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Neuropsychology

Long COVID ‘can impact everyday living for months’

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Long COVID can cause psychological symptoms including mood disorders, fatigue and perceived cognitive impairment that can impact on returning to work and resuming normal activities, new research has revealed. 

A new study reports on the first 100 patients to participate in Mayo Clinic’s COVID-19 Activity Rehabilitation program (CARP), one of the first multidisciplinary programmes established to evaluate and treat patients with post-COVID-19 syndrome, also known as Long COVID. 

More than a third of patients reported difficulties performing basic activities of daily living, and only one in three patients had returned to unrestricted work activity. 

Most had no pre-existing health conditions and did not experience a severe case of COVID-19. 

The most common symptom was fatigue, Mayo Clinic found, with 80 per cent of people reporting unusual levels of extreme tiredness. Additionally, 59 per cent reported respiratory complaints and a similar percentage had neurologic issues, such as ‘brain fog’. 

“Most patients in the study had no pre-existing comorbidities prior to COVID-19 infection, and many did not experience symptoms related to COVID-19 that were severe enough to require hospitalisation,” says Greg Vanichkachorn, medical director of Mayo Clinic’s COVID-19 Activity Rehabilitation programme and first author of the study. 

“Most of the patients had normal or non-diagnostic lab and imaging results, despite having debilitating symptoms. That’s among the challenges of diagnosing PCS in a timely way and then responding effectively.”

However, the symptoms often resulted in significant negative effects as patients tried to return to normal daily activities, including work. 

“Most patients with whom we worked required physical therapy, occupational therapy or brain rehabilitation to address the perceived cognitive impairment,” says Dr. Vanichkachorn. 

“While many patients had fatigue, more than half also reported troubles with thinking, commonly known as ‘brain fog.’ And more than one third of patients had trouble with basic activities of life. Many could not resume their normal work life for at least several months.”

The patients were evaluated and treated between June 1 and December 31, 2020. They had a mean age of 45, and 68 per cent were female. They were evaluated a mean of 93 days after infection.

Mayo Clinic developed the COVID-19 Activity Rehabilitation program at Mayo Clinic in Rochester in the US in June 2020, to care for patients experiencing persistent symptoms after COVID-19 infection. 

In addition to Dr Vanichkachorn, Mayo Clinic staff from many specialty fields are involved in diagnostics and treatment. Among services provided are psychosocial support for patients who frequently report feelings of abandonment, guilt and frustration during initial evaluation.

Mayo Clinic is conducting intensive research on post-COVID-19 syndrome, in part to better define how the condition presents across different socioeconomic groups and ethnicities. Prolonged symptoms, such as those experienced with post-COVID-19 syndrome, have been reported in prior epidemics.

“As the pandemic continues, we expect to see more patients who experience symptoms long after infection, and health care providers need to prepare for this, know what to look for, and know how to best provide for their patients’ needs,” says Dr. Vanichkachorn.

Neuropsychology

COVID affecting mental health ‘the norm, rather than the exception’

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Neurological and psychiatric symptoms including fatigue and depression are common among people with COVID-19 and may be just as likely in people with mild cases, according to a new study.

By reviewing evidence from 215 studies of COVID-19, the extent of the virus affecting mental health and the brain has been discovered. 

“We had expected that neurological and psychiatric symptoms would be more common in severe COVID-19 cases, but instead we found that some symptoms appeared to be more common in mild cases,” says lead author Dr Jonathan Rogers, UCL Psychiatry and South London and Maudsley NHS Foundation Trust. 

“It appears that COVID-19 affecting mental health and the brain is the norm, rather than the exception.”

The research team systematically reviewed evidence from 215 studies of COVID-19 from 30 countries, involving a total of 105,638 people with acute symptoms, including data up until July 2020 (acute refers to the main disease stage, rather than longer-term impacts). 

The studies varied as to which symptoms they were tracking, and the research team pooled data to compare how common each symptom was among the studies that tracked it.

Across the whole dataset, the most common neurological and psychiatric symptoms were: 

  • anosmia, or loss of smell, reported by 43 per cent of patients with COVID-19
  • weakness – 40 per cent 
  • fatigue – 38 per cent 
  • dysgeusia, or loss of taste – 37 per cent
  • myalgia, or muscle pain; 25 per cent
  • depression – 23 per cent 
  • headache – 21 per cent 
  • anxiety – 16 per cent.

They also identified the presence of major neurological disorders such as ischaemic stroke – 1.9 per cent of cases in the dataset – haemorrhagic stroke (0.4 per cent) and seizure (0.06 per cent).

But among people with symptomatic acute COVID-19 who were not hospitalised, neurological and psychiatric symptoms were still common: 

  • 55 per cent reported fatigue 
  • 52 per cent loss of smell 
  • 47 per cent muscle pain 
  • 45 per cent loss of taste 
  • 44 per cent headaches. 

The researchers say it’s still possible that such symptoms are just as common in severe cases, as mild symptoms might not be reported by a patient in critical care.

While this review did not investigate causal mechanisms, the researchers suggest a few possible explanations. In the acute phase of the illness, inflammation has been found in the brain, which may explain some of the symptoms. 

Psychosocial factors relating to the context of the global pandemic may play a role, as people who are acutely ill may feel isolated when they cannot see their family or friends, which may explain why depression and anxiety have been found in some COVID-19 studies to be more common than in other viral illnesses such as the flu.

Dr Rogers says: “Many factors could contribute to neurological and psychiatric symptoms in the early stages of infection with COVID-19, including inflammation, impaired oxygen delivery to the brain, and psychological factors. More studies are needed to understand these links better.”

Joint senior author Dr Alasdair Rooney, University of Edinburgh, adds: “Neurological and psychiatric symptoms are very common in people with COVID-19. With millions of people infected globally even the rarer symptoms could affect substantially more people than in usual times.

“Mental health services and neurological rehabilitation services should be resourced for an increase in referrals.”

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Neuropsychology

Pandemic ‘significantly’ impacts teenagers’ mental health – especially among girls

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The COVID-19 pandemic has had a “significant, detrimental” impact on adolescent mental health, especially in girls, a new study has found.

In research involving over 59,000 Icelandic teenagers, negative mental health outcomes were disproportionately reported by girls and older adolescents (13 to 18-year-olds), compared to same-age peers prior to the pandemic. At the same time, it revealed a decline in cigarette smoking, e-cigarette usage and alcohol intoxication among 15 to 18-year-old adolescents during the pandemic.

The study is the first to investigate and document age and gender-specific changes in adolescent mental health problems and substance use during the COVID-19 pandemic, while accounting for upward trends that were appearing before the pandemic.

Thorhildur Halldorsdottir, a clinical psychologist and assistant professor of psychology at Reykjavik University who is the study co-principal investigator, says the study represents a “landmark contribution to what we now know about just how psychologically devastating being socially isolated from peers and friends during the ongoing pandemic has been for young people.”

“Isolation during the pandemic has been universal and it is global, and it is having a clinically important, negative impact on young people who have not been in school during the pandemic,” says collaborating senior investigator John Allegrante, an affiliated professor of sociomedical sciences at Columbia University Mailman School of Public Health and an applied behavioral scientist.

“Whether an adolescent was an Icelander in Reykjavik who had been at home for most of the last year or an American in New York City, living under the same circumstances – being at home, engaged in remote learning and separated from friends – the consequences of not going to school not only set back their learning but also negatively affected their mental health. What we don’t know is by how much.”

The study shows that population-level prevention efforts, especially for girls, are warranted,” but that “more study is needed to determine the long-term effects of quarantine and being socially isolated from one’s peers, including the effects on learning and academic achievement and relationships with parents, siblings, and peers,” says Allegrante.

According to the researchers, prior studies have not been designed to determine whether clinically relevant levels of depression – as opposed to self-reported depressive symptoms – and substance use have increased during the pandemic.

Inga Dora Sigfusdottir, professor of sociology at Reykjavik University, said the study “differs in methodology from previous studies in that it tracked population-based prevalence of mental health outcomes and substance use over several years in order to better understand the potential effects of COVID-19 from recent upward trends in adolescent mental health problems”.

“The decrease observed in substance use during the pandemic may be an unintended benefit of the isolation that so many adolescents have endured during quarantine,” says Allegrante.

Previous studies of adolescents during COVID-19 found evidence of increased mental health problems and certain types of substance use that had been rising before the pandemic. This study, however, compares current data with several pre-pandemic time points, which enabled the researchers to separate the effect of COVID-19 from other recent, downward trends in adolescent mental health.

The implication of the new study is that interventions intended to lessen the negative impact of the pandemic on adolescent mental health might help improve the mental health outlook for young people around the world who have been caught up in the pandemic, observed Allegrante, who is also senior professor of health education at Columbia Teachers College.

Alfgeir L Kristjansson, senior scientist at ICSRA and associate professor of Public Health at West Virginia University and a co-author of the study, says the “results underline the significance of social relationships in the health and well-being of youth and the importance of nurturing and maintaining strong social support mechanisms in their lives. The Lancet Psychiatry study report highlights these findings at population scale.”

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Neuropsychology

‘Decision acuity’ underpins decision making in young people

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Young people have a decision making ability distinct from IQ, which is associated with good social function but may be linked to poor mental health, a new study has revealed. 

The decision-making ability, called ‘decision acuity’, is a novel construct and may be underpinned by how strongly certain brain networks are connected, researchers from UCL and Karolinska Institutet found. 

“We worked to improve understanding of the brain underpinnings of decision-making ability in adolescence and early adulthood – a critical period of development and a common time for the emergence of psychiatric disorders,” says Dr Michael Moutoussis, of Max Planck UCL Centre for Computational Psychiatry & Ageing Research and Wellcome Centre for Human Neuroimaging, UCL Queen Square Institute of Neurology.

“We find that a general factor underpins multiple types of decision-making, which we term ‘decision acuity’.

“People with higher decision acuity do not always make the best decisions, but they opt for specific decisions in a consistent way. Low decision acuity is associated with poorer social function, and may be linked with mental illness symptoms.”

For the study, 830 young people, aged 14 to 24, completed decision-making tasks testing for 32 separate measures, which related to facets such as risk-taking, trusting in other people, and sensitivity to gains and losses.

The researchers found that a common factor underpinned how well people could make decisions, and called this ‘decision acuity’. High decision acuity reflected factors such as fast learning, considering outcomes in the distant future, reward sensitivity, trust in others, and low propensity for retaliation. 

Independent of IQ, decision acuity predicted performance in the decision-making tasks, was higher in older subjects, and increased with parental education. In addition, decision acuity remained stable over time among 571 of the original participants who were re-tested on the same behavioural tasks 18 months later.

The participants also answered questions about mental health symptoms. The researchers found that high decision acuity was associated with better social functioning, while there were also weak relationships with aberrant thought patterns, including obsessionality and compulsivity, and general distress.

The researchers explain they are as yet uncertain about whether high decision acuity causes improved mental health, or if the relationship may be the other way around, as it may be that poor mental health could affect the development of decision-making ability, or some factor might affect both decision acuity and mental illness symptoms.

Some – 295 – of the participants also underwent MRI brain scanning, and the researchers found that decision acuity was correlated with functional, rather than structural, connections between numerous brain regions, including several areas that have previously been linked to decision-making. The researchers replicated the findings when they re-tested 223 participants 18 months later.

Joint senior author Dr Marc Guitart-Masip, who works alongside co-first author Dr Benjamín Garzón at the Karolinska Institutet, Sweden, says: “While our study participants here were conducting tasks based on simple decisions, this decision acuity may similarly apply to more complex decisions, as it relates to how far ahead people think into the future and how impulsive or trusting they are.”

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