UK researchers have found further evidence of the ongoing mental impacts of COVID-19 in people who have recovered from the disease.
In a study involving more than 80,000 people, researchers found that those with more severe COVID-19 symptoms scored lower in an a series of online tests, with performance on reasoning and problem-solving tasks being most affected.
Further analysis showed that those who received mechanical ventilation to help them breathe whilst in hospital had the greatest impairment on cognitive tasks.
According to the team, the findings further highlight how COVID-19 infection can have lasting, and measurable, impacts on people’s brain function.
The study was a collaboration between King’s College London, Imperial College London and Cambridge University.
Dr Adam Hampshire, from Imperial’s Department of Brain Sciences and first author, said the work adds to a growing body of research looking at how COVID-19 might be impacting the brain and brain function.
“This research is all converging to indicate that there are some important effects of COVID-19 on the brain that need further investigation,” he says.
The latest study carries on from a series of online tests developed by Dr Hampshire as part of BBC2 Horizon’s Great British Intelligence test. In early 2020, the study team extended the questionnaires to gather information on SARS-CoV-2 infection, the symptoms experienced and the need for hospitalisation.
From 81,337 people who provided complete data, 12,689 people suspected they had COVID-19. Participants reported a range of severity of illness, with many experiencing respiratory symptoms whilst still being able to stay at home (3,559 participants).
Nearly 200 were hospitalised (192 participants) and about a quarter of these (44 participants) required mechanical ventilation.
The time since illness onset was around one to six months, meaning the study could not draw any definitive conclusions about whether these effects on cognition were long-lasting.
Researchers found a relationship between deficits in overall cognitive performance and the severity of respiratory symptoms people experienced.
They also found that not all areas of thinking ability correlated in the same way with COVID-19 illness and that some abilities were spared, including emotional discrimination (recognition of faces that were expressing the same emotion) and working memory (remembering where a sequence of squares appears on the screen).
In comparison ‘executive’ tasks that required skills in reasoning (such as deciding if relationships between words were similar) and problem solving seemed to show the greatest deficit.
To understand the size of the deficits the authors compared the pattern of scores on the tests to cognitive changes that occur for other reasons.
The effects in those hospitalised with mechanical ventilation were similar to the average cognitive decline seen over a period of ten years of ageing and equivalent to a seven-point difference in IQ.
As part of the study, the team wanted to ensure these cognitive effects were associated with COVID-19, and not linked something else. By separating those who had a confirmed positive test for SARS-CoV-2 they could show the cognitive deficits were greater in those who had a confirmed infection.
Further checks suggested the results were not due to a minority with pre-existing conditions or on-going symptoms of COVID-19. Analysis also indicated that it was unlikely that the results could be explained by the fact that those who contracted more severe COVID-19 disease were less cognitively able before they were ill.
Dr Hampshire adds: “Going forward it would be valuable to bring together brain imaging and cognitive tests with other information on mental health and everyday function, ideally in studies that track peoples’ trajectories for months or even years. To really know what the long-term effects are for people will require people to be followed up over time.”
COVID cognitive symptoms linked to cerebrospinal fluid
The study could help increase understanding of ‘brain fog’ among people recovering from COVID and those with Long COVID
Cognitive symptoms experienced by people recovering from COVID-19 may be linked to abnormalities found in cerebrospinal fluid, new research has revealed.
The new findings around the role of cerebrospinal fluid, which saw similar changes in those recovering from a mild bout of COVID as people with other infectious diseases, may provide new insight into how the SARS-CoV-2 virus impacts the brain.
‘Brain fog’ has become recognised as a common after effect of COVID and symptom of Long COVID, which can cause varying degrees of cognitive issues.
In a small study with 32 adults, comprising 22 with cognitive symptoms and ten control participants without, researchers from UC San Francisco and Weill Cornell Medicine, New York, analysed the cerebrospinal fluid of 17 of the participants who consented to lumbar puncture.
All participants had had COVID but had not required hospitalisation.
They found that ten of 13 participants with cognitive symptoms had anomalies in their cerebrospinal fluid – but all four of the cerebrospinal samples from participants with no post-COVID cognitive symptoms were normal.
Participants with these symptoms presented with executive functioning issues, said senior author Dr Joanna Hellmuth, of the UCSF Memory and Aging Center.
“They manifest as problems remembering recent events, coming up with names or words, staying focused, and issues with holding onto and manipulating information, as well as slowed processing speed,” she said.
Examinations of the cerebrospinal fluid revealed elevated levels of protein, suggesting inflammation, and the presence of unexpected antibodies found in an activated immune system.
Some were found in the blood and cerebrospinal fluid, implying a systemic inflammatory response, or were unique to the cerebrospinal fluid, suggesting brain inflammation.
While the targets of these antibodies are unknown, it is possible that these could be “turncoat” antibodies that attack the body itself.
“It’s possible that the immune system, stimulated by the virus, may be functioning in an unintended pathological way,” said Dr Hellmuth, who is principal investigator of the UCSF Coronavirus Neurocognitive Study and is also affiliated with the UCSF Weill Institute for Neurosciences.
“This would be the case even though the individuals did not have the virus in their bodies,” she said, noting that the lumbar punctures took place on average ten months after the participants’ first COVID symptom.
The researchers also found that the participants with cognitive symptoms had an average of 2.5 cognitive risk-factors, compared with an average of less than one risk factor for participants without the symptoms.
These risk-factors included diabetes and hypertension, which can increase the risk of stroke, mild cognitive impairment and vascular dementia; and a history of ADHD, which may make the brain more vulnerable to executive functioning issues. Other risk factors included anxiety, depression, a history of heavy alcohol or repeated stimulant use, and learning disabilities.
Cognitive Rehab Coach – harnessing the power of remote therapy
Inspired by seeing the impact digital could make in rehab, Natalie Mackenzie has gone on to build an internationally-successful business
Out of the necessity to pivot to digital during the early days of the pandemic, an international online business – The Cognitive Rehab Coach – has been created to support people living with the impact of concussion and brain injury around the world.
The Cognitive Rehab Coach was born from seeing how effective remote support could be for clients who are eager and able to embrace it, with people from the United States to New Zealand now benefitting from therapy delivered from the UK.
Founder Natalie Mackenzie, a highly-esteemed cognitive rehab therapist and also director of BIS Services, runs both individual and group sessions across the globe – something she admits she embarked on from the greater acceptance of the quality and impact of virtual therapy which has come from COVID-19.
“I still do client work and love doing client work, but the challenges of running a business often mean you can’t do as much as you’d like. You can get very lost in the running of a business when you’re a clinician. So this has been very interesting and led by the changes in digital offering we’ve seen from COVID,” she says.
“Through delivering therapy this way, I can do a large amount of client work with much less travel time and greater reach.
“With the BIS, we can spend anywhere between two and eight hours with a client. I’ve got clients who are two hours away, so I can spend six hours of my day only seeing a client for two hours.
“But with the Cognitive Rehab Coach, I can spend six hours online with six different different groups or six different clients. It’s kind of brought back the reason why I love the work that I do.
“Clients can be a bit more autonomous and self-led with the learning and assignments I give them, so they can be shorter packages, but with the same level of information they’re being given.
“That also led on to me doing group programmes. That kind of one-to-many offering through small groups, in addition to the one-to-one sessions, are proving to be really effective.
“But it was through what we did with BIS that showed me what was and wasn’t possible. The virtual timetable was a huge learning curve for me in terms of what clients will tolerate right in a group online setting – which at BIS is not a lot – whereas the concussion and post-concussion syndrome demographic find that slightly easier. There have been a lot of lessons.”
And the lessons in what was possible also extended into what was essentially a ‘needs must’.
For many clients at BIS Services – which delivers innovative in-person cognitive rehabilitation to clients living with brain injury and neurological problems across the country – the experience of digital adoption into therapy was rather more challenging.
“We did take our virtual timetable online for a period of time, we did pivot to adapt to the challenges of staffing and keeping clients and staff safe,” she says.
“But now, the only time we go digitally is if someone is in isolation and we can flip back into the online support. We do face the same challenges with engagement and being able to functionally practice things with clients, but at least we know it will be for a short period of time. And the transition is much easier now, too.
“But for BIS and our team of RAs (rehab assistants), all of whom have been specifically matched to each client, wherever possible, we’ll do face to face. But although that’s from a therapy point of view, that’s not to say digital hasn’t been really important in many other ways.”
But while Kent-based BIS has not adopted digital as a core part of its therapy offering to clients, it has proven to be effective in other ways. Through the creation of online events and opportunities, clients continued to be challenged and stimulated.
“Our weekly quiz night became a therapeutic activity, as well as a bit of fun,” says Natalie.
“We had a group of people who really got on well, but you’d probably never have put those people in a room together. It was the one it was the one activity that we kept going for the longest because clients were so engaged in it.
“We rotated themes and gave clients the opportunity to write a quiz themselves, and we know hours of work went into that 45-minute quiz. It was a lovely thing to see.
“We also did a couple of comedy nights where the clients did comedy for us, and we would record it for them. I thought that was really brave to do that in front of your peers. Then the following week, the client would then review it as part of their learning to see what they wanted to improve on.
“These were ways in which Zoom did really deliver some great benefits to us.”
And in terms of its impact on how BIS operates, technology has also delivered benefits in terms of staff training and supervision.
With 45 rehab assistants across the South of England, and extending as far north as Manchester, the opportunity to unite the team online rather than in person has been a very welcome opportunity.
“They’re all so busy with clients that to even find one day a quarter where we bring everyone in for training can be really prohibitive,” says Natalie.
“But now, I’ll deliver it live for any staff who can’t be here in person, and then it’s made available on our virtual library. For supervisions too, you don’t want to have people coming down from Manchester, spending all those hours travelling, when you can do it online now.”
Online training and learning has been a key area of development and acceptance, within BIS and for countless other organisations around the world. For Natalie too, she has embarked on her own digital learning experience, securing qualification as an ADHD coach.
“I have a lot of brain injured clients with ADHD, but there isn’t an ADHD coaching course in the UK. I ended up doing a year-long course in America and the ability to train digitally has been amazing,” she says.
“While the opportunity would have been available before COVID, I guess it wasn’t as accepted, my preference would probably have been face to face. But now, there is much greater awareness and acceptance, because it works and we’re all seeing that.”
Going forward, digital will continue to be a key part in the administration role of BIS, and of course will be fundamental to the continued growth of the Cognitive Rehab Coach – although the early experiences of COVID showed Natalie and her team the need to avoid becoming over-reliant on its use for some very human reasons.
“In clinical work, we’re not used to being on computers for six or seven hours a day, let alone the challenges of talking pretty continuously for that long,” says Natalie.
“We had really bad headaches and were just so tired, we even started having problems with our vision. I remember losing my voice for a couple of days too.
“But now, we have got into what I think is a good working pattern, where we can flip to digital for our clients if we need, but we’ve learnt what works and what doesn’t. We are now using that to our advantage and making it work best for everyone.”
- Natalie will be speaking at the Virtually Successful conference next week, organised by Remote Rehab in association with NR Times. For more information and to sign up, visit here
Depression and anxiety ‘rose sharply over Christmas’
Life satisfaction and happiness reached their lowest levels since March 2021, the COVID-19 Social Study revealed
Levels of depression and anxiety rose sharply last month in the UK, especially among young adults, reaching similar levels to lockdown at the start of 2021.
The latest phase of the COVID-19 Social Study looked at the experiences of 31,151 people during December, and found a drop since November in reported life satisfaction and happiness.
Both life satisfaction and happiness reached their lowest levels since March 2021, the UCL-led research found.
Additionally, the study revealed that confidence in devolved governments’ handling of COVID-19 fell in England and Wales over the same period – between the end of November and start of January – but remained steady in Scotland.
In England, the level of confidence was close to the lowest level recorded during the pandemic back in October 2020.
Lead author Dr Daisy Fancourt, of the UCL Institute of Epidemiology & Health Care, said: “The findings reported here highlight the ongoing adverse effects of the pandemic on mental health.
“Even though there were many fewer restrictions this Christmas compared with Christmas 2020, levels of anxiety and depression were on a par with the same time last year.
“Our findings suggest that it is not just the presence of social restrictions that affect mental health but also concerns and stressors relating to high levels of the virus and a high risk of infection.
“The decrease in confidence in government to handle the pandemic likely contributed to the stresses many people faced over this period.”
In terms of people’s concerns about COVID-19, the study showed that the proportion of people concerned about catching or becoming seriously ill from the virus increased sharply over the Christmas period, with:
- 43 per cent of respondents saying catching COVID-19 was a major concern
- 46 per cent worried about becoming seriously ill from COVID-19
- 58 per cent concerned about family or friends catching COVID-19
- 52 per cent reporting that the possibility of developing Long COVID was a major concern
Three in four (73 per cent) people reported being concerned about non-COVID-19 NHS treatment being cancelled, postponed or otherwise adversely affected over the next three months.
A further 64 per cent of respondents also had a major worry about hospitals being overwhelmed. These fears were greatest amongst adults over the age of 30 compared to adults aged 18 to 29.
Meanwhile, 86 per cent of respondents reported that their experiences and behaviours had been different over the Christmas period compared to typical Christmases, such as staying at home more, changing travel plans, meeting up with fewer people, shopping online rather than in-store, avoiding large gatherings, and making fewer plans.
Younger adults (aged 18 to 29) reported the fewest differences to usual compared to older adults.
Compliance with guidelines to prevent the spread of COVID-19 slightly increased over the Christmas period, indicating that people tightened up their behaviours. This pattern was seen clearly in 30 to 59-year-olds and 60+ year olds.
However, only four in 10 (43 per cent) people said they currently understood the rules fully or near fully and one in 10 (10 per cent) said they did not understand them at all.
Older adults were more likely over the Christmas period to maintain a safe distance when meeting (30 per cent always did among those aged 60+, compared to nine per cent of those aged 18 to 29) as well as washing their hands, wearing face masks, increasing ventilation in indoor spaces and meeting outdoors, but adults under the age of 60 were more likely to take lateral flow tests and ask others to take them, the survey found.
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