How long covid reshapes the brain — and how we might treat it

Personal Stories: Individuals recount experiencing debilitating symptoms such as hearing loss, anxiety, and cognitive impairment long after recovering from COVID-19.
Medical Community's Response: Initially, many healthcare professionals dismissed "long covid" as a psychosomatic illness, but the perception is changing with new research findings.

Reservoir in Tissues: Initially, it was hypothesized that the virus could establish a reservoir in various tissues, including the gastrointestinal tract, leading to prolonged symptoms.
Inflammation and Nervous System Alterations: The virus triggers sustained inflammation and alters the nervous system, potentially causing long-term effects even in individuals who had mild cases of COVID-19.

Brain Size Reduction: Recent research has shown that even mild cases of COVID-19 can lead to a reduction in the overall size of the brain (also known as Cerebral Atrophy (Brain Shrinkage), affecting regions responsible for memory and cognition. This helps explain the profound anxiety, depression, memory loss, and cognitive impairment experienced by many long-covid patients.

Lancet Study: A significant study published in the Lancet analyzed over 2.5 million people to understand the recovery rate from mental health complaints and neurological deficits in long-covid patients. It found that while anxiety and mood disorders tend to resolve over months, serious issues like dementia-like problems and seizures can persist for up to two years.
UK Biobank Neuroimaging Study: This study revealed that COVID-19 could lead to a reduction in brain size (Cerebral Atrophy (Brain Shrinkage)), notably affecting the frontal cortex and limbic system, which are areas responsible for emotions and memory.
PET Scan: Show abnormalities in various brain regions, aligning with symptoms such as memory issues and chronic pain.

Infection of Astrocytes: The virus can infect astrocytes, cells that support the brain structure, disrupting the supportive and nourishing environment for neurons, leading to a cascade of brain injuries.
Blood-Brain-Barrier: The virus affects the integrity of the blood-brain-barrier, causing issues with blood flow and initiating a process of swelling and brain injury that is hard to reverse.

Daily Life: Patients struggle with daily tasks, exhibiting symptoms similar to Alzheimer's disease.
Younger Patients: Neurological injuries are more common in younger patients (20-50 years old) who were not hospitalized during their initial infection.

Validation of Experiences: The author emphasizes the need to validate patients' experiences and not dismiss their symptoms as fabricated.
Apology and Assurance: Physicians are encouraged to apologize for the lack of sufficient treatment options and to assure patients that they will not be abandoned, promising continued support as more knowledge is gained.

Clinical Trials: Calls for well-designed clinical trials to find effective treatments for long covid.
Neuroplasticity: Highlights the potential of neuroplasticity in aiding recovery, with the brain's ability to remodel itself being a hopeful avenue for rehabilitation.
Cognitive Exercises: Encouraging results have been seen in cancer patients and ICU survivors who have engaged in mental exercises like computer programs, word, and number games to improve their cognitive function. It is hoped that similar approaches might aid long-covid patients.
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Supportive Approach: The article urges for a compassionate and empathetic approach towards patients, helping them feel less isolated and fostering a sense of hope and community in their recovery journey.