Brain Fog in post-COVID-19 syndrome: a bibliographic review
DOI:
https://doi.org/10.25118/2763-9037.2023.v13.1109Keywords:
Mental fatigue, brain fog, epídemiology, prognosis, mental confusion, treatment, COVID-19Abstract
Introduction: Studies are indicating a high incidence of acute psychiatric symptoms post SARS-CoV-2 infection. Those who experience persistent symptoms and/or prolonged organic dysfunctions after the acute phase of COVID-19 are diagnosed with post-covid syndrome. Cognitive impairment in this syndrome includes short-term memory deficits, difficulties with concentration and execution and slower thinking compared to the previous pattern of functioning. Objective: To provide an overview of the topic of “Brain Fog” and, in this way, contribute to the knowledge of health professionals and the development of mental health management strategies. Method: This is narrative review of literature, with data collection carried out in the PubMed, LILACS and Scielo databases. 14 papers were selected, which covered the following items on the topic: epidemiology, clinic, prognosis and treatment. Results: Female gender was observed to be associated with a greater chance of presenting post-covid cognitive impairment. Treatment strategies include neuropsychological assessment, cognitive rehabilitation, mental health support and adequate sleep. A multidisciplinary approach is crucial in managing persistent symptoms and supporting the return to normal life. Conclusion: A high prevalence of cognitive dysfunction was observed in the post-acute period of COVID-19 infection. There was also great heterogeneity in the characterization of symptoms, making it necessary to establish consensual definitions about the condition studied, for better investigation of prevention and treatment strategies.
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References
Tucci V, Moukaddam N, Meadows J, Shah S, Galwankar SC, Kapur GB. The forgotten plague: psychiatric manifestations of ebola, zika, and emerging infectious diseases. J Glob Infect Dis. 2017;9(4):151-6. https://doi.org/10.4103/jgid.jgid_66_17 PMID:29302150 PMCID:PMC5750439 DOI: https://doi.org/10.4103/jgid.jgid_66_17
Hu Y, Chen Y, Zheng Y, You C, Tan J, Hu L, Zhang Z, Ding L. Factors related to mental health of inpatients with COVID-19 in Wuhan, China. Brain Behav Immun. 2020;89:587-93. https://doi.org/10.1016/j.bbi.2020.07.016 PMID:32681866 PMCID:PMC7362867 DOI: https://doi.org/10.1016/j.bbi.2020.07.016
Nalbandian A, Sehgal K, Gupta A, Madhavan MV, McGroder C, Stevens JS, Cook JR, Nordvig AS, Shalev D, Sehrawat TS, Ahluwalia N, Bikdeli B, Dietz D, Der-Nigoghossian C, Liyanage-Don N, Rosner GF, Bernstein EJ, Mohan S, Beckley AA, Seres DS, Choueiri TK, Uriel N, Ausiello JC, Accili D, Freedberg DE, Baldwin M, Schwartz A, Brodie D, Garcia CK, Elkind MSV, Connors JM, Bilezikian JP, Landry DW, Wan EY. Post-acute COVID-19 syndrome. Nat Med. 2021;27(4):601-15. https://doi.org/10.1038/s41591-021-01283-z PMID:33753937 - PMCID:PMC8893149 DOI: https://doi.org/10.1038/s41591-021-01283-z
Asadi-Pooya AA, Simani L. Central nervous system manifestations of COVID-19: a systematic review. J Neurol Sci. 2020;413:116832. https://doi.org/10.1016/j.jns.2020.116832 PMID:32299017 PMCID:PMC7151535 DOI: https://doi.org/10.1016/j.jns.2020.116832
Fernández-de-Las-Peñas C, Palacios-Ceña D, Gómez-Mayordomo V, Cuadrado ML, Florencio LL. Defining post-COVID symptoms (post-acute COVID, long COVID, persistent post-COVID): an integrative classification. Int J Environ Res Public Health. 2021;18(5):2621. https://doi.org/10.3390/ijerph18052621 PMID:33807869 PMCID:PMC7967389 DOI: https://doi.org/10.3390/ijerph18052621
Greenhalgh T, Knight M, A'Court C, Buxton M, Husain L. Management of post-acute COVID-19 in primary care. BMJ. 2020;370:m3026. https://doi.org/10.1136/bmj.m3026 PMID:32784198 DOI: https://doi.org/10.1136/bmj.m3026
Premraj L, Kannapadi NV, Briggs J, Seal SM, Battaglini D, Fanning J, Suen J, Robba C, Fraser J, Cho SM. Mid and long-term neurological and neuropsychiatric manifestations of post-COVID-19 syndrome: a meta-analysis. J Neurol Sci. 2022;434:120162. https://doi.org/10.1016/j.jns.2022.120162 PMID:35121209 PMCID:PMC8798975 DOI: https://doi.org/10.1016/j.jns.2022.120162
Ceban F, Ling S, Lui LMW, Lee Y, Gill H, Teopiz KM, Rodrigues NB, Subramaniapillai M, Di Vincenzo JD, Cao B, Lin K, Mansur RB, Ho RC, Rosenblat JD, Miskowiak KW, Vinberg M, Maletic V, McIntyre RS. Fatigue and cognitive impairment in post-COVID-19 syndrome: a systematic review and meta-analysis. Brain Behav Immun. 2022;101:93-135. https://doi.org/10.1016/j.bbi.2021.12.020 PMID:34973396 - PMCID:PMC8715665 DOI: https://doi.org/10.1016/j.bbi.2021.12.020
Xiong J, Lipsitz O, Nasri F, Lui LMW, Gill H, Phan L, Chen-Li D, Iacobucci M, Ho R, Majeed A, McIntyre RS. Impact of COVID-19 pandemic on mental health in the general population: a systematic review. J Affect Disord. 2020;277:55-64. https://doi.org/10.1016/j.jad.2020.08.001 PMID:32799105 PMCID:PMC7413844 DOI: https://doi.org/10.1016/j.jad.2020.08.001
Guedes BF. NeuroCOVID-19: a critical review. Arq Neuropsiquiatr. 2022;80(5 Suppl 1):281-9. https://doi.org/10.1590/0004-282x-anp-2022-s136 PMID:35976326 PMCID:PMC9491425 DOI: https://doi.org/10.1590/0004-282x-anp-2022-s136
Hugon J, Msika EF, Queneau M, Farid K, Paquet C. Long COVID: cognitive complaints (brain fog) and dysfunction of the cingulate cortex. J Neurol. 2022;269:44-6. https://doi.org/10.1007/s00415-021-10655-x PMID:34143277 - PMCID:PMC8211714 DOI: https://doi.org/10.1007/s00415-021-10655-x
Jennings G, Monaghan A, Xue F, Duggan E, Romero-Ortuño R. Comprehensive clinical characterisation of brain fog in adults reporting long COVID symptoms. J Clin Med. 2022;11(12):3440. https://doi.org/10.3390/jcm11123440 PMID:35743516 PMCID:PMC9224578 DOI: https://doi.org/10.3390/jcm11123440
Almeria M, Cejudo JC, Sotoca J, Deus J, Krupinski J. Cognitive profile following COVID-19 infection: clinical predictors leading to neuropsychological impairment. Brain Behav Immun Health. 2020;9:100163. https://doi.org/10.1016/j.bbih.2020.100163 PMID:33111132 - PMCID:PMC7581383 DOI: https://doi.org/10.1016/j.bbih.2020.100163
Chasco EE, Dukes K, Jones D, Comellas AP, Hoffman RM, Garg A. Brain fog and fatigue following COVID-19 infection: an exploratory study of patient experiences of long COVID. Int J Environ Res Public Health. 2022;19(23):15499. https://doi.org/10.3390/ijerph192315499 PMID:36497573 PMCID:PMC9737348 DOI: https://doi.org/10.3390/ijerph192315499
Callan C, Ladds E, Husain L, Pattinson K, Greenhalgh T. 'I can't cope with multiple inputs': a qualitative study of the lived experience of 'brain fog' after COVID-19. BMJ Open. 2022;12(2):e056366. https://doi.org/10.1136/bmjopen-2021-056366 PMID:35149572 PMCID:PMC8844964 DOI: https://doi.org/10.1136/bmjopen-2021-056366
Krishnan K, Lin Y, Prewitt KM, Potter DA. Multidisciplinary approach to brain fog and related persisting symptoms post COVID-19. J Health Serv Psychol. 2022;48(1):31-8. https://doi.org/10.1007/s42843-022-00056-7 PMID:35128461 PMCID:PMC8809226 DOI: https://doi.org/10.1007/s42843-022-00056-7
Daroische R, Hemminghyth MS, Eilertsen TH, Breitve MH, Chwiszczuk LJ. Cognitive impairment after COVID-19: a review on objective test data. Front Neurol. 2021;12:699582. https://doi.org/10.3389/fneur.2021.699582 PMID:34393978 PMCID:PMC8357992 DOI: https://doi.org/10.3389/fneur.2021.699582
Helms J, Kremer S, Merdji H, Clere-Jehl R, Schenck M, Kummerlen C, Collange O, Boulay C, Fafi-Kremer S, Ohana M, Anheim M, Meziani F. Neurologic features in severe SARS-CoV-2 infection. N Engl J Med. 2020;382(23):2268-70. https://doi.org/10.1056/nejmc2008597 PMID:32294339 PMCID:PMC7179967 DOI: https://doi.org/10.1056/NEJMc2008597
Richardson BW. Physical disease from mental strain. Am J Psychiatry. 1870;26(4):449-69. https://doi.org/10.1176/ajp.26.4.449 DOI: https://doi.org/10.1176/ajp.26.4.449
Taylor RE. Death of neurasthenia and its psychological reincarnation: a study of neurasthenia at the National Hospital for the Relief and Cure of the Paralysed and Epileptic, Queen Square, London, 1870-1932. Br J Psychiatry. 2001;179:550-7. https://doi.org/10.1192/bjp.179.6.550 PMID:11731361 DOI: https://doi.org/10.1192/bjp.179.6.550
Morakinyo O. A psychophysiological theory of a psychiatric illness (the brain fag syndrome) associated with study among Africans. J Nerv Ment Dis. 1980;168(2):84-9. https://doi.org/10.1097/00005053-198002000-00004 PMID:6101609 DOI: https://doi.org/10.1097/00005053-198002000-00004
Ocon AJ. Caught in the thickness of brain fog: exploring the cognitive symptoms of chronic fatigue syndrome. Front Physiol. 2013;4:63. https://doi.org/10.3389/fphys.2013.00063 PMID:23576989 - PMCID:PMC3617392 DOI: https://doi.org/10.3389/fphys.2013.00063
Pena Orbea C, Wang L, Shah V, Jehi L, Milinovich A, Foldvary-Schaefer N, Chung MK, Mashaqi S, Aboussouan L, Seidel K, Mehra R. Association of sleep-related hypoxia with risk of COVID-19 hospitalizations and mortality in a large integrated health system. JAMA Netw Open. 2021;4(11):e2134241. https://doi.org/10.1001/jamanetworkopen.2021.34241 PMID:34757409 - PMCID:PMC8581726 DOI: https://doi.org/10.1001/jamanetworkopen.2021.34241
Venkatesan UM, Ramanathan-Elion DM. Psychoeducation as precision health in military-related mild traumatic brain injury. Arch Phys Med Rehabil. 2022;103(6):1222-32. https://doi.org/10.1016/j.apmr.2021.08.012 PMID:34516996 DOI: https://doi.org/10.1016/j.apmr.2021.08.012
Jamieson A, Goodwill AM, Termine M, Campbell S, Szoeke C. Depression related cerebral pathology and its relationship with cognitive functioning: a systematic review. J Affect Disord. 2019;250:410-8. https://doi.org/10.1016/j.jad.2019.03.042 PMID:30878653 DOI: https://doi.org/10.1016/j.jad.2019.03.042
Garg M, Maralakunte M, Garg S, Dhooria S, Sehgal I, Bhalla AS, Vijayvergiya R, Grover S, Bhatia V, Jagia P, Bhalla A, Suri V, Goyal M, Agarwal R, Puri GD, Sandhu MS. The conundrum of 'long-COVID-19': a narrative review. Int J Gen Med. 2021;14:2491-506. https://doi.org/10.2147/ijgm.s316708 PMID:34163217 PMCID:PMC8214209 DOI: https://doi.org/10.2147/IJGM.S316708
Posner K, Brown GK, Stanley B, Brent DA, Yershova KV, Oquendo MA, Currier GW, Melvin GA, Greenhill L, Shen S, Mann JJ. The Columbia-suicide severity rating scale: initial validity and internal consistency findings from three multisite studies with adolescents and adults. Am J Psychiatry. 2011;168(12):1266-77. https://doi.org/10.1176/appi.ajp.2011.10111704 PMID:22193671 PMCID:PMC3893686 DOI: https://doi.org/10.1176/appi.ajp.2011.10111704
Joshee S, Vatti N, Chang C. Long-term effects of COVID-19. Mayo Clin Proc. 2022;97(3):579-99. https://doi.org/10.1016/j.mayocp.2021.12.017 PMID:35246288 PMCID:PMC8752286 DOI: https://doi.org/10.1016/j.mayocp.2021.12.017
Mikkelsen ME, Abramoff B. COVID-19: evaluation and management of adults with persistent symptoms following acute illness ("long COVID"). Manaker S, Elmore JG, Finlay G, editors. Waltham (MA): UpToDate; 2023. https://www.uptodate.com/contents/covid-19-evaluation-and-management-of-adults-with-persistent-symptoms-following-acute-illness-long-covid/print
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Copyright (c) 2023 Valdir Donizeti Alves Junior, Ana Sofia Arradi Campos, Ananda Soares de Brito Freire, Isabella La-Côrte Morais Matos, Kescya Miranda de Paula Silva
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