Key TakeawaysNeurological issues such as brain fog, memory loss, speech problems, and attention deficits plague up to 80% of COVID-19 patients.New studies show that this may be due to damage to the frontal lobe, brain aging, or symptoms associated with oxygen deprivation in the brain.Implementing diagnostic tests and brain scans is vital to understanding the full spectrum of these conditions, but many patients do not have access to these tests.
Key Takeaways
Neurological issues such as brain fog, memory loss, speech problems, and attention deficits plague up to 80% of COVID-19 patients.New studies show that this may be due to damage to the frontal lobe, brain aging, or symptoms associated with oxygen deprivation in the brain.Implementing diagnostic tests and brain scans is vital to understanding the full spectrum of these conditions, but many patients do not have access to these tests.
In the eight months since contracting COVID-19, 31-year-old artist Nora Lieberman knows the disease’s physical manifestations well: the memory loss, the migraines, the muscle aches, the fatigue, the nerve pain, the GI distress, and the breaths that never seem to find their way out. She falls into the first wave of patients who contracted the virus before there were enough tests to keep up with it; the “healthy, young, and fit” demographic who were told they would not get sick, only to paradoxically become the symbol of who may get the sickest. Or, at least, stay the sickest.
This is Lieberman’s first self-portrait. And it is her attempt to capture what COVID-19 did to her.
Nora Lieberman
At the beginning of the pandemic, doctors’ most pressing concern was keeping hospitalized patients alive, with the respiratory and cardiovascular sides of COVID-19 taking the spotlight. Stories oflong-haulerslike Lieberman were simply vignettes of neurological symptoms, with no data to quantify or explain them. Now, more researchers are looking beneath the surface, using scans and surveys to show how COVID-19 may be impacting the brain.
What’s Causing Neurological Symptoms In COVID-19 Patients?
Frontal Lobe Disturbances
The neurological impact of COVID-19 is complex and extensive. The disease can induce strokes, seizures, and hemorrhages. It can trigger symptoms such as memory loss, difficulty concentrating, headaches, speech aphasia, confusion, and dizziness in up to 80% of patients.
Multiple theories account for why COVID-19 can impact the brain: direct viral entry, systemic inflammation, blood clots, cardiac arrests, and more. While the mechanisms are still being uncovered, new information may point to which areas are affected.
A recent study published in theEuropean Journal of Epilepsyanalyzed the electroencephalogram (EEG) results of COVID-19-positive patients from 84 reports. An EEG records electrical activity in different areas of the brain, and in this case, detected abnormalities in the brain’s frontal lobe in over 600 patients—one-third of the people studied.
“Frontal lobe damage can cause all of these symptoms that patients are complaining of. We call the frontal lobe the ‘master executor’ because it manages all the executive functioning of the brain,”Neha Dixit, PhD,a clinical neuropsychologist in private practice in Philadelphia, Pennsylvania, tells Verywell. “The frontal lobe is involved in behavioral self-control, connecting plans, ideas, and goal-oriented thoughts to behaviors, sequencing, abstract thinking, verbal fluency, initiating behavior, and the speed of thinking, processing, and fluidity of thoughts.”
Neha Dixit, PhDIs a full recovery possible? I can never answer that question. But is recovery possible? Yes.
Neha Dixit, PhD
Is a full recovery possible? I can never answer that question. But is recovery possible? Yes.
Dixit describes the frontal lobe as the CEO of the brain, as it connects multiple brain areas and regulates almost all cognitive activity. Damage to this region can lead to personality and mood changes, attention deficits, memory issues, and communication dysfunction (particularly with regards to speech production, as the frontal lobe houses the main region responsible for speech, called Broca’s area).
The study found overall slowing in the frontal lobe, which could be indicative of potential brain damage. However, it gave no clear prognosis about whether or not this damage is permanent. Dixit says that if the findings are accurate, then recovery, or at least partial recovery, is possible.
“Our brains are amazing; they can withstand a lot," Dixit says. “If you think about a stroke patient who regained function in an arm that was limp when they first had a stroke or learned to talk again, it’s because of the plasticity in the brain—the brain’s ability to change and to withstand damage.”
While Dixit can’t predict for sure what outcomes will look like for COVID-19 patients with frontal lobe damage, she remains optimistic.
“Is a full recovery possible? I can never answer that question. But is recovery possible? Yes,” she says. “Sometimes with cognitive rehabilitation, speech therapy, or other therapies, people can regain an amount of functionality even if they still live with the chronic effects of a brain injury. However, it doesn’t always go away, and depending on the injury, sometimes you can have permanent frontal lobe damage.”
Symptoms and Treatment for Frontal Lobe Damage
Barbara Malamut, PhD, a neuropsychologist who diagnoses and treats the impact of brain disorders on cognition and behavior, says that with time and training, other regions of the brain can take over the function that was lost.
“Patients can practice certain skills so that they can strengthen parts of the brain that aren’t damaged,” she tells Verywell. “They’re not regenerating new tissue in their frontal lobe, but they are reorganizing their brain. For example, language is something you can retrain, and even memory retrieval.”
However, she says it’s too early to make any conclusions because more research is needed.
“This is completely unchartered territory. This virus is unlike any other virus, and the effects it has on the brain are unlike anything we’ve seen before with previous viruses,” she says.
How to Cope With Cognitive SymptomsAccording to Dixit, the best thing people experiencing cognitive symptoms can do is to give their brains small breaks. This may include:Breaking tasks up into more manageable chunksDoing more demanding tasks when you are most alertGetting sleep and exercise, if allowedStaying focused on the present as best you canUsing strategies like mindfulness and meditationGetting support from people who understand that you are struggling
How to Cope With Cognitive Symptoms
According to Dixit, the best thing people experiencing cognitive symptoms can do is to give their brains small breaks. This may include:Breaking tasks up into more manageable chunksDoing more demanding tasks when you are most alertGetting sleep and exercise, if allowedStaying focused on the present as best you canUsing strategies like mindfulness and meditationGetting support from people who understand that you are struggling
According to Dixit, the best thing people experiencing cognitive symptoms can do is to give their brains small breaks. This may include:
Oxygen Deprivation Patterns
Breathing difficulties plague patients both in the acute phase of COVID-19 and in the months that follow. According to Dixit, even non-hospitalized patients like Lieberman who exhibit a low blood oxygen level for a prolonged period of time can develop brain dysfunction. This is known ashypoxia.
Researchers at Massachusetts General Hospital were the first to assess this through a specialized magnetic resonance (MR) technique. They examined the brains of six COVID-19 patients and found similar metabolic abnormalities to those found in hypoxia.
Brain Fog After COVID-19 Possibly Linked to PTSD
Dixit says she sees this phenomenon in her practice in patients with respiratory illnesses such as chronic obstructive pulmonary disease (COPD). Sustained oxygen deprivation leaves patients more susceptible to mood disorders, depression, and memory complaints.
“These kinds of pulmonary diseases can lead to this entire race of global cognitive changes like decreases in attention and speed of processing," Dixit says. “If we see that in people who have decreased oxygenation over time like with COPD or chronic asthma, then it’s possible that with COVID, you’re seeing that same kind of etiology where the body is not sending enough oxygen to the brain.”
Uncovering this type of information is important because understanding the source of brain abnormalities in COVID-19 can aid in modulating treatment.
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Potential Brain Aging
Before COVID-19, Lieberman’s life never stood still. Her full-time job as a nanny meant she was always physically active, and her artistic work meant she was often in front of a canvas, exploring her cognitive and creative side. Now, she says she is shocked when she remembers the things she was physically and mentally capable of doing—they’re completely unimaginable now. Though she was only 30 when she contracted the virus, she feels like it has aged her in a way her self-portrait can’t portray.
What This Means For YouThe prevalence of neurological symptoms in COVID-19 is extremely high. Many patients who experience cognitive symptoms are debilitated for months after infection. If you are experiencing cognitive disturbances following a COVID-19 infection, consult a neurologist, neuropsychologist, or your primary care physician for proper brain testing and imaging.
What This Means For You
The prevalence of neurological symptoms in COVID-19 is extremely high. Many patients who experience cognitive symptoms are debilitated for months after infection. If you are experiencing cognitive disturbances following a COVID-19 infection, consult a neurologist, neuropsychologist, or your primary care physician for proper brain testing and imaging.
Incorporating Brain Tests into Treatment
The authors behind the EEG study suggest that EEG abnormalities can serve as a biomarker for COVID-related brain damage or disease. However, Dixit emphasizes that EEGs are notoriously unspecific—they show us more of a blanket finding as opposed to pinpointing areas with direct damage.
Instead, she recommends a combination of EEGs, functional MRIs, and neuropsychology testing to assess proper brain function and localization in acute and long-term COVID-19 patients. If patients develop cognitive disruptions, then these tests need to be done as soon as possible, she says.
However, for many patients like Lieberman, who do not have health insurance and cannot work due to debilitating long-term COVID-19 complications, that type of diagnostic testing feels like a pipe dream. But it’s one that Lieberman desperately needs. If she were to take a written cognitive test like the one that discovered COVID-induced brain aging, it might help her understand why she now writes out words phonetically—why “idea” becomes “eye-de-a,” and “house” becomes “how-s.” If she were able to get an EEG or an MRI of her brain, she might know if there is damage to her frontal lobe or hippocampus, which could explain why she forgets which faucet is for hot water and which is for cold, and why she is too afraid to drive because she can’t differentiate between the gas pedal and the brake.
Unfortunately, that type of information is a luxury she simply cannot afford.
“It’s no secret that COVID-19 has terrible neurological consequences, and I do believe that more tests need to be conducted to help us understand the potential long-term effects of the virus on the brain. However, all patients need to have access to these tests for us to understand the true neurological impact,” Abigail Schmelz, a public health graduate student at the University of Miami (UM) and a Research Assistant in UM’s neurology department, tells Verywell. “From a public health perspective, it’s more important than ever for young people to stay home and adhere to social distancing guidelines, because our healthcare system is strained beyond capacity right now, so this will make it even harder to receive diagnostic testing and treatment for these neurological problems.”
Doctors: Preventing Hospital Overcrowding Is Crucial to Reducing COVID-19 Deaths
As her brain and body continue to collapse from the long-term ramifications of COVID-19, Lieberman’s canvases also collect dust. When she does gather the strength to paint, the only color she can reach for is black.
“This virus is crazy. Things change from hour to hour sometimes. Time doesn’t exist for me anymore,” Lieberman says. “People are like, ‘We have to get out of our house for our mental health,’ but they don’t realize how housebound you can get when you’re sick. And I just want to remind them to stay vigilant because you don’t want this. It’s bad. It’s not fun. It sucks. And I have no idea when it will end.”
The information in this article is current as of the date listed, which means newer information may be available when you read this. For the most recent updates on COVID-19, visit ourcoronavirus news page.
4 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Liotta EM, Batra A, Clark JR, et al.Frequent neurologic manifestations and encephalopathy‐associated morbidity in Covid‐19 patients.Ann Clin Transl Neurol. 2020;7(11):2221-2230. doi:10.1002/acn3.51210Antony A, Haneef Z.Systematic review of EEG findings in 617 patients diagnosed with COVID-19.Seizure. 2020. doi:10.1016/j.seizure.2020.10.014Rapalino O, Weerasekera A, Moum S et al.Brain MR spectroscopic findings in 3 consecutive patients with COVID-19: Preliminary observations.Am J Neuroradiol. 2020. doi:10.3174/ajnr.a6877Hampshire A, Trender W, Chamberlain S et al.Cognitive deficits in people who have recovered from COVID-19 relative to controls: An N=84,285 online study.mdRxiv. 2020. doi:10.1101/2020.10.20.20215863
4 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Liotta EM, Batra A, Clark JR, et al.Frequent neurologic manifestations and encephalopathy‐associated morbidity in Covid‐19 patients.Ann Clin Transl Neurol. 2020;7(11):2221-2230. doi:10.1002/acn3.51210Antony A, Haneef Z.Systematic review of EEG findings in 617 patients diagnosed with COVID-19.Seizure. 2020. doi:10.1016/j.seizure.2020.10.014Rapalino O, Weerasekera A, Moum S et al.Brain MR spectroscopic findings in 3 consecutive patients with COVID-19: Preliminary observations.Am J Neuroradiol. 2020. doi:10.3174/ajnr.a6877Hampshire A, Trender W, Chamberlain S et al.Cognitive deficits in people who have recovered from COVID-19 relative to controls: An N=84,285 online study.mdRxiv. 2020. doi:10.1101/2020.10.20.20215863
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Liotta EM, Batra A, Clark JR, et al.Frequent neurologic manifestations and encephalopathy‐associated morbidity in Covid‐19 patients.Ann Clin Transl Neurol. 2020;7(11):2221-2230. doi:10.1002/acn3.51210Antony A, Haneef Z.Systematic review of EEG findings in 617 patients diagnosed with COVID-19.Seizure. 2020. doi:10.1016/j.seizure.2020.10.014Rapalino O, Weerasekera A, Moum S et al.Brain MR spectroscopic findings in 3 consecutive patients with COVID-19: Preliminary observations.Am J Neuroradiol. 2020. doi:10.3174/ajnr.a6877Hampshire A, Trender W, Chamberlain S et al.Cognitive deficits in people who have recovered from COVID-19 relative to controls: An N=84,285 online study.mdRxiv. 2020. doi:10.1101/2020.10.20.20215863
Liotta EM, Batra A, Clark JR, et al.Frequent neurologic manifestations and encephalopathy‐associated morbidity in Covid‐19 patients.Ann Clin Transl Neurol. 2020;7(11):2221-2230. doi:10.1002/acn3.51210
Antony A, Haneef Z.Systematic review of EEG findings in 617 patients diagnosed with COVID-19.Seizure. 2020. doi:10.1016/j.seizure.2020.10.014
Rapalino O, Weerasekera A, Moum S et al.Brain MR spectroscopic findings in 3 consecutive patients with COVID-19: Preliminary observations.Am J Neuroradiol. 2020. doi:10.3174/ajnr.a6877
Hampshire A, Trender W, Chamberlain S et al.Cognitive deficits in people who have recovered from COVID-19 relative to controls: An N=84,285 online study.mdRxiv. 2020. doi:10.1101/2020.10.20.20215863
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