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COGNITION & COVID-19 RESOURCE HUB

About Cognition & COVID-19

It is estimated that one in three individuals receive a neurological or psychiatric diagnosis within six months of having the virus. Viral illnesses like COVID-19 can contribute to neurological disorders directly (e.g., entering the brain through the nerves involved with smell), indirectly (e.g., inflammation in brain tissue), or as a result of treatments for the illness (e.g., complications arising from ventilation in the ICU). In addition to affecting smell and taste, acute COVID-19 infection can cause headache, delirium (agitation and altered consciousness), stroke (including in younger people), and even psychosis in rare cases.

In the months following the start of the COVID-19 pandemic, it became clear that effects on brain function and mental health are not limited to the acute phase. While the majority of people infected with COVID-19 make a good recovery, many have lingering issues. COVID-19 long-hauler syndrome is characterized by persisting respiratory effects, fatigue, headache, and especially by low mood, anxiety, and changes to thinking abilities. The cognitive effects have been described as "brain fog.”

If you have a cognitive lapse or inefficient mental functioning in the context of COVID-19, it is important not to panic; everybody slips up from time-to-time. Mental slowing, inefficiency, and feeling blue are – to some degree – expected with any serious illness. The purpose of this page is to describe the state of knowledge concerning the chronic cognitive effects of COVID-19, and what you can do about it.
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Frequently Asked Questions (FAQ)

  • Do I have brain fog?
    Many individuals affected by COVID-19 report "brain fog" related to inefficient cognitive functioning. Although this term can be used in different ways, the metaphor of fogginess is an apt description for the cognitive effects caused by COVID-19 involving impaired concentration and attentional focus. This metaphor has also been used by individuals who have had chemotherapy or radiation treatment for cancer. Brain fog can make us less effective in day-to-day tasks through impairment of executive functions.
  • What are executive functions?
    Imagine you are running a business, such as a corner store. You have to decide what to sell, monitor inventory, manage your staff, deal with unexpected situations – such as your ice-cream freezer going on the blink – among many other things.

    Like the shop owner, we have to make decisions about our day-to-day lives, allocate resources, and make adjustments when circumstances change. All of that requires us to stay focused and avoid distractions.

    Executive functions are a collection of higher level cognitive abilities that support decision making, planning, attentional focus, and error correction. Executive functions are associated with the frontal lobes of the brain, but they are mediated by distributed networks across the brain. Individuals with executive function impairments have difficulty completing tasks efficiently both at home and on the job.
  • Should I be concerned?
    Executive functioning impairment (also known as “executive dysfunction”) is defined when the effects are greater than normal and disrupt our ability to do the things we need to do, whether at work, at home, or at school. Concern is warranted in the instance of a major change or a sustained period of functioning below expectation. If you find that your symptoms are greater than expected, you should seek guidance from a healthcare provider.

    Click here to learn more
  • What causes executive function impairment?
    Brain research has shown that damage to the brain's frontal lobes (as in head injuries or strokes) causes executive impairment. Yet we know from neuroscience that there is no single brain region that is “in charge.” Just like a network of highways can be affected by weather disruption, interruption anywhere along the brain’s pathways can affect our ability to focus and resist distraction.

    You need not have a stroke or a brain injury to have executive function impairment. Executive function impairment can occur from brain compromise attributable to effects of conditions such as fatigue, intoxication or grief. It can also be affected by mental health disruption such as mood, anxiety, and stress due to (for example) caregiving or emotional trauma.

    If you are experiencing a mental health condition such as a mood disorder, anxiety, or other mental illness, it is recommended that you seek treatment for those as cognitive effects may resolve with appropriate treatment. Click here for a list of mental health resources
  • When will I return to normal?
    The time course of cognitive impairment depends on the cause of that impairment, which you should investigate with your doctor. Many individuals recovering from illness are eager to return to normal function before they have fully recovered. Return to normal activity gradually and monitor yourself, keeping expectations within reason and not pushing yourself too hard.
  • What can I do to improve my cognitive functioning?
    Practicing good health in general is known to improve cognitive functioning. Healthy habits (especially regular exercise – even walks make a difference), avoiding excessive drug/alcohol use, eating right, and getting enough sleep are all important. Managing stress through leisure activities is also recommended. Many people report benefits from meditation, yoga, stretching, or other light physical activity. Treatment of cardiovascular risk factors (see above) can prevent future decline. In the case of COVID-19, getting vaccinated and safe practices is the best protection.

    If you feel that many areas of your life are out of control, start with something small, such as moving your body outside every day (if you are able). If you are feeling overwhelmed, seek help.
     
    Time management. Many struggle with time management due to caregiving, work, or school responsibilities. Time management techniques – such as using a planner or calendar app – are often effective for organizing and keeping track of tasks. However, the technology is not as important as having a daily habit of tracking and prioritizing, even if that is done with a pencil and paper.
  • What can I do if a friend or loved one is experiencing cognitive impairment?
    If you are concerned about another person’s functioning, encourage them to talk to their health care provider. Offer to accompany them, if possible. If you are concerned about serious health consequences, try one of these resources.
  • What is cognitive rehabilitation?
    Cognitive rehabilitation refers to techniques designed to improve cognition through compensation or building upon one's strengths and developing more effective habits to manage cognitive tasks. Many healthcare professionals, such as psychologists and occupational therapists can provide guidance and advice on seeking cognitive rehabilitation, often in combination with other psychotherapeutic techniques, such as Cognitive Behavior Therapy.
  • Is my cognitive impairment due to dementia?
    The brain is not spared from the effects of aging on the body; problems with attention and memory are among the most common complaints with aging. Individuals with hypertension, diabetes, obesity, smoking, or high cholesterol may be an enhanced risk due to the effect of subtle vascular changes in the brain. Underlying brain conditions – such as multiple small strokes that accumulate over time – cause progressive executive impairment and, in some cases, lead to dementia.
  • Aging: is this normal or is this dementia
    The brain is not spared from the effects of aging on the body; problems with attention and memory are among the most common complaints with aging. Individuals with hypertension, diabetes, obesity, smoking, or high cholesterol may be an enhanced risk due to the effect of subtle vascular changes in the brain. Underlying brain conditions – such as multiple small strokes that accumulate over time – cause progressive executive impairment and, in some cases, lead to dementia.