Even though most of the press and general public have tuned out, the Covid-conscious have kept their eyes on research and news reports of long-term conditions and/or slow to be reversed damage. Some of these outcomes don’t show up in day-to-day living or in routine tests, but do in imaging. As we’ll discuss below, cognitive effects are harder to substantiate than others, but based on a teeny sample, we wonder if difficulty with checklists could be a Covid after effect.
Arguably, brain impacts have not been well studied, despite some efforts to do so. A big reason is the lack of a baseline. While most adults get regular bloodwork, perhaps an EKG, and quickly notice changes in their digestion, energy level, exercise performance, and pain levels, that’s not true for cognitive function, save for individuals being watched for dementia or other at-risk situations.
Nevertheless, studies have found post-Covid-era changes in behavior across the population, such as an increase in road rage. One study attributed that change not to the disease but the effects of lockdowns, work-from-home, greater substance abuse, and multitasking.
A later large-scale study using UK REACT participants, published in the New England Journal of Medicine, found small but measurable mental deficits among those who had suffered mild cases:
Participants were asked to perform an innovative online cognitive assessment on the Cognitron platform, which comprises tasks that can detect subtle changes in different aspects of their brain function, such as memory, reasoning, executive function, attention and impulsivity.
The study examined factors contributing to cognitive deficits in very fine detail while controlling for population variables such as age, demographics and pre-existing medical conditions.
Cognitive findingsThe study revealed small cognitive deficits that were still detectable a year or more after infection, even in people who had short duration illness. They were larger for people who had symptoms lasting 12 weeks or more (consistent with long Covid), those who had been to hospital for their illness or those who were infected with one of the early variants of the virus.
People who had longer lasting symptoms but whose symptoms had gone by the time they did the cognitive assessment showed small deficits that were similar to those of people who had a shorter duration illness.
The results showed that Covid‐19 was associated with deficits in multiple areas of cognition, most notably in memory, such as the ability to remember pictures of objects that were viewed a few minutes earlier. The researchers believe this may be due to problems forming new memories rather than accelerated forgetting. People also showed small deficits in some tasks testing executive and reasoning abilities, such as those that require spatial planning or verbal reasoning.
A 2023 Lancet study profiled “post-COVID cognitive dysfunction.” From its “Current status of epidemiology” section:
A recent two-year retrospective cohort study including over one million COVID-19 patients found that the risk of cognitive deficit was higher than that in matched controls at six months, with a hazard ratio of 1.36 (1.33–1.39), and that the risk remained higher at the end of the two-year follow-up period. Another longitudinal cohort study in China including 3233 COVID-19 survivors reported that severe COVID-19 was associated with higher risks of early-onset cognitive decline (six months after discharge), late-onset cognitive decline (12 months after discharge), and progressive cognitive decline than in controls, with an odds ratio (OR) of 4.87 (3.30–7.20), 7.58 (3.58–16.03) and 19.00 (9.14–39.51), respectively. Non-severe COVID-19 was associated with a higher risk of early onset cognitive decline, with an OR of 1.71 (1.30–2.27). The increased risk of cognitive impairment, seizures, dementia, psychosis, and other neurocognitive conditions persisted for at least two years.
Note that these studies did not seem to be testing for fine-grained changes as the REACT study did.
Some studies cited deterioration in spatial reasoning as a Covid effect; one found evidence of possible physical causes. From Molecular Psychiatry:
We aimed to investigate adults at least four months after recovering from mild COVID-19, which were assessed by neuropsychological, ocular and neurological tests, immune markers assay, and by structural MRI and 18FDG-PET neuroimaging to shed light on putative brain changes and clinical correlations. In approximately one-quarter of mild-COVID-19 individuals, we detected a specific visuoconstructive deficit, which was associated with changes in molecular and structural brain imaging, and correlated with upregulation of peripheral immune markers. Our findings provide evidence of neuroinflammatory burden causing cognitive deficit, in an already large and growing fraction of the world population.
With that as an introduction, I’ve been seeing enough of what I call “Covid brain” to be pretty confident it’s a real phenomenon. For instance, people with good general intelligence sometimes seem to have trouble processing what they have been told. There’s more “It goes in one ear and out the other” than usual.
One noteworthy example has been with three individuals, all with backgrounds that say they have had followed detailed protocols before, being given instructions (as in written documentation) for a small set of simple tasks. Each failed to do them, not once, not twice, but at least three times, even when given written correction (as in images of what was wrong and what needed to happen) and sometimes verbal on top of that. These instructions were not difficult yet the need for repeated correction was maddening. It was as if they were having difficulty processing the instructions. And I’ve given the same sort of instructions pre-Covid and never had this happen, not even once.
The procedure most resembles executing a short checklist, the sort of thing you might do when leaving your house in the morning (check you bag to make sure you have certain items, turn out the lights or turn off air con/fans, lock the door…), as in a brief and routine mental catalogue, as opposed to one so long as to be kept in written form.
Have any of you noticed difficulties in colleagues or family members in adapting to new checklists? And is this an issue of fresh memories (as one study above suggested) or might it apply to existing, checklist-driven routines (think flying airplanes or scuba diving as examples). Reader input appreciated.
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As a person of a certain age who self-monitors for slipping into mental decline for himself and – and physical, as well – I must say that it is tough to know which category to place failures in perfection. I can successfully gain more capabilities by actively pushing more exercise on the bike and walking by breaking the long-held habit of letting the current screen-time keep control (and the next screen distraction, and the next…) and just getting outside; and likewise mentally, by breaking habits of noting numbers in units of 6 instead of 2 or 4 and forcing focus when for 70some years I have gotten away by scanning and gleaning.
Is it that I can no longer scan and glean as well, or that I am more interested in my projects, or the peer pressure of delivering for other team members is more important? …or am I noticing and correcting for the effects of a long ago viral attack? As a science guy still running teams, it seems there is not enough data and no real baselines.
But watching and ‘testing’ others, I notice that I can salt data that is remembered well a bit later, then a while later, yet there seems to be more frustration by more self-inflicted lapses in …? …is there more stumbling wrt previous habits? …are there just more interesting rabbit holes they get distracted by? …or is it just good ol’ lack of focus – a problem identified by Sister Anne Joseph and many others too many decades ago wrt me and doubtless many others. …or that clever retro-virus?
Interesting and thanks for the links.
“As a person of a certain age who self-monitors for slipping into mental decline for himself”
This is something I have been wondering for a while: are there procedures to check for one’s mental decline that give an explicit alert before one has reached the point where self-awareness, memory, or reasoning capabilities have declined to such an extent that it is impossible to understand and act upon the results of such tests?
I’ve certainly noticed changes in some peoples behaviour since 2020, but its hard to disentangle the social effects from any neurological impacts.
As an urban cyclist, one thing I’ve definitely noticed is a rise in aggression and lack of care on the roads, although this could be due to changing driving habits (hybrid working has significantly changed travel patterns). When I moved from the south of England back to Ireland some years ago, it was a relief to me that while there are plenty of bad drivers here, I didn’t experience the outright aggression and anger that was the regular lot of the bike commuters life in England. But its definitely changed. Just two weeks ago I was nearly run off a cycle path by an SUV making a lane change. I remonstrated with the driver at the next red light stop and was somewhat taken aback to find that he was a well known left wing politician (he did, to be fair, apologise profusely). Oddly enough, about 5 years ago after falling off my bike (my fault) I was helped to get back on my feet by Mick Wallace, another well known lefty, so I guess it all balances up.
Its hard to judge from colleagues at work as my work has changed substantively in its nature, but I’ve certainly noticed an increase in some types of errors, but its very hard to know whether to attribute this to neurological changes or just work changes. One colleague retired early due to long covid – his neurological damage was very obvious and life changing.
I’ve been thinking about this myself, actually, and I think the common denominator is speed (both cars and bikes). Speed in itself makes angry, dangerous and reckless. Slowness makes for happy and care. Obviously, speed increases heart rate, does danger release testosterone too?
As a driver and a rider I’ve noticed a rise in people making bad decisions, a decrease in situational awareness and simple logic. If COVID is slowing brains down, then slow brain + speed seems to be exacerbating the bad decisions. I think even before COVID people came built with a certain CPU processor speed and riding or driving fast was overwhelming that processing time. Now that CPU processing speed is degrading too.
And for work-related tasks too. People are taking longer and doing things badly, but yes, hard to say if that’s due to COVID or just general giving up on life, no longer caring, the world is going to hell sort of thing, or both, or neither.
Does it mean that COVID-19 is similar to accelerated aging (people are no longer quick-witted, take more time to process information, are slower to do things, become forgetful), or is it a different kind of degradation (such as becoming insane or demented)?
In my experience, the former. Memory-based tasks (unless muscle-memory from childhood etc) are less reliable. I don’t think I’m becoming insane or demented (!)
Though you guys can judge that. I have good days when I can interact for hours on here….then it’s as if I’ve exhausted my mental reserve and get 2 bad days. If you lot watch my interactions by day you could probably spot the two for me anyway.
“…The researchers believe this may be due to problems forming new memories rather than accelerated forgetting. People also showed small deficits in some tasks testing executive and reasoning abilities, such as those that require spatial planning or verbal reasoning.” All these functions depend upon efficient access to inner language or word finding/retrieval. Efficient inner language of this kind, verbal mediation, is needed to capture and hold onto information especially when there is a lot of it and when the individual can’t control the rate of intake. Slowed word finding is the most common outcome of any kind of stressor on the brain such as trauma, aging, learning disabilities, emotional stress…
No, not everyone forms memories verbally. One of my brothers, who has a freakishly good memory does not. And the tasks here have a significant visual component, as in finding and using certain data entry fields.
I’m a participant in the REACT study and this hit HARD. In the latest round – a fortnight ago whilst I was in the midst of my latest Long COVID flare-up (and I am on antibiotics for an opportunistic infection which followed) – I did the latest online cognitive test.
I spotted all the things I had been trained when “on the other side of the screen”. On various psychological/neurological criteria it quoted “you are in the 80% percentile” (or whatever). Back when I was naive and realised my surveys could quote every respondent’s percentiles I was rightly taken down a peg or two: do you want to tell someone who might be emotionally vulnerable that they’re in the bottom percentile? Lesson learnt.
The compromise was that anybody doing badly – the exact “level” in terms of “below THIS percentile” can vary – does NOT get quoted back to them their percentile or decile. The research program simply say you’re in the “bottom half of the distribution”. It is, as they say in poker, a “tell”. My memory scores were all all “in the bottom half of the distribution” so I KNEW I’d done really badly. Gut punch. Now whilst regulars on here know I am not afraid to give out info re my health, THIS was something I didn’t know whether I should tell anyone.
But I told my GP and have a referral (finally) to a Long COVID clinic. Partly because they actually have longitudinal data relating my deterioration to all my infections and suspected infections. However, I do spot all sorts of obviously COVID-related changes in behaviour that are neuropsychological in nature. It is frigthening for society in general. As well as for me in terms of what my actual results were on those <50% dimensions actually were. I made my former career on "my brain" – to find it is failing is very very scary. I'll stop there cause I don't feel able to write more…..
ZOMG I am so so sorry!!! Aieee!
Thanks Yves. This afternoon has witnessed more developments. There is clearly STILL a long COVID clinic serice you can be referred to…..but you must jump through hoops.
Yesterday I had to see the nurse, have my sitting and standing BP taken (though my psychiatrist has been doing this for WEEKS now in clinic ….. but of course GPs don’t GAF). The classic picture showed: “Normal BP on sitting; the drop in BP on standing is right on the border for problems here. Coulda told you that the time I jumped up thinking mum had fallen and then *I* promptly fell down the stairs because I briefly lost consciousness due to hypotension.
Anyway according to the NHS App the referral has been done……though after an excruciating process of recreating a Microsoft account (Which I’d been avoiding because, you know, it is MS) and of course the docs all use MS (sigh) I looked at the letter……it has no info in any of the fields……weird…..either I’m not being shown the true letter (medics in the UK have the right to keep their “secondary” letters private which you as a patient will NEVER get to see. Anyone who says otherwise is lying and med docs claim that under new transparency rules you must see EVERYTHING – *cough* no, and there are good reasons why clinically a patient should NOT see a letter, but to use that simplistic defence just makes me hate my primary carers even more for BSing me).
Anyway, I now must chase up WHAT is happening regarding the Long COVID referral. It’s funny in a dark way….the GP who saw me was the senior partner who last saw me 3 years ago. She knew EVERYTHING about me, suggesting she’d done a load of homework…..which doesn’t surprise me. Our last interaction led to her practice being hauled in front of the General Medical Council for misconduct and she was told to sack the GP who dealt with me. Ironically this was NOT me whistle blowing – been there, NEVER going to to do it again. It was the local HOSPITAL who reported them – an incredibly bolshy German specialist working Boxing day about 3 or 4 years ago was horrified (annoyed Germans can be a force for good!). She blew the whistle and I reluctantly had to provide facts. The senior partner at my practice clearly now adopts a “don’t mess with Terry” policy. Well, if it works………we’ll see how things play out.
Just had phonecall. Amazing how fast the NHS CAN work under certain conditions.
I suspect the condition was “don’t eff with this guy”. I have a consultation next week. Fingers crossed but in meantime since I’m very much in brain fog mode I probably won’t/shouldn’t post.
Terry, I’m sorry to hear this. A question in my mind is about these flares. Long Covid has flare-ups, I have not had Covid, but I have MCAD (Mast Cell Activation Disorder) and Ehler’s Danlos, both of which are genetic, but both got progressively worse starting in 2018 and I have flares. I’m 77 years old. CFS/ME patients also have flares. Mono, caused by Epstein-Barr, can also flare up later in life.
I think we might make progress on all of these conditions if we understood what these flares are all about. Is there some reservoir of virus that surges on and off? Does a virus retreat back into the nervous system and then return under conditions of stress in the same manner as herpes simplex does when it causes cold sores?
Thanks. This actually ties into a story a couple of oldies are probably bored of hearing. Believe it or not I had Mono (or “Glandular fever” as we called it in UK) at about age 30. I was a “late stage” guy when it came to the kissing/etc disease.
I had the symptoms during a period in my postdoc when I could work at home and largely hide how ill I was…..plus it was gonna be 28 days before I could see a GP. By the time that date approached I was on the mend so cancelled.
Fast forward to 2010 when I’d moved across the world to Sydney and was ill. They tested various things and asked “When did you have mono?” I replied “never”. They said “your antibodies say otherwise”. Penny drops.
My Aussie docs were always suspicious I had flare-ups of the Epstein-Barr Virus but had not studies to back them up. Now I’m thinking “hmm is THIS enough evidence for you?”. Because I do not have HIV or other nasties and various doctors have confirmed that their preconceptions about “things I might have that make me vulnerable to flare-ups simply are not there…….except COVID”.
Thanks for the input. Given me lots to think about.
Proteins are a problem.
We need amino acids that make up the long chain proteins.
Clots and spikes are proteins.
The solution to these is enzymes that cut up the long into the short. Serrapeptase, Nattokinase, Bromelain, Papain, Lumbrokinase and many others are cheap.
Ambulances may carry more expensive enzymes for amelioration of ischaemic stroke.
When I go shopping, I must have a shopping list, and even with that I will forget stuff. I am forever making lists of things I have to remember, and when I am cooking from a recipe then I will have to check many times if I haven’t forgotten anything…
“Have any of you noticed difficulties in colleagues or family members in adapting to new checklists? And is this an issue of fresh memories (as one study above suggested) or might it apply to existing, checklist-driven routines (think flying airplanes or scuba diving as examples).”
Two years ago this month a good friend crashed his plane a few hundred yards short of the runway on a perfectly clear morning. He and his dog were killed instantly. He was the most physically competent person I have known, a Navy SEAL who was medically retired due to a leg injury (surgically repaired) acquired in combat. He published two bestsellers. He had several thousand hours as a pilot in fixed-wing aircraft and helicopters and was a stalwart Angel Flight pilot. Another few hundred parachute jumps, all without incident. He had a particularly nasty bout with COVID-19 in the first wave. I am convinced the crash was caused by some kind of spatio-mental impairment. I suppose “pilot error” as been found to be the cause of the accident. I have no desire to look.
Another casualty of the “let ‘er rip for herd immunity” recommendation of the current Director of the National Institutes of Health…the first such Director who is not a physician and/or biomedical scientist. Nothing to see here, move along.
This totally resonates. I care for mum (in her early 80s) and Dad still has to work (mid 70s). They both show marked changes that date from 2020. Mum is harder to diagnose due to previous medical conditions but Dad admits (when feeling honest) to mistakes that have come on rather suddenly. He relies a lot more on lists etc to ensure he can run his business.
Dad’s “existing check-list routines” are no longer at his fingertips. And this is SUDDEN. They used to be things in his working memory and now must be written down. Thankfully he can still drive, do his job, run his business, but he has had to make a much bigger effort to document stuff to ensure he remembers everything properly.
He drives well, generally and in an example of tech helping us (gosh!) his dashcam has both helped him not contribute to multiple pile-ups on motorways but also has documented the INSANE behaviour that is increasingly common on UK roads. He was very dismissive of my COVID worries in 2020. Not so now. Indeed all those “posh” people in London insist he masks up before he enters their property. Interesting, eh? He’s just lucky that the material he uses for Shojis turned out to be the key layer in masks and he has a supply of them. He also refuses to go near to mum at the moment because she clearly has a chest infection. Suddenly he’s all “I don’t want my health risked”. Again, interesting.
I’ll try to be concise – background to establish my baseline. 63 years old – own/manage 2 small businesses that I’m about to close as I simply can’t perform at a professional level anymore.
Steered a small (49 person) design build firm through the GFC in 2008 and managed to grow the biz from 3M to 9.5M annually (revenue) between 2006 and 2011. Residential work, carpenters, architects and a custom cabinet shop. Some amazing work (hindsight, superfluous – full sized underground basketball court with tunnel to house, indoor pool opening to outside waterfall, etc., etc.) – north suburbs of Chicago. Intense and complex work environment.
COVID in January of 2022 – omicron wave. Very mild symptoms – developed an all over body rash immediately. Started cancelling client meetings when I started slurring my words so badly that I was embarrassed to meet with people. Except, none of my coworkers could hear it – it was entirely in my head. Staggering loss of vocabulary. Right arm asleep for 18 months, still have the rash today. Doctor’s response (typical) was “I’m not sure” and one that said “if I didn’t learn about it in med school, it doesn’t exist”. Brain MRI’s show large areas of white matter but neurologists unable to commit. Massive gaslighting. Custom medications with zero response. Finally found a concerned doc (bless you Octavia) only to have her burn out and retreat to a small, private practice – me not included. Participated in the infamous billion dollar RECOVER study – a short story in and of itself. Long story long, almost total memory failure. Can not multitask anymore – fatal in a small biz. Can not survive without notes that I never needed before. My son Miles (freshman at the university of illinois – merit program) was captain of his high school hockey team. We travelled all over as he played growing up – but I couldn’t find the ice rink 6 miles from home – that I had been to a hundred times – without asking my patient wife for directions as I drove. The only thing I have managed to do is to learn to cope – to adjust to a new person that isn’t me. I use the concept of grace with myself (and others) when I get frustrated. My symptoms have moderated (still have that rash tho) but I am different. And as this commentariat must be wondering, how many people have had cognitive changes that they’re too stubborn to admit ?
Sorry you’re going through all of that, it sounds absolutely terrible to deal with. Have you enrolled in any local studies? I’m no doctor but it seems like there has been some success with anti-viral therapies similar to HIV treatment in China, and I’ve seen some suggestions that drugs like metformin can help as well.
alrhundi, thank you for the kind words of support/encouragement. honestly, one of the most challenging aspects of a cognitive issue is that the sense of being overwhelmed at times is all that can be managed. i don’t know of any local studies – there was a time when i looked for them and perhaps i’ll look again. there are parallels to the ageing process and, responding to an earlier comment, there definitely seems to be an issue with flare ups – hence the modification of behavior. it is simply easier to remove myself from aspects of my life that no longer hold as much promise as they used to.
As an otherwise healthy 31-year-old, after having COVID once, I had serious brain fog for at least a month. It is still hard to determine what aspects of cognition decline were due to poor sleep, stress, or sickness. I have a feeling we will all have a better idea 20 years from now. I hope it isn’t as bad as we worry.
I have not noticed the checklist problem, but I intentionally put myself in a situation where I am not responsible for noticing whether others follow instructions. My past life experience has generally been that people simply do not follow a list of instructions in an email, for example. They pick out something from the list they wanted to do anyway and ignore the rest.
My husband and I both have had disabling Long Covid since 2021. The kind of brain fog difficulty described here is typical for us. For example, whenever we step out of the house or after going to the gym or somehwere, we have to count to check the number of items we must make sure we have with us. It’s a basic 5 count: wallet, keys, cell phone, glasses, face mask (just now it took me a few moments to remember all 5). Often I have to repeat the count 2 or 3 times. And very often we forget one item. He or I have walked all the way to the subway only to realize we are missing our wallet; or returned home from the gym only to realize we left our keys in the locker room (luckily someone turned them in). It’s very taxing. And that’s with simple lists of tasks to complete.
Doesn’t answer your question regarding checklists, but it seems to me over the last couple of years there have been more and more horrific traffic accidents on the highways near me.
Sort of related; the “Look both ways” jingle we were taught as school children has now become: “Look right, look left, look right again, look left again. Take the average of remembered observations. Proceed ahead, or not. When in doubt, repeat list of actions.”
Yeah. We are being forced into a world where a bunch of simple rules, which generally will suffiice, cannot possibly work now due to the total “we will do what we want…….move fast and break things,,,,,etc” philosophy is The Thing. Looking right and left? Nah.Old school.
You must be a PC enabled to anticipate all stuff.
I don’t wish harm on anyone but it’d have been interesting if all the big trillionaires had been on that Titan “submersible”. Just a thought experiment…..
Maybe not related, but twice I’ve had support staff at a brokerage totally ghost a scheduled time or not complete a request that I submitted. Impossible to know if this is just short staffing, or any number of other things.
I so rarely interact with people, I mostly only hear of this from studies. I do still see stuff like coworkers having multi-month long coughs, webinars and meetings canceled due to illness, and people generally talking about being out sick or not feeling well or their kids being sick, again.
This was not a thing I ever saw prior to 2020, really 2022 when Biden told everyone it was over.
I’ve actually not had COVID yet to my knowledge, but when writing comments I often find I actually typed random words. I’m not sure if this is a legacy of using Swype on my phone and not really thinking in entire words anymore, or if I’m actually losing my ability to write coherent sentences. Definitely mind bending to experience. And my spelling was already not amazing, and spell check kind of nuked learning how to spell words correctly 25 years ago, so whatever I knew then I know now. And that’s it I think.
My best wishes to anyone experiencing cognitive decline!
When there is a new deficit or difference in cognition, or how (or if) memories form, we still expect our brains to work like they used to. So, impacts can be amplified by habitual expectations, or mitigated by awareness and adapting – which can require a tough journey of acceptance.