Brain-Fog Treatments: COVID-19 Research Is Getting Better

While identifying long-COVID patients is challenging, helping them through the uncharted territory of their illness is more difficult still. Benjamin Abramoff, the director of Penn’s post-COVID clinic, is a physiatrist with a specialty in spinal-cord injury. Like most U.S. physicians, he was abruptly introduced to COVID-19 a year ago, when hospitals were inundated with critically ill patients—some of whom suffered brain damage from oxygen loss, blood clots, or strokes. Many of those who survived with the help of ventilators emerged, expectedly, with “post-ICU syndrome,” a series of deficits that include memory, attention, and processing-speed impairments. The sickest patients can experience hallucinations and psychoses. “A pneumonia patient in the ICU can be delirious,” Abramoff says. “It’s not a surprise.”

But no one was prepared for the second wave of neurocognitive complaints, which came from people who had never been hospitalized. One man in his early 30s, whose physical COVID-19 symptoms had been limited to shortness of breath, appeared in Abramoff’s clinic in January, concerned about his ability to do his job. His work involved keeping many things in his head at once, and he could no longer manage it. Another man, a physician responsible for complex and nuanced diagnoses of heart patients, could not remember phrases that he used every day at work, such as blood pressure. He said he sometimes felt disembodied—depersonalized, as if he were outside of himself.

As these new patients—some 350 to date—arrived at the Penn clinic, Abramoff noticed the patterns now codified by Koralnik and his colleagues. For some people, coordinating Zoom calls and emails was too much to handle. Others could no longer work at all. Some began to get better after a couple of weeks or months, but a worrying minority remained ill. Abramoff had never seen so many people with a single viral illness stay so impaired for so long.

At Beth Israel Deaconess Medical Center in Boston, patients with milder COVID-19 began requesting help with mental fatigue and concentration problems late last year. The cognitive neurologist Tamara Fong thought they resembled patients with post-concussive syndrome (PCS), which some neurologists hypothesize results from inflammation of the brain. Like PCS patients, many members of the long-COVID group were brain-fogged and depressed. They often had headaches and trouble sleeping.

So far, Fong says, the most effective treatments for long COVID resemble those for physical brain injuries. She starts by restoring good sleep hygiene, limiting daytime naps and screen time before bed. She also wants her patients to reduce stress: Because heavy exercise tends to be too taxing at first, she recommends yoga, meditation, or tai chi. “Mindfulness helps,” she told me. After patients are rested and have learned to relax, she helps them recover their cognitive function through steady, gradual practice. Patients might start by reading newspaper headlines and short articles. “Doing too much too fast is like trying to run a marathon without training,” she said.

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