Corona Makes the Brain Struggle

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Corona can enter the central nervous system and cause considerable damage. Although long-term effects are yet unclear, the virus might leave your mind slowed down and struggling.

The message thus far has been relatively easy: save lives by following through with effective preventive measures such as social distancing, hand washing, and mask-wearing (1)Zhang, L., Tao, Y., Shen, M., Fairley, C. K., & Guo, Y. (2020). Can self-imposed prevention measures mitigate the covid-19 epidemic? PLoS Medicine, 17(7), e1003240. doi: 10.1371/journal.pmed.1003240. However, such measures might not only save people from dying, but also from being cognitively scarred for life. SARS-CoV-2 has been shown to affect the central nervous system, causing symptoms from headache, nausea, and vomiting up to direct damages to the brain, such as stroke and brain inflammation (2)Ahmed, M. U., Hanif, M., Ali, M. J., Haider, M. A., Kherani, D., Memon, G. M., … Sattar, A. (2020, May 22). Neurological Manifestations of COVID-19 (SARS-CoV-2): A Review. Frontiers in Neurology, Vol. 11. doi: 10.3389/fneur.2020.00518 (3)Guadarrama-Ortiz, P., Choreño-Parra, J. A., Sánchez-Martínez, C. M., Pacheco-Sánchez, F. J., Rodríguez-Nava, A. I., & García-Quintero, G. (2020). Neurological Aspects of SARS-CoV-2 Infection: Mechanisms and Manifestations. Frontiers in Neurology, 11, 1039. doi: 10.3389/fneur.2020.01039 (4)Panariello, F., Cellini, L., Speciani, M., De Ronchi, D., & Atti, A. R. (2020). How Does SARS-CoV-2 Affect the Central Nervous System? A Working Hypothesis. Frontiers in Psychiatry, 11, 582345. doi: 10.3389/fpsyt.2020.582345 (5)Pezzini, A., & Padovani, A. (2020). Lifting the mask on neurological manifestations of COVID-19. Nature Reviews Neurology, 16(11), 636–644. doi: 10.1038/s41582-020-0398-3.

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Which Brains Change Because of Corona?

Neurological manifestations refer to neurological signs and symptoms that are caused by a disease or injury that is not primarily neurological (6)https://www.nature.com/subjects/neurological-manifestations. This includes everything from damages to cerebral cellular structures to changes of cells’ metabolism, which can in turn influence how the brain works.

Some evidence suggests that only when having a severe progression of the illness, there seems to be a chance to eventually develop persisting neurological manifestations (7)Nuzzo, D., & Picone, P. (2020). Potential neurological effects of severe COVID-19 infection. Neuroscience Research, Vol. 158, pp. 1–5. doi: 10.1016/j.neures.2020.06.009 (8)Pezzini, A., & Padovani, A. (2020). Lifting the mask on neurological manifestations of COVID-19. Nature Reviews Neurology, 16(11), 636–644. doi: 10.1038/s41582-020-0398-3. The “same old, same old” risk groups are specifically vulnerable to such progression, and hence not only of dying but also of a severe illness progression causing neurocognitive deficits after recovery (9)Pezzini, A., & Padovani, A. (2020). Lifting the mask on neurological manifestations of COVID-19. Nature Reviews Neurology, 16(11), 636–644. doi: 10.1038/s41582-020-0398-3 (10)Nuzzo, D., & Picone, P. (2020). Potential neurological effects of severe COVID-19 infection. Neuroscience Research, Vol. 158, pp. 1–5. doi: 10.1016/j.neures.2020.06.009 (11)Zhou, H., Lu, S., Chen, J., Wei, N., Wang, D., Lyu, H., … Hu, S. (2020). The landscape of cognitive function in recovered COVID-19 patients. Journal of Psychiatric Research, 129, 98–102. doi: 10.1016/j.jpsychires.2020.06.022 (see (12)Jin, J., Agarwala, N., Kundu, P., Harvey, B., Zhang, Y., Wallace, E., & Chatterjee, N. (2020). Individual and community-level risk for COVID-19 mortality in the United States. Nature Medicine, 1–6. doi: 10.1038/s41591-020-01191-8 for an overview). However, a recent pre-printed large-scale study suggests that also less severeSARS-CoV-2 progressions can lead to increased risk for stroke, nerve damage, dementia and different psychopathologies, including mood and anxiety disorders, psychosis, substance misuse and insomnia (13)Taquet, M, Ch, B., Geddes, J. R., Psych, F. R. C., Husain, M., Phil, D., … Harrison, P. (2021). Six-month Neurological and Psychiatric Outcomes in 236,379 Survivors of COVID-19. MedRxiv. doi: 10.1101/2021.01.16.21249950.

One study even suggests that a severe disease progression might lead to structural changes in the thalamus and sagittal stratum (14)Raman, B., Cassar, M. P., Tunnicliffe, E. M., Filippini, N., Griffanti, L., Alfaro-Almagro, F., … Neubauer, S. (2021). Medium-term effects of SARS-CoV-2 infection on multiple vital organs, exercise capacity, cognition, quality of life and mental health, post-hospital discharge. EClinicalMedicine, 31, 100683. doi: 10.1016/j.eclinm.2020.100683. However, evidence connecting brain imaging and SARS-CoV-2 is sparse. Nevertheless, such structural cortical changes are likely to influence neurotransmission and hence brain functioning. In turn, the functioning of the brain can influence cognition and daily life. Some evidence is available on how a SARS-CoV-2 infection can influence cognition and life in general.

Cognitive Deficits

Evidence shows that a severe SARS-CoV-2 illness progression can hamper cognition. Executive and visuospatial functions seem to be most affected (15)Iroegbu, J. D., Ifenatuoha, C. W., & Ijomone, O. M. (2020). Potential neurological impact of coronaviruses: implications for the novel SARS-CoV-2. Neurological Sciences, 41(6), 1329–1337. doi: 10.1007/s10072-020-04469-4 (16)Raman, B., Cassar, M. P., Tunnicliffe, E. M., Filippini, N., Griffanti, L., Alfaro-Almagro, F., … Neubauer, S. (2021). Medium-term effects of SARS-CoV-2 infection on multiple vital organs, exercise capacity, cognition, quality of life and mental health, post-hospital discharge. EClinicalMedicine, 31, 100683. doi: 10.1016/j.eclinm.2020.100683 (17)Zhou, H., Lu, S., Chen, J., Wei, N., Wang, D., Lyu, H., … Hu, S. (2020). The landscape of cognitive function in recovered COVID-19 patients. Journal of Psychiatric Research, 129, 98–102. doi: 10.1016/j.jpsychires.2020.06.022. Executive functions include a whole range of high-level cognitive processes which enable us to process new information efficiently and by doing so to optimize our behaviour (18)Gilbert, S. J., & Burgess, P. W. (2008). Executive function. Current Biology, Vol. 18. doi: 10.1016/j.cub.2007.12.014. Visuospatial functions refer to the ability to identify, analyze and mentally manipulate objects. This can be used in reference to one’s own body, for example to avoid walking into walls.

Typical neuropsychological tests, given to hospitalised corona patients, assess for example working memory (19)Baddeley, A. (2010). Working memory. Current Biology, Vol. 20, pp. R136–R140. doi: 10.1016/j.cub.2009.12.014 through tasks which require patients to remember sequences of numbers (20)Mao, L., Wang, M., Chen, S., He, Q., Chang, J., Hong, C. D., … Hu, B. (2020). Neurological manifestations of hospitalized patients with COVID-19 in Wuhan, China: A retrospective case series study. MedRxiv. doi: 10.1101/2020.02.22.20026500 (21)Zhou, H., Lu, S., Chen, J., Wei, N., Wang, D., Lyu, H., … Hu, S. (2020). The landscape of cognitive function in recovered COVID-19 patients. Journal of Psychiatric Research, 129, 98–102. doi: 10.1016/j.jpsychires.2020.06.022. Other assessments test visual attention and task switching, for example by connecting dots labelled with numbers (22)Mao, L., Wang, M., Chen, S., He, Q., Chang, J., Hong, C. D., … Hu, B. (2020). Neurological manifestations of hospitalized patients with COVID-19 in Wuhan, China: A retrospective case series study. MedRxiv. doi: 10.1101/2020.02.22.20026500 (23)Zhou, H., Lu, S., Chen, J., Wei, N., Wang, D., Lyu, H., … Hu, S. (2020). The landscape of cognitive function in recovered COVID-19 patients. Journal of Psychiatric Research, 129, 98–102. doi: 10.1016/j.jpsychires.2020.06.022. That means that having a severe illness progression can make you “slower in the head” and have difficulties in cognitively straining situations. Another often reported effect of the illness is chronic fatigue (24)Komaroff, A. L., & Bateman, L. (2021). Will COVID-19 Lead to Myalgic Encephalomyelitis/Chronic Fatigue Syndrome? Frontiers in Medicine, 7, 606824. doi: 10.3389/fmed.2020.606824. And just as the neurological manifestations, these effects might be permanent.

Consequences in Daily Life

Additionally, and eventually as a consequence of the disease and decreased daily functioning, participants of one study also reported lower life quality and higher depression symptoms (25)Raman, B., Cassar, M. P., Tunnicliffe, E. M., Filippini, N., Griffanti, L., Alfaro-Almagro, F., … Neubauer, S. (2021). Medium-term effects of SARS-CoV-2 infection on multiple vital organs, exercise capacity, cognition, quality of life and mental health, post-hospital discharge. EClinicalMedicine, 31, 100683. doi: 10.1016/j.eclinm.2020.100683. However, as described earlier, negative effects for psychological health also seem increased for patients who were not in need of hospital treatment (26)Taquet, M, Ch, B., Geddes, J. R., Psych, F. R. C., Husain, M., Phil, D., … Harrison, P. (2021). Six-month Neurological and Psychiatric Outcomes in 236,379 Survivors of COVID-19. MedRxiv. doi: 10.1101/2021.01.16.21249950. Hence, survivors of SARS-CoV-2 seem to be at increased risk to develop psychological disorders (27)Taquet, Maxime, Luciano, S., Geddes, J. R., & Harrison, P. J. (2020). Bidirectional associations between COVID-19 and psychiatric disorder: retrospective cohort studies of 62 354 COVID-19 cases in the USA. The Lancet Psychiatry, 8(2), 130–170. doi: 10.1016/S2215-0366(20)30462-4, which has shown to have a negative influence on self-reported life quality (28)Berghöfer, A., Martin, L., Hense, S., Weinmann, S., & Roll, S. (2020). Quality of life in patients with severe mental illness: a cross-sectional survey in an integrated outpatient health care model. Quality of Life Research, 29(8), 2073–2087. doi: 10.1007/s11136-020-02470-0 (29)Evans, S., Banerjee, S., Leese, M., & Huxley, P. (2007). The impact of mental illness on quality of life: A comparison of severe mental illness, common mental disorder and healthy population samples. Quality of Life Research, 16(1), 17–29. doi: 10.1007/s11136-006-9002-6.

Besides direct effects in the body, the pandemic represents a challenging time, and it is not uncommon to feel distressed (30)Pierce, M., Hope, H., Ford, T., Hatch, S., Hotopf, M., John, A., … Abel, K. M. (2020). Mental health before and during the COVID-19 pandemic: a longitudinal probability sample survey of the UK population. The Lancet Psychiatry, 7(10), 883–892. doi: 10.1016/S2215-0366(20)30308-4. The pandemic might also have negative effects on mental health, especially anxiety and depression levels, as evidence from all around the world suggests (31)González-Sanguino, C., Ausín, B., Castellanos, M. Á., Saiz, J., López-Gómez, A., Ugidos, C., & Muñoz, M. (2020). Mental health consequences during the initial stage of the 2020 Coronavirus pandemic (COVID-19) in Spain. Brain, Behavior, and Immunity, 87, 172–176. doi: 10.1016/j.bbi.2020.05.040 (32)Wang, C., Pan, R., Wan, X., Tan, Y., Xu, L., Ho, C. S., & Ho, R. C. (2020). Immediate Psychological Responses and Associated Factors during the Initial Stage of the 2019 Coronavirus Disease (COVID-19) Epidemic among the General Population in China. Int. J. Environ. Res. Public Health, 17, 1729. doi: 10.3390/ijerph17051729. Besides economic challenges, loneliness seems to play a central role in SARS-CoV-2-related mental health outcomes (33)Dawel, A., Shou, Y., Smithson, M., Cherbuin, N., Banfield, M., Calear, A. L., … Batterham, P. J. (2020). The Effect of COVID-19 on Mental Health and Wellbeing in a Representative Sample of Australian Adults. Frontiers in Psychiatry, 11, 579985. doi: 10.3389/fpsyt.2020.579985. There is some good news suggested by some data: we might feel better when we are over the infection peak (34)Wang, Y., Hu, Z., Feng, Y., Wilson, A., & Chen, R. (2020). Changes in network centrality of psychopathology symptoms between the COVID-19 outbreak and after peak. Molecular Psychiatry, 25(12), 3140–3149. doi: 10.1038/s41380-020-00881-6. So, let us gather what we got, follow the guidelines and work against the pandemic together. 

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