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It’s been almost two years into the Coronavirus pandemic and doctors and scientists are witnessing the neurological and mental complications of COVID-19. Some long term effects include delirium, agitation, severe fatigue, cognitive issues and memory lapses, not only due to the COVID-19 itself but due to isolation, fear, loss of income and sorrow trigger mental health conditions or exacerbate existing ones. 

Brain injury victims and those with preexisting mental, neurological or substance use issues are more vulnerable to SARS CoV-2 infection and face a higher risk of severe outcomes and even death. In the U.S alone, doctors have found 40% of patients with COVID showed neurologic manifestations at the onset and 30% of them had lasting impaired cognition after initial COVID-19 infection. 

Coronavirus and its effect on the brain:

Numerous reports of people suffering from brain fog, heart disease, gastrointestinal disease, inattention, chronic fatigue syndrome and PTSD have puzzled scientists. What effect does COVID-19 have on the body after the acute symptoms have resolved? 

Immunological injury to the brain: Biological mechanism 

COVID-19 is associated with CNS dysfunction, probably due to neuroinflammation, which can harm neurons essential for cognitive function. Some COVID patients suffer from encephalitis, or swelling of the brain, which can lead to double vision and confusion. In serious cases, hearing, speech and vision defects, which if left untreated causes cognitive issues. Though rare with the Coronavirus, autoimmunity can contribute to blood clots and inflammation. 

In severe cases of COVID-19, microglia may get activated signalling molecules called inflammatory cytokines, leading to changes in the cerebral cortex. This influences memory and decision-making, indicating an imbalance in neurons. This is similar to patients with Alzheimer's disease.

Another reason for cognitive issues due to COVID-19 may restrict blood flow to the brain, depriving it of oxygen. Studies on patients who died from COVID-19 showed damage to brain tissue caused by hypoxia (lack of oxygen). Other accompanying symptoms of COVID-19 syndrome, fatigue, pain and shortness of breath can negatively affect cognition too. 

Long term effects of COVID infection:

Impairment in sustained attention due to underlying inflammatory processes, lack of oxygen and silent strokes due to micro embolisms. The presence of autoantibodies in COVID patients mistakenly target and attack a patient's tissues or organs and appear to develop dysregulation of the autonomic nervous system that regulates involuntary functions such as digestion, breathing and heart rate. 

Increased risk of larger strokes and dementia and possibly Alzheimer’s: The combination of systemic inflammation, strokes and direct effect of the virus and damage to bodily organs can make COVD survivors at high risk of Alzheimer’s. 

Sleep problems, fatigue, joint and muscle pain: Along with COVID-19, SARS, Ebola, MERS, Spanish Flu and H1N1 all these viral infections have been associated with these long term effects. 

Multiple organ damage: While Covid starts in the lungs, it often affects the heart, kidneys, nervous and digestive systems. Signs of heart inflammation, scarring, and injury months after illness were indicated by abnormal findings on cardiac magnetic resonance imaging. Fluctuations in blood pressure and heart rate 

According to research, the Coronavirus infects the intestinal lining of some COVID-19 patients suggesting the virus can infect and damage the cells of the gut. The virus might also cause changes in gut bacteria, with diarrhoea and abdominal pain persisting weeks or months after coming down with COVID. 

Until now, there are no specific treatments for COVID-related brain fog, memory loss and other cognitive effects. Occupational therapy, cognitive or speech-language pathology to treat symptoms are being used. Studies are underway to understand the underlying mechanisms of cognitive dysfunction in long COVID patients in hopes of identifying potential treatments.