Global Health Asia-Pacific May 2022 May 2022 - Page 60


Long COVID and brain health :

Why you should have a brain function check if you ’ ve had COVID-19

Three medical experts explain why even patients who ’ ve had just mild COVID should do the examination
“ Cognitive screening of post-covid patients as standard of care may be prudent , regardless of age and Covid-19 severity ”
JH Becker , Dept of General Internal Medicine , Icahn School of Medicine , Mt Sinai , New York

COVID-19 is best known for the respiratory tract and lung damage it causes . But multiple organs can also be harmed , the most serious of which is the brain .

A series of recent studies has documented longterm brain damage in as many as one quarter of all those infected with COVID-19 , while one large study showed this number rose to up to one third . The damage occurred regardless of the severity of the initial disease . Those numbers are disconcerting considering that an estimated 140 million people in Asia and the Middle East , 43 million Indians , 100 million Americans , more than a million Singaporeans , more than six million Indonesians , and four million Malaysians have been infected with COVID-19 . It ’ s possible that these numbers are actually higher as not all infections are officially reported .
Symptoms of COVID-19-induced brain damage include brain fog , forgetfulness , fatigue , depression , anxiety , and a host of other maladies , which could be mild or incapacitating . Several studies warn that the treatment of those with long-term brain injury will strain healthcare care systems , both local and globally for years to come . There is also the possibility of a “ tsunami of strokes ”, both silent and obvious , dementia , and other neurodegenerative diseases , such as Parkinson ’ s , occurring in the survivors of COVID-19 in the coming months and years . Understanding the origins and treatment of COVID- 19-related brain damage should therefore be a high priority for medical science .
A new study from the UK biobank of 785 participants , including 401 who tested positive for COVID-19 and underwent brain scans and cognitive tests , showed brain damage with significant grey matter reduction in the frontal lobe and the limbic system , with large cognitive declines in those who had COVID-19 as compared to those who did not .
Another recent study by Frontera et al of the NYU Grossman School of Medicine evaluated the cognitive function of COVID-19 patients six months after they were hospitalised for the disease . To their surprise , over 90 percent of the total cohort reported at least one neurological symptom . Among those that had not experienced neurological complications while hospitalised , 88 percent reported new cognitive symptoms .
These cognitive impairments seem to be separate and apart from damage due to hypoxia , or the lack of oxygen to the brain , often experienced by those hospitalised for severe COVID-19 . Reportedly , some individuals that recover from mild or asymptomatic infection may later develop complications that are not immediately apparent . The table below lists commonly reported neurological symptoms by previously hospitalised COVID-19 patients .
Through in-person screenings of those who participated in the NYU study , a team of neurologists diagnosed more than half with encephalopathy , meaning damage or disease that alters the brain ’ s structure or function and a higher-than-expected incidence of strokes and seizures among those diagnosed with it . Another 21 percent had symptoms related to oxygen starvation linked to COVID-19 damage to the lung and , in some cases , to the heart .
Frontera et al found significant correlations between the prevalence of neurological complications and an inability asdf to return to daily activity , even six months after the initial infection . Those that developed neurological
58 MAY 2022 GlobalHealthAsiaPacific . com