Is Long COVID Affecting Your Cognitive Health and Memory? It’s More Common Than You Think.

By now you may have heard of “long COVID,” and perhaps you’ve heard stories of “long haulers” suffering from a variety of symptoms many months, even years, after their initial recovery from the disease.  Maybe that person is you.  These are not isolated events, and scientists and physicians throughout the world have been studying these occurrences since 2020, not long after COVID first burst onto the scene.  It’s been almost three years now, and theories to explain long COVID are beginning to take shape. 

At this point it is clear:  long COVID affects many organs, especially the brain.  We’re particularly concerned that long COVID acts in many respects to accelerate brain aging.  We’ll cover this as you read on.   

What’s more:  long COVID is more common than most people think. 

We’ll start by addressing some basic questions. 

What is Long COVID (or Long-Haul COVID)? 

Long COVID is the condition when a person survives COVID but is unable to achieve full recovery, leaving him or her with persistent symptoms that could last months or even years.  The US Centers for Disease Control and Prevention (CDC) broadly defines long COVID as when people experience “long-term effects from their infection.”​¹ The United Kingdom is more precise, defining long COVID as “signs and symptoms that develop during or after an infection consistent with COVID-19, continue for more than 12 weeks, and are not explained by an alternative diagnosis.”​² ​  Basically, if you were infected with SARS-CoV-2 (the virus that causes COVID-19) and you’re experiencing symptoms that cannot be explained by any other diagnoses many weeks or months after your initial illness, then you’re likely experiencing long COVID. 

Figure adapted from Jarrott, et al.​³​  

The medical community gives long COVID many names, and it is good to know that these all have the same meaning to avoid confusion:  post-acute COVID syndrome (PCS), post-acute sequelae of SARS-CoV-2 infection (PASC), post-COVID condition (PCC), post-acute COVID-19, long-haul COVID, long COVID syndrome, and simply, long COVID.

Who Gets Long COVID?  

In short, a lot of people get long COVID, which is why you may want to consider whether you’ve noticed any unexplained health irregularities that have persisted long after your initial infection.  It is estimated that 20-70% of people who have had COVID develop long COVID symptoms.^2,4​ This wide range gives us a clue to great extent of its prevalence, as well as the difficulty in diagnosing long COVID.   

Bear in-mind, long COVID can and does affect those who have had mild or even asymptomatic cases.  In fact, about 30% of non-hospitalized COVID patients report lingering symptoms after 2 months.^2,5​  Though, people at higher risk of long COVID are those who have had more severe cases initially, asthma, diabetes, poor mental health, and have advanced age (over 70).​^2,6-11​  Also, it is worthy to note that perimenopausal and menopausal women have higher risk of long COVID, especially given our earlier article on women’s brain health and Alzheimer’s risk (see here).​^2,5,12

What are the Symptoms of Long COVID?  How Does It Feel? 

The symptoms of long COVID are diverse and affect many organs and body systems.  This is because the SARS-CoV-2 virus targets the enzyme called ACE-2.  ACE-2 is widely distributed in many organs, such as the lungs, heart, blood vessels, liver, kidneys, and brain,​³​ giving the virus multiple points of attack.  This could cause long-term direct and indirect damage. 

As a result, if you have long COVID, you may be experiencing one or more of the following persistent symptoms:^2,4,13 

• Fatigue (29-58%) 
• Dyspnea, which is the medical term for shortness of breath, which can manifest as chest tightening, labored breathing, hunger for air, breathlessness, or feelings of suffocation (20-40%) 
• Cognitive disorders or impairment, affecting attention, concentration, executive function, and memory (both short- and long-term memory loss); “COVID brain” or “brain fog” (25-28%) 
• Depression/anxiety (20-27%) 
• Cough (20%) 
• Sleep disorders or insomnia (20-40%)
• Heart palpitations (strong, rapid, or irregular heart beat) (10-28%) 
• Chest pain (20%) 
• Myalgia (muscle aches and pain) (12-28%) 
• Arthralgia (joint stiffness) (18-28%) 
• Anosmia (smell loss) (10-20%) 
• Dysgeusia (taste impairment) (8-20%) 
• Digestive disorders 
• Hair loss 
• Higher risk of developing diabetes 
• Impaired liver, lung, or kidney function 

Figure adapted from Lopez-Leon, et al.​¹³ 

Which Symptoms Persist the Most?  Brain and Fatigue. 

Among all these symptoms, the two categories most likely to persist more than a year after initial infection are:  (1) cognitive and mental health related, such as memory loss, concentration difficulties, depression/anxiety, and insomnia, and (2) fatigue that can be clinically significant or even incapacitating.​^13-16 Interestingly, this particular combination of symptoms partly resembles myalgic encephalomyelitis / chronic fatigue syndrome (ME/CFS).  ME/CFS is notoriously complex and difficult to diagnose, but a potential cause is viruses, such as Epstein-Barr, cytomegalovirus, enterovirus, and herpesvirus.  Researchers may be adding the COVID virus to that list as well. 

The brain symptoms deserve special attention, given that they are so broad, involving concentration, executive function, decision-making, problem solving, memory, loss of smell/taste, and depression and anxiety.​^4,17,18​ Brain imaging studies show decreased energy usage (hypometabolism) and changes in gray and white matter in long COVID patients, which correspond to the cognitive abilities affected.​^4,19​ Perhaps most concerning is a study that tracked the cognitive abilities of over 1400 COVID patients for 12 months after infection.  In this study, cognitive testing was done at 6 and 12 months, and those who had severe cases of COVID showed significantly greater cognitive decline and incidence of dementia than those with non-severe cases (or non-infected controls).  Also, even the patients with non-severe cases did not escape unscathed; they showed cognitive decline over the first 6 months.​²⁰

These results are leading researchers to classify COVID as a risk factor for dementia and neurodegenerative diseases, like Alzheimer’s.​²¹  As time goes by and more data becomes available, we’ll see if this is ultimately the case, and if so, it has the potential of significantly adding to the world dementia burden in the years to come if not adequately addressed.​²⁰

What Can We Do About It?  How Can We Take Steps Toward Long COVID Recovery?

If you think you’re experiencing long COVID, see your doctor.  Everyone’s background and symptoms are unique, and some health systems are now introducing guidelines to assess long COVID, which could include a combination of blood tests and imaging.​^2,22  You may be wondering:  Is long COVID permanent?  The science is still emerging on this condition, but your doctor, along with specialists if needed, may be able to devise an individualized treatment regimen to help with long COVID recovery. 

There are also drugs being tested to treat long COVID, such as anticoagulants, antivirals, and antihistamines, although clinical results on those are not ready quite yet.²³

Finally, it is helpful to think of long COVID the way we think about diabetes or heart disease.  These chronic diseases can be well-managed or maybe even eliminated through lifestyle changes.  Make sure to take care of yourself through:  

• Stress reduction 
• Good sleep habits 
• Staying physically active without over-exertion (pacing) 
• Proper diet and nutrition 

What are Our Options for Nutrition?

When considering nutrition for long COVID, keep in-mind that the science is pointing toward chronic inflammation and potential microclotting of blood vessels as key drivers for the condition.​²³  Thus, nutrients with anti-inflammatory, antioxidant, and blood flow properties may be helpful. 

Researchers have been evaluating the following nutrients and supplements for long COVID:​^2,24-26 

• Vitamin B3 
• Vitamin D 
• Omega-3 fats, such as DHA and EPA 
• Coenzyme Q10 (CoQ10) 
• Plant-based flavonoids, like quercetin, kaempferol, luteolin, epigallocatechin 
• Probiotics and prebiotics 
• Melatonin 
• Minerals like iron, zinc, magnesium, and selenium 

To learn more about these nutrients, visit here. 

Also, consider following the Mediterranean (MeDi) or MIND diets.  Not only are these diets well-known to promote a long life, but also recent evidence shows that they’re the most brain-protective diets as well.  That could be particularly helpful for long COVID.  The MeDi and MIND are primarily plant-based, rich in unsaturated fats, and include some healthy meats like fish and poultry.  This provides a good source of anti-inflammatory and antioxidant nutrients.  They also limit pro-inflammatory foods like red meat, saturated fats, and added sugar.  You can learn more about these diets by clicking here. 

Consider RELEVATE® to Take Care of Your Brain. 

If you want to adopt a healthy diet like MeDi and MIND and increase your intake of anti-inflammatory, antioxidant, and blood flow-promoting nutrients, try RELEVATE to support that effort.  RELEVATE is a nutritional supplement designed to help people achieve the MeDi and MIND diets. It closes the most common nutritional gaps between those diets and what most people eat.  Because of that, RELEVATE contains many of the nutrients mentioned in the article above, including vitamins, fats, minerals, and plant-based flavonoids. 

Learn more about RELEVATE by clicking here. 

And take action for your brain health today. 

 

 

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References

​​1. National Center for Immunization and Respiratory Diseases (NCIRD), D. of V. D. Long COVID or Post-COVID Conditions. https://www.cdc.gov/coronavirus/2019-ncov/long-term-effects/index.html (2022). 

​2. Koc, H. C., Xiao, J., Liu, W., Li, Y. & Chen, G. Long COVID and its Management. International Journal of Biological Sciences vol. 18 4768–4780 Preprint at https://doi.org/10.7150/ijbs.75056 (2022). 

​3. Jarrott, B., Head, R., Pringle, K. G., Lumbers, E. R. & Martin, J. H. “LONG COVID”—A hypothesis for understanding the biological basis and pharmacological treatment strategy. Pharmacology Research and Perspectives vol. 10 Preprint at https://doi.org/10.1002/prp2.911 (2022). 

​4. Mantovani, A. et al. Long Covid: where we stand and challenges ahead. Cell Death and Differentiation vol. 29 1891–1900 Preprint at https://doi.org/10.1038/s41418-022-01052-6 (2022). 

​5. Huang, Y. et al. COVID Symptoms, Symptom Clusters, and Predictors for Becoming a Long-Hauler Looking for Clarity in the Haze of the Pandemic. https://doi.org/10.1177/10547738221125632 31, 1390–1398 (2022). 

​6. Su, Y. et al. Multiple early factors anticipate post-acute COVID-19 sequelae. Cell 185, 881-895.e20 (2022). 

​7. Stavem, K., Ghanima, W., Olsen, M. K., Gilboe, H. M. & Einvik, G. Persistent symptoms 1.5–6 months after COVID-19 in non-hospitalised subjects: a population-based cohort study. Thorax 76, 405–407 (2021). 

​8. Cirulli​, E. T. et al. Long-term COVID-19 symptoms in a large unselected population. medRxiv 2020.10.07.20208702 (2020) doi:10.1101/2020.10.07.20208702. 

​9. Thompson, E. J. et al. Long COVID burden and risk factors in 10 UK longitudinal studies and electronic health records. Nature Communications 2022 13:1 13, 1–11 (2022). 

​10. Poyraz, B. Ç. et al. Psychiatric morbidity and protracted symptoms after COVID-19. Psychiatry Res 295, 113604 (2021). 

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​12. Stewart, S. et al. Long COVID risk - a signal to address sex hormones and women’s health. The Lancet Regional Health - Europe 11, 100242 (2021). 

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​14. Xie, Y. & Al-Aly, Z. Risks and burdens of incident diabetes in long COVID: a cohort study. Lancet Diabetes Endocrinol 10, 311–321 (2022). 

​15. Han, Q., Zheng, B., Daines, L. & Sheikh, A. Long-Term Sequelae of COVID-19: A Systematic Review and Meta-Analysis of One-Year Follow-Up Studies on Post-COVID Symptoms. Pathogens 11, 269 (2022). 

​16. Alkodaymi, M. S. et al. Prevalence of post-acute COVID-19 syndrome symptoms at different follow-up periods: a systematic review and meta-analysis. Clinical Microbiology and Infection 28, 657–666 (2022). 

​17. Blomberg, B. et al. Long COVID in a prospective cohort of home-isolated patients. Nature Medicine 2021 27:9 27, 1607–1613 (2021). 

​18. Davis, H. E. et al. Characterizing long COVID in an international cohort: 7 months of symptoms and their impact. EClinicalMedicine 38, 101019 (2021). 

​19. Douaud, G. et al. SARS-CoV-2 is associated with changes in brain structure in UK Biobank. Nature 2022 604:7907 604, 697–707 (2022). 

​20. Liu, Y. H. et al. One-Year Trajectory of Cognitive Changes in Older Survivors of COVID-19 in Wuhan, China: A Longitudinal Cohort Study. JAMA Neurol 79, 509–517 (2022). 

​21. Taquet, M., Geddes, J. R., Husain, M., Luciano, S. & Harrison, P. J. 6-month neurological and psychiatric outcomes in 236 379 survivors of COVID-19: a retrospective cohort study using electronic health records. Lancet Psychiatry 8, 416–427 (2021). 

​22. NICE. COVID-19 rapid guideline: managing the long-term effects of COVID-19. (2020). 

​23. Couzin-Frankel, J. Clues to Long COVID. Science (1979) 376, 1261–1265 (2022). 

​24. Hagenlocher, Y. & Lorentz, A. Immunomodulation of mast cells by nutrients. Mol Immunol 63, 25–31 (2015). 

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​26. Bardelčíková, A., Miroššay, A., Šoltýs, J. & Mojžiš, J. Therapeutic and prophylactic effect of flavonoids in post-COVID-19 therapy. Phytotherapy Research vol. 36 2042–2060 Preprint at https://doi.org/10.1002/ptr.7436 (2022).