Patients Who Survive COVID-19 May Have Long-Term Brain Deficits

To date, the focus on COVID-19 patients has been more on keeping them alive and less on examining the impact the disease on their long-term health, although neurological issues in patients who suffer from COVID-19 call for better assessments to shape treatments.

Dr. Majid Fotuhi, MD, PhD, a Harvard- and Johns Hopkins-trained neurologist and neuroscientist, has warned about neurological issues in patients who suffer from COVID-19 and is encouraging more study of the neurological effects of the disease to promote better treatments.

According to Fotuhi, medical director of NeuroGrow Brain Fitness Center, COVID-19’s neurological manifestation can be grouped into three stages. In NeuroCovid Stage I, the virus damage is limited to epithelial cells of nose and mouth. In NeuroCovid Stage II, patients may experience blood clots in their brain or have auto-antibodies that damage their peripheral nerves and muscles. In this stage, the virus can trigger a flood of inflammatory markers, called cytokine storm, which begin in the lungs and travel throughout all body organs. This may lead to blood clots resulting in a series of strokes that can kill neurons. In NeuroCovid Stage III, the blood brain barrier, a protective insulation in blood vessels of the brain, is damaged and patients may develop seizures or encephalopathy. In this rare late stage, the virus particles themselves may invade the brain directly, including the brain region that controls breathing.

Fotuhi has pointed out that many patients with COVID-19 may have no noticeable neurological symptoms at first; but in some cases, patients may present with neurological symptoms even before they have fever, cough, or shortness of breath. He stresses that having an MRI while at the hospital will be an important tool in developing an optimal treatment strategy for these patients. In addition, patients will need to be monitored in a few months after their hospitalization as they may have new symptoms not experienced early in their disease process.

“Our experience with other forms of respiratory viruses that affect the brain suggest that in the long-term patients may develop depression, insomnia, Parkinson’s disease, memory loss, or accelerated aging in the brain,” said Fotuhi.