by Vera Martinella
The “neuro-Covid” impact was notable, but the ailments became less frequent with each subsequent pandemic wave
In English it is called brain fog, mostly literally translated into Italian as “mental”, cerebral or cognitive fog. It is one of the most widespread and debilitating characteristics of Long Covid. It is actually a collection of symptoms. Those who suffer from it struggle to concentrate, are slow in processing thoughts, are confused and often have memory problems. Saying how many people it affects is complicated, because these disorders are not always easy to diagnose and trace with certainty to Sars-CoV-2 infection. An Italian study from 2023 reports that after Covid, around 30% of people report memory problems and 20% attention problems.
«Over time, we have seen how Long Covid was a very common condition, characterized by three categories of main symptoms: fatigue, a sense of chronic tiredness that lasts for a long time, weeks and sometimes months, cognitive problems and respiratory disorders – clarifies Valentina Di Mattei, coordinator of the Clinical Health Psychology Service of the San Raffaele Hospital in Milan. Cognitive fog has been defined as a condition characterized by poor thinking, difficulty focusing attention, subjective confusion and forgetfulness. Precisely quantifying how many patients suffer from it is a difficult task due to the complexity of arriving at a precise diagnosis and the diversity of long-term manifestations.”
The Italian study
The results of the Neuro-Covid Italy study, promoted by the Italian Society of Neurology (Sin) and published in the journal Neurology, provide a specific snapshot of the situation in our country. The investigation involved 38 Neurology operating units in Italy and the Republic of San Marino and lasted from March 2020 until June 2021, with subsequent checks until December 2021. «Out of almost 53 thousand patients hospitalized for Covid-19, approximately 2 thousand were affected by neuro-Covid disorders and were followed for at least six months after diagnosis, to analyze the evolution of the disorders – specifies Carlo Ferrarese, coordinator of the study and director of the Neurological Clinic of the University of Milan-Bicocca at the Irccs San Gerardo dei Tintori Foundation of Monza —. The neurological disorders associated with Sars-CoV-2 infection, defined with the term “neuro-Covid”, are among the most alarming, controversial and least understood aspects of the recent pandemic. These are different symptoms and diseases: from acute encephalopathy (with severe confusional state, with disorientation and hallucinations) to ischemic stroke, cerebral hemorrhage, concentration and memory difficulties, chronic headache, reduced sense of smell and taste, some forms of epilepsy and inflammation of the peripheral nerves.”
A reassuring picture
The picture that emerges is, however, partly reassuring: over time, neurological problems have become less frequent and in the majority of cases they disappear, often within a short time. «A first important fact is that neuro-Covid disorders have gradually become less frequent with each subsequent pandemic wave, going from around 8% of the first wave to around 3% of the third – clarifies Simone Beretta, neurologist at the San Fondazione Gerardo dei Tintori and first author of the study —. This is regardless of the respiratory severity of the infection and before the arrival of vaccines. The most probable reason for the reduction therefore seems linked to the variants of the virus, which, passing from the first ones (from Wuhan to Delta) made it less dangerous for the nervous system. With Omicron and the spread of vaccines, the situation then improved further and neuro-Covid disorders have now become very rare.”
When problems persist
Those cases in which brain fog or other cognitive problems persist for months or years remain to be explained, but most people return to normal. «In over 60% of patients there was a complete resolution of neurological symptoms or the persistence of mild symptoms, which do not impede daily life activities – concludes Ferrarese -. It rises to over 70% for those of working age, between 18 and 64 years old. However, in more or less 30% of the subjects, the neurological symptoms lasted more than six months after the infection. «And also for “cognitive fog”, concentration and memory disorders, the resolution of symptoms was much slower than for other neurological conditions, so much so that it fell into what has been called Long Covid syndrome».
When we talk about brain fog and post-Covid cognitive disorders, it should not be forgotten that they can be intertwined with other discomforts experienced by many people during and after the pandemic: anxiety, depression, stress have often worsened in those who already suffered from psychiatric disorders, creating a «vicious circle» with insomnia. «Arriving at a precise diagnosis is therefore as important as it is complicated, also considering the fact that the disorders can be many and intersect with each other – explains Valentina Di Mattei -. A careful evaluation is therefore needed, which cannot ignore both the clinical history of the patient who had Covid and his psychological condition prior to the viral infection”.
Depending on the disorders they suspect (for example depression, cognitive problems, brain fog), specialists proceed using the most suitable screening tools available, with tests and questionnaires already validated for the various psychological and psychiatric pathologies. Similarly, for the neurological manifestations of the infection, tests are prescribed (such as electroencephalogram, tomography, magnetic resonance imaging) depending on the pathology hypothesized in the individual patient, obviously combined with the evaluation of a neurologist specialist.
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December 10, 2023 (changed December 10, 2023 | 07:25)
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