Category Archives: COVID-19

The Cognitive Complications of COVID-19

At this time, the long-term complications of COVID-19 remain unknown although there is evidence of changes aside from acute symptoms referred to as “long COVID.” Several case studies have reported neurological problems in severely affected COVID-19 patients – such complications may arise from associated stroke, inflammatory syndrome, immune responses, and other health factors.

Currently, there is little clinical information concerning the nature and prevalence of cognitive consequences post-COVID infection, the full spectrum of their severity, or the connection between hospitalization status. Emerging evidence points to potential cognitive deficits associated with the virus, revealing significant brain function impacts in the worst cases of infection, according to a recent non-peer-reviewed study.

Cognitive Performance in COVID-19 Survivors

Led by Imperial College London doctor, Adam Hampshire, the study encompassed a cohort of over 84,000 participants who performed cognitive tests aimed at assessing brain performance, including word recall and puzzles. Data for analysis was gathered from the Great British Intelligence Test. The research team controlled results for age, gender, education level, income, racial-ethnic group, and pre-existing medical conditions.

The study revealed that participants who recovered from suspected or confirmed COVID-19 performed worse on cognitive tests in multiple domains than expected given their age and demographic profiles. Observed cognitive defects were of “substantial effect size,” especially among individuals who had been hospitalized with COVID-19. Furthermore, deficits scaled with symptom severity with the worst cases of illness showing a cognitive impact equivalent to a 10-year decline in global performance in patients aged between 20 and 70 years.

“Our analyses … align with the view that there are chronic cognitive consequences of having COVID-19,” the researchers wrote in a report of their findings. “People who had recovered, including those no longer reporting symptoms, exhibited significant cognitive deficits.”

Study Limitations

Hampshire and his team’s results are worrisome, however, their findings are yet to be reviewed by other researchers. Experts warn that the latest results should be interpreted with caution as the cognitive health of participants pre-COVID infection was not known or accounted for in the study. In addition, the study’s findings do not reflect long-term recovery, indicating that the cognitive effects may only be present for the short term. Study’s findings can not be entirely reliable as they do not compare before and after scores, involved a large number of people who self-reported having COVID-19 with no positive test measure

Nonetheless, the latest study alongside other emerging research on the potential cognitive repercussions of COVID-19 illness add to a growing list of concerns. While current literature signals potential for cognitive complications, it warrants further investigation and understanding of the duration of such cognitive deficits. Forthcoming studies should aim to identify the extent to which cognition is affected after infection and whether permanent neurological damage to brain function is possible.

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Seasonal Depression Risk at All-Time High During Pandemic Winter

As many studies have already reported, rates of mental illness symptoms in the population have been rising throughout 2020 due to social distancing measures, increased isolation, and a general upheaval of normal life due to the COVID-19 pandemic. For this reason, the prevalence of seasonal affective disorder (SAD) is also projected to reach an all-time high in the forthcoming months as surges in virus cases coincide with declining options for activities as colder weather encroaches. Alongside the widespread, multi-faceted devastation caused by the pandemic, political concerns and social unrest leave the American population increasingly vulnerable to SAD this fall/winter season.

Seasonal Affective Disorder 

According to current estimates, approximately 5% of Americans experience seasonal depression which usually begins during transitions from the summer to fall and fall to winter.

The onset of colder weather and decreased sunlight exposure contribute to a biochemical imbalance in the brain characterized by lowered serotonin levels and altered circadian rhythms. Common symptoms include sadness, loss of interest in activities, changes in appetite or eating patterns, changes in sleep, and loss of energy. The condition typically lasts for approximately 40% of the year although, in some patients it can last even longer.

Seasonal affective disorder is more common among women, young adults, those living further from the equator, as well as those with a personal or family history of depression. Nonetheless, the current environment is not conducive to overall wellbeing, putting more individuals at risk for depression even if they have never experienced mental health concerns before.

SAD Amid COVID-19 Restrictions

The symptoms of seasonal depression are likely to be exacerbated by pandemic conditions across the world as the number of activities decreases and feelings of isolation, compounded by stress and anxiety, increase across populations and age groups. Protective measures against COVID-19, including the closure of many business and limited social contact, contribute not only to declining in-person interactions but also growing financial burden. The lack of physical mobility, reduction in activities, and persisting threat of the novel coronavirus greatly heighten the risk for mental health symptoms in the population.

“There’s less activity, there’s less socialization, there are less mastery activities, there are less pleasurable activities, so in general there is an increase in depression, not to mention job losses and losses of people,” Dr. Lata McGinn, co-founder of Cognitive and Behavioral Consultants told USA Today in a recent article.

Therapeutic Options

It is paramount to find safe ways to socialize and remain active throughout the coming fall/winter season. Individuals are encouraged to maintain a strong support system of family and friends with frequent video and phone calls, socially-distanced visits, and other safe interactions. Experts recommend keeping a consistent exercise routine, which can greatly benefit mental health while also increasing overall emotional and physical wellbeing. Despite the cold, it is important to continue spending time outdoors for sunlight and fresh air exposure in a safe way.

Another potential therapeutic option recommended by psychologists is light therapy, which can be used indoors to mimic sunlight exposure. Daily treatment involves approximately 20 minutes of exposure to the light throughout the winter months with improvements seen between 1-2 weeks after initiating treatment.

In addition, experts recommend pursuing an “activity diet” focused on learning and building new skills – such as studying a new language – in order to derive a sense of accomplishment. CNN outlines several other helpful options and ideas for combating seasonal depression symptoms during this time, including journaling and other meditative practices. 

However, some patients may need to undertake more aggressive treatment measures to improve their seasonal depression symptoms. Talk therapy and cognitive behavioral therapy can effectively treat SAD as can antidepressant medications, such as selective serotonin reuptake inhibitors (SSRIs). With the rise of telemedicine, there has also been an increase in available options for virtual psychologist and psychiatrist visits bringing mental health support to patients in the comfort of their own home.

Although the National Institute of Health does not recommend diagnosing seasonal affective disorder until symptoms are experienced for two or more consecutive years, if symptoms begin to negatively affect daily functioning individuals are urged to seek professional support. As per the American Psychiatric Association, “anyone feeling severe symptoms of depression or suicidal thoughts to contact a doctor immediately or seek help at the closest emergency room. The National Suicide Prevention Lifeline can be reached at 800-273-TALK (8255) or via online chat.

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Estrogen & COVID-19 Severity in Women

Growing clinical evidence reveals that the intensity of COVID-19 infection and incidence of related complications are more prominent in male patients. Current data suggests that men experience a greater risk than women for more severe COVID-19 symptoms and poorer outcomes regardless of their age. These burgeoning findings signal that sex may function as a determinant of COVID-19 infection severity.

While the body of evidence examining sex differences in virus outcomes is lacking, researchers believe the functional modulation of angiotensin-converting enzyme 2 by estrogen may explain disparities in morbidity and mortality. Further reasons for higher male sex-specific COVID-19-related mortality are likely multi-fold and may include lifestyle differences such as higher rates of tobacco smoking and alcohol consumption as well as innate immunity. The mounting evidence suggesting sex-based differences in clinical outcomes emphasizes the need for an assessment of sex-specific hormone activity – in particular, estrogen – in COVID-19 pathogenesis.

Sex-Specific Differences in COVID-19 Outcomes 

A recent study conducted by researchers at the Wake Forest Baptist Medical Center attempts to elucidate the mechanisms underlying these notable differences. Led by Leanne Groban, MD, professor of anesthesiology at Wake Forest School of Medicine, a team of researchers conducted a review of published literature to determine whether sex plays a role in COVID-19 outcomes by examining pre-clinical data on sex-specific hormone activity.

Beneficial Impact of Estrogen

The study’s authors reported that angiotensin-converting enzyme 2 – attached to cell membranes in heart, arteries, kidneys, and intestines – acts as a cellular receptor of the coronavirus responsible for COVID-19 infections and helps the virus gain access to cells of those organ systems. According to the researchers, their review also pointed to estrogen’s impact on ACE2 levels in the heart; the hormone lowered ACE2 levels. This may modulate the severity of COVID-19 in women, while higher levels of ACE2 present in tissues could account for why the disease presents worse in men.

“We know that coronavirus affects the heart and we know that estrogen is protective against cardiovascular disease in women, so the most likely explanation seemed to be hormonal differences between the sexes,” said the lead author of the review, Dr. Groban told ScienceDaily in an interview.

“We hope that our review regarding the role of estrogenic hormones in ACE2 expression and regulation may explain the gender differences in COVID-19 infection and outcomes and serve as a guide for current treatment and the development of new therapies,” Groban said.

An enhanced understanding of the role of estrogenic hormones in ACE2 expression and regulation may not only help uncover potential mechanisms that explain sex differences in COVID-19 clinical outcomes, but also guide future disease management techniques and spur the discovery of novel therapeutic methods.

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