There’s the man who used to be so handy around the house, he could repair just about anything.
“But he had a problem with the fence, and he had to call his brother over to help fix it,” says Dr. Jacqueline Rondeau, director of the Montclair Memory Clinic.
And there’s the registered nurse whose memory is suddenly failing her. “She didn’t know what day it was,” Rondeau says. “She’s forgetting a lot of things.”
These new patients were referred to the Montclair Memory Clinic in recent months with one thing in common. They had coronavirus, and now they’re experiencing significant cognitive impairment — the kind more typically seen in someone who is at risk for dementia.
“I have had a handful of post-COVID patients, and they are having serious problems,” says Rondeau, a neuropsychologist who’s been treating people with memory loss for nearly two decades.
“We’re talking about people who were functioning normally (prior to contracting coronavirus), but now they’re not able to function the way they used to,” she says. “There can be neurocognitive impairment. There can be neurobehavioral impairment, or emotional impairment.”
The trend is being seen not just here in New Jersey, but at memory centers around the country and globally. The journal Neurology Today is reporting hundreds of COVID-19 “long-haulers” being treated for cognitive problems at specialty clinics set up in areas hardest hit by the virus.
Experts say it will take years of study to understand how coronavirus affects cognition and how severe or long-lasting the impact might be. But this much we already know: coronavirus is bad for the brain in ways that become immediately apparent in many people who have it.
Somewhere between 40% and 50% of percent of Covid-19 patients develop neurological or psychiatric problems while they are still in the hospital, according to Dr. Robert Stevens, a Johns Hopkins University neurologist.
Worrisome as that is, what concerns scientists even more is the potential that people who’ve had the virus will continue to face cognitive problems long after they go home.
A team of leading specialists spoke to that concern in a paper published in Alzheimer’s Research and Therapy, warning that the virus could result in “potentially very significant” long-term cognitive problems for people who are recovering from it. The evidence strongly suggests survivors of COVID-19 are at higher risk of eventually developing neurological diseases, including Alzheimer’s disease, they say.
“There are indications it could be potentially a big threat,” says Dr. Michael T. Heneka, professor of neurology at the University of Bonn and co-author of the paper. “I’m concerned about patients who are calling in (to the memory clinic) after a very short time, reporting memory problems. They were infected in March, and now suffer from severe memory deficits.”
That is a potential outcome that Rondeau says she saw coming even back in February, as coronavirus was turning into a full-bore global pandemic.
Rondeau, who founded the Montclair Memory Clinic in 2001, had seen instances in the past where a virus similar to COVID-19 led to perplexing cognitive loss in a person who had no previous memory issues. She recalls the case of “Amy,” a well-educated woman in her 40s who was a working mother with a thriving career as a civil engineer.
“This was pre-coronavirus and she had a viral infection that caused brain damage or brain lesions, around 2013,” Rondeau says. “She came into my practice after she had survived the virus. The first stage can be apathy or fatigue. She was an engineer, but she couldn’t get herself up to make breakfast for herself, or take care of her child.”
Amy also lost her sense of smell, a symptom that many people with coronavirus also are experiencing, and showed significant deficits in short-term memory and executive function. She was diagnosed with mild cognitive impairment, a condition that can potentially progress to dementia.
Rondeau says Amy responded to treatment and therapy, and did not go on to develop dementia, but never fully recovered from her short-term memory loss.
That’s what leaves Rondeau and other experts concerned about the cognitive issues now being seen in people who have survived coronavirus.
While researchers try to determine what the long-term impact of coronavirus may be on the brain, the short-term impacts are already well-documented.
Coronavirus patients who are hospitalized exhibit a range of cognitive problems, including headaches, dizziness and brain fog.
In fact, four out of every five patients who end up in the hospital with COVID-19 experienced neurological problems during their illness, based on research done at Northwestern University’s Feinberg School of Medicine.
The study followed more than 500 people admitted to Chicago hospitals during March and April, and found 42% of them complained of some neurological symptoms at the time they first sought care, and 82% had cognitive issues during the time they were under care.
Among the most common symptoms were:
- Headaches
- Encephalopathy, or altered mental function
- Dizziness
- Impaired sense of taste
- Loss of smell
Almost 30% percent of them continued to have cognitive problems even after they were discharged from the hospital.
There are many potential reasons for that, including the effect that being on a ventilator can have on the brain.
“There are studies suggesting that ventilation, as long as it lasts, has a negative influence on cognitive function,” Heneka says. “COVID patients are often ventilated much longer than other patients usually are.”
The trauma of having a major, life-threatening medical condition can leave people functioning at less than their cognitive best, Rondeau adds.
“We know very well the mental health aspect of this, as well as the neurocognitive aspect,” she says. “If a person has been in ICU or hospitalized in general, there’s going to be trauma. There is going to be an acute stress reaction. They have a very strong foundation for anxiety that may develop into PTSD.”
Rondeau says anxiety is the “enemy of the brain,” and when the traumatic impact of a major illness is combined with the neurological damage that a virus can potentially cause, it becomes even more concerning.
“That’s going to affect the brain,” she says. “We know there is muscle weakness and fatigue. We can see difficulty with motivation, with apathy. We know these factors will affect the brain, with or without neural damage, and now we’re looking at neural damage.”
Understanding the nature of that possible damage will take years of study, Heneka says. The effects of coronavirus could exacerbate an existing neurological disease, or represent some “independently new syndrome,” he says.
“We all know Alzheimer’s disease has a 30-year trajectory prior to (the patient showing symptoms),” Heneka says. “It could be that infection with coronavirus accelerates the progression of the disease.
“Another possibility is that COVID-19 results in a novel infection of Alzheimer’s-like pathology,” he says. “It could be an independent cognitive deficit. We just don’t know. This is why we have to study it. We have to follow up for years.”
In the meantime, experts say it is important for coronavirus survivors and their families to watch for signs of cognitive decline.
“Families know their patient best,” says Dr. Douglas Golenbock, chief of the Division of Infectious Diseases and Immunology at the University of Massachusetts Medical School and a co-author of the Heneka paper. “They can tell if there are issues. When they see something that concerns them, they shouldn’t ignore it. Bring the patient to a memory center or neurologist.”
Rondeau says the kinds of symptoms she’s already seeing in people recovering from coronavirus involve a range of cognitive domains.
“Basically, you’ve got problems with attention, with short-term memory and with language as well,” she says. “There are word-finding difficulties, there are problems with fluency in speech. All these areas can be affected. The profile of cognitive deficits may vary depending on the person’s pre-COVID status. This is true for any acute medical condition.”
Rondeau expects to continue to see an influx of coronavirus patients going forward, and encourages families not to wait if they see a loved one who appears to be struggling with memory or emotional problems.
“We are going to have a population of people with some level of disability that may be on the path to cognitive impairment,” she says. “We’re trying to reverse that impact. That’s what you can do with rehabilitation. We are starting to formulate programs.”
She says rehabilitation therapy can help as can improvements in health behaviors. “Once we’ve started some activation therapies and addressing these foundational issues, then we want to educate the family as much as we can,” she says. “I would stress nutrition, hydration and some level of physical activity, whatever they can do initially.”
Rondeau adds that during this time of resurgence in coronavirus cases, it’s as important as ever to put safety and prevention first.
“People need to get tested, and follow the guidelines and wear a mask,” she says. “It’s good for you; it’s good for people around you. We have to be better about sanitizing the environment. If you cough, don’t cough toward someone. We have to make these our habits. It can’t be political. It’s to protect lives, and to protect against the potential for disability.”
Tony Dearing may be reached at tdearing@njadvancemedia.com. Follow him on Twitter @TonyDearing. Find NJ.com on Facebook.