The exact reasons for ongoing neurocognitive symptoms after a SARS-CoV-2 infection are still not entirely clear. Some theories suggest that the virus might directly affect parts of the brain responsible for these cognitive skills. Brain fog can significantly impact a person's psychological and physical recovery after COVID-19, as well as their ability to return to work. A recent Italian study thus investigated if a rehabilitation program that combines physical and mental therapies can help improve lingering brain fog symptoms after a moderate-to-severe COVID-19 infection that required hospitalization.
Most patients had cognitive issues before rehabilitation
In this study, 64 patients who left the hospital and tested negative for COVID-19 joined a standard 30-day rehabilitation program. On average, they were 67 years old and two-thirds of them were male. Many had other health issues like high blood pressure, gastrointestinal diseases, diabetes, and heart problems.
This program, which was tailored to each patient's specific health needs, involved supervised daily aerobic and muscle-building exercises and mental training sessions that lasted about 45 minutes each. Patients who showed any level of cognitive issues were given personalized mental exercises to improve their most deficient skills, such as memory, attention, or orientation. The program also included therapies to help patients manage anxiety or depression and stress as well as improve communication with their families.
When patients entered and left the rehabilitation program, the researchers collected various types of data from them, such as medical history, current symptoms, and emotional well-being. They used specific tests to check different factors like cognitive function, stress levels, and anxiety and depression, as well as quality of life. Cognitive function was assessed by a questionnaire called Montreal Cognitive Assessment (MoCA) and based on their score, patients were categorized as having normal, mild, moderate, or severe cognitive issues.
Significant improvement in mental skills after 30 days of day-by-day cognitive therapies
After testing for cognitive function using the MoCA test, the study found that almost 88% of patients had some level of cognitive issues when first entered the program (Figure). When they completed the 30-day rehabilitation program, patients showed a significant improvement in mental skills like attention, language, memory, orientation, reasoning, and visuospatial abilities.
At the end of the program, 50% of patients had normal cognitive performances and many of those who initially had mild or moderate cognitive problems had improvements (Figure). The mental improvement was especially noticeable among patients who were specifically treated for cognitive issues. Even when researchers considered in their analyses various factors like age, previous medical conditions and severity of COVID-19, the improvement remained significant. Results further showed no significant improvements in anxiety and depression based on specific psychological tests.
Cognitive impairment at admission and after the rehabilitation program. The pie charts show percentages of patients with different levels of cognitive impairment (normal, mild, moderate, and severe).
The researchers pointed out that the study has some limitations, including a small sample size and the lack of a control group, and more complex clinical studies are needed to confirm the efficacy of psychological treatment in Long COVID patients. Despite these limitations, this study is important because it shows that individualized day-by-day psychological therapies can help improve cognitive symptoms.
However, brain areas related to memory and language might be physically affected in patients with Long COVID, as some studies previously demonstrated. Results of this study also suggest that brain fog is linked to specific areas in the brain and is not just a result of stress, anxiety, or depression.
