fog is a nutritional approach. It now appears that the most important of the ways to combat brain fog after COVID-19 is to introduce an anti-inflammatory diet. This includes eating foods rich in anti-inflammatory nutrients, such as colorful vegetables, certain types of nuts, and olive oil, among others. Minimizing the intake of refined carbohydrates, added sugars and saturated fats in food can also help reduce inflammation in the body.

It is not insignificant to consume probiotic-rich foods, which can support a healthy gut microbiome, and has been noted in studies to be associated with improved cognitive function. By incorporating these dietary changes, individuals can experience improvements in cognitive function and a subsiding of brain fog. Another important nutrient for brain health that we should keep in mind is omega-3 fatty acids. These essential fatty acids have been shown to have anti-inflammatory effects and can improve mood and cognitive function. Good sources of omega-3 are fatty fish, flaxseed and chia seeds. In addition, supplements such as omega-3 fatty acids, vitamin D and curcumin administered in appropriate doses have been shown in studies to have potential benefits for cognitive symptoms. However, it is important to consult with your doctor before starting any new supplements. The wrong combination of these can sometimes be counterproductive. Under no circumstances should you stock up on preparations that are now readily available on the Internet. These are often drugs sold illegally, which the relevant institutions responsible for controlling the sale of drugs on the Internet do not deal with very well, and these compounds can seriously endanger our health. Many of the drugs offered on suspicious sites do not have registration in Poland, and if we are unsure about their safety we should inquire with the relevant authorities.

In Poland, supervision of the legality of the sale of drugs over the Internet belongs to the Chief Pharmaceutical Inspector and the Pharmaceutical Inspectorate, both of which report to the Ministry of Health. Their task is to control the legality of the sale of drugs, including those sold over the Internet. In addition, in the case of the sale of dietary supplements, control over their legality is exercised by the Chief Sanitary Inspectorate, which is responsible for supervising the safety of food and nutrition products, including dietary supplements.

What supplements can be helpful in treating brain fog?

Vitamin and mineral supplements can have a beneficial effect, leading to faster normalization of cognitive function. Additional magnesium supplementation may lead to improved cognitive function and may help reduce some symptoms of brain fog. Other supplements that have been studied for their potential cognitive benefits include B vitamins and ginkgo biloba. However, supplements should not be the only treatment for brain fog and should be used in conjunction with other forms of therapy, such as pharmacotherapy suggested by the patient's treating physicians, or behavioral strategies and psychological counseling.

Patients with pre-existing dementia, as previously mentioned, or mild cognitive impairment are less likely to make a full recovery. However, brain fog after COVID-19 can be treated additionally, sometimes with good results through various supportive care options. Patient education and the formation of support groups can ensure that patients are better able to cope with the symptoms of brain fog and the challenges of recovering from the disease. Occupational therapy and rehabilitation can also be beneficial for those who have experienced brain fog after COVID-19.

Exercises involving repetition of certain activities can help restore normal function to malfunctioning areas of the CNS after a period of time, while in addition, physiotherapy and cognitive therapy can help achieve full recovery. Additionally, alternative therapies and practices involving both mind and body, such as meditation and yoga, while less popular and treated differently by doctors, can improve cognitive function and reduce brain fog symptoms. While there are currently no breakthrough treatments for brain fog attributed to COVID-19 that can guarantee a quick recovery to full health, with proper supportive care, implementation of pharmacotherapy, and adequate sleep and an anti-inflammatory diet - people who have experienced brain fog symptoms after COVID-19 can improve their cognitive function and achieve full recovery.

Dr. Marek Derkacz, MD

References with the author.