Brain Fog, Insomnia, and Stress - Coping after COVID-19

#longcovid #brain_health #biomarkers

Webinar Summary

Introduction

• Presenter: Dr. Christine Lochner, a chief psychologist at UAB Medicine.
• Topic: Neuropsychiatric effects of post-COVID-19, focusing on brain fog, insomnia, and stress.
• Objective: To provide an understanding of the neuropsychiatric effects of COVID-19 and offer coping strategies.

Mental Health Impact of the Pandemic

• Increased mental health issues: Due to job loss, isolation, and social unrest.
• Affected groups: Young adults and certain ethnic groups reported higher adverse mental and behavioral health symptoms.
• Symptoms: Difficulties with focus, attention, memory issues, and increased rates of substance abuse and suicidal ideation.

Neurological and Psychological Symptoms of COVID-19

Potential Pathways

Reduced Oxygen Supply to the Brain

• Respiratory complications: COVID-19 primarily affects the respiratory system, causing issues such as pneumonia and acute respiratory distress syndrome (ARDS), which can severely hamper the body's ability to transport oxygen to vital organs, including the brain.

• Hypoxia: Reduced oxygen supply can lead to a condition called hypoxia, where there is insufficient oxygen to sustain bodily functions. In the brain, hypoxia can impair the functioning of neurons, leading to cognitive issues such as confusion, memory problems, and in severe cases, loss of consciousness.

• Long-term effects: Chronic hypoxia can potentially lead to long-term neurological issues, including an increased risk of neurodegenerative diseases and cognitive decline. It can also exacerbate pre-existing neurological conditions.

Systemic Pro-inflammatory States

• Blood-brain barrier disruption:
  • Definition: The blood-brain barrier is a semi-permeable barrier that separates the circulating blood from the brain and extracellular fluid in the central nervous system, protecting the brain from potentially harmful substances.
  • COVID-19 and inflammation: COVID-19 can induce a systemic inflammatory response in the body. This inflammation can potentially disrupt the blood-brain barrier, allowing harmful substances and pathogens easier access to the brain.
  • Consequences: Disruption of the blood-brain barrier can lead to a range of neurological issues, including neuroinflammation, which is associated with a variety of neuropsychiatric symptoms such as anxiety, depression, and cognitive dysfunction. It can also facilitate the onset of other neurological conditions, including seizures and encephalopathy.
  • Recovery: The extent of recovery from blood-brain barrier disruption depends on the severity of the disruption and the individual's overall health. In some cases, the barrier can repair itself over time, but severe disruptions can lead to lasting neurological issues.

Cytokine Storm

• Definition: A cytokine storm is an overreaction of the immune system where it releases a large number of cytokines into the bloodstream.

• Effects: This overreaction can cause severe inflammation and potential damage to brain tissues, leading to neuropsychiatric symptoms such as brain fog and cognitive issues.

• Initial symptoms:

  • Fatigue and insomnia: Many patients experienced extreme fatigue but found it difficult to sleep.
  • Severe cases: Some individuals faced confusion, delirium, encephalitis, seizures, and even stroke.

Post-COVID-19 Persistent Symptoms and Treatment

Early Identification

• Objective: To identify individuals most susceptible to psychological and cognitive issues post-COVID-19 early on for effective intervention.

Biomarkers

• Biomarkers: The webinar mentioned ongoing work in identifying biomarkers that can help in early identification of individuals who are more prone to experiencing neuropsychiatric symptoms post-COVID-19.

Here is the list of potential biomarkers categorized under different titles as you requested:

• Inflammatory Markers
  These markers can indicate levels of inflammation in the body, which might be associated with neuropsychiatric symptoms post-COVID-19.

1. C-reactive protein (CRP)
2. Ferritin
3. D-dimer
4. Lactate dehydrogenase (LDH)
5. Procalcitonin
6. Erythrocyte sedimentation rate (ESR)
7. Serum amyloid A (SAA)

• Immune Response Markers
  These markers can help in understanding the immune response to the virus, potentially giving insights into the individual's response to COVID-19 and its aftermath.

1. Interleukin-6 (IL-6)
2. Tumor necrosis factor-alpha (TNF-α)
3. White blood cell (WBC) count

• Neurological Markers
  These markers can indicate neural inflammation or damage, which might be linked to the neuropsychiatric symptoms seen in post-COVID-19 patients.

1. Neuron-specific enolase (NSE)
2. S100 calcium-binding protein B (S100B)
3. Brain-derived neurotrophic factor (BDNF)

• Genetic Markers
  While the webinar summary did not provide details on specific genetic markers, it is plausible that certain genetic factors might predispose individuals to more severe neuropsychiatric symptoms post-COVID-19. Research in this area would be focused on identifying genetic variations associated with a higher risk of developing neuropsychiatric symptoms post-infection.

Interventions Under Exploration

• Cognitive Training: Programs aimed at enhancing cognitive functions are being explored as potential interventions.
• Non-invasive Methods: These refer to treatments that don't involve entering the body with instruments, and can include therapies and lifestyle modifications.
• Lifestyle Modifications: Changes in daily habits and routines to promote better outcomes in individuals recovering from COVID-19.

Recommendations for Coping with Post-COVID Symptoms

Diet

Anti-inflammatory Diet

• Objective: To reduce neural inflammation which is suspected to be a part of the brain fog issues and can also lead to depression and anxiety.

• Recommendations:

  • Whole Foods: Encouraging the consumption of whole foods that are low in inflammatory substances.
  • Avoiding Processed Foods: Steering clear of foods that can induce inflammation, including heavily processed foods and those high in sugar and unhealthy fats.

• Benefits:

  • Mental Health: An anti-inflammatory diet can potentially help in reducing symptoms of brain fog, depression, and anxiety by reducing inflammation in the brain.
  • Overall Well-being: Apart from mental health benefits, such a diet can also promote physical well-being and aid in recovery post-COVID-19.

• Exercise:

  • Regular physical activity: To combat fatigue and promote overall well-being.

• Cognitive training:

  • Programs like Brain HQ: Recommended for enhancing processing speed and other cognitive functions.

• Sleep:

  • Adequate sleep: Ensuring a proper sleep cycle to aid in recovery.
  • Sleep hygiene: Including avoiding caffeine after 2 pm and promoting a conducive environment for sleep.

• Therapies:

  • Cognitive Behavioral Therapy for Insomnia (CBT-I): To help manage insomnia effectively.
  • Cognitive Processing Therapy: For individuals dealing with trauma-related issues post-COVID.

• Mindfulness and relaxation:

  • Mindfulness practices: To reduce anxiety and alleviate brain fog.
  • Stress management techniques: Including apps and strategies available on the UAB post-COVID website.

Conclusion

• Seeking help: Encouraging individuals to seek help if symptoms persist for a prolonged period.
• Future webinars: Mention of upcoming webinars in the series for further information and assistance.