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brain fog

not really a true medical term [6] Etiology: - most common neurological symptom of long COVID-19 - commonly reported 7.6 months after COVID-19 - more common among hospitalized [2] - underactive thyroid preceding hypothyroidism [2] - breast implants - breast cancer therapy - brain injury [6] - dementia [6] - brain infection [6] Clinical manifestations: - short-term memory loss - memory encoding 24% - memory recall 23% - dysphasia - word-finding difficulty or speech difficulty, communication difficulty - category fluency 20% - processing speed 18% - executive function 16% - inattention - confusion - dissociative phenomena - feeling that their brain is lost in a maze [6] - fuzziness or pressure - fatigue [4] - feeling sluggish [6] - symptoms may persist for weeks, months or years after Covid-19 infection [6] Special laboratory: - formal cognitive testing [6] Management: - guanfacine: start 1 mg PO QHS, increase to 2 mg QHS after 1 month + N-acetylcysteine 600 mg daily [5] - cognitive behavioral therapy - sleep hygiene [6] - exercise [6] - minimize stress, prioritize emotional health [6] - prevention - Covid-19 vaccines reduce risk [6] - treatment of Covid-19 with Paxlovid reduces risk [6] - avoid getting COVID-19 again [6]

General

neurologic sign/symptom; neurologic deficit

References

  1. Walker M Clinicians Struggle to Make Sense of 'Long COVID' - No correlation with clinical severity of illness, and some symptoms may be entirely new. MedPage Today January 29, 2021 https://www.medpagetoday.com/infectiousdisease/covid19/90959
  2. Monaco K Patients With Underactive Thyroid Report Pervasive Brain Fog. Many said they had symptoms well before a hypothyroidism diagnosis. MedPage Today May 30, 2021 https://www.medpagetoday.com/meetingcoverage/aace/92854 - Ettleson M, et al Seeing through the fog: characterizing "brain fog" in those treated for hypothyroidism. American Association of Clinical Endocrinology (AACE) 2021.
  3. George J Brain Fog After COVID-19 May Last Longer Than We Think. Relatively young people wrestle with cognitive dysfunction for months. MedPage Today October 22, 2021 https://www.medpagetoday.com/neurology/generalneurology/95198 - Becker JH, Lin JJ, Doernberg M et al Assessment of Cognitive Function in Patients After COVID-19 Infection. JAMA Netw Open. 2021;4(10):e2130645. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2785388
  4. McWhirter L, Smyth H, Hoeritzauer I et al What is brain fog? J Neurol Neurosurg Psychiatr 2022. Dec 6, https://jnnp.bmj.com/content/early/2022/12/06/jnnp-2022-329683
  5. Fesharaki-Zadeh A, Lowe N, Arnsten AFT Clinical experience with the alpha-2A adrenoceptor agonist, guanfacine, & N-acetylcysteine for the treatment of cognitive deficits in "long Covid-19" Neuroimmunology Reports. 2023. 3
  6. Berg S What doctors wish patients knew about long COVID-19 brain fog. American Medical Association. AMA News Wire. Feb 17, 2023 https://www.ama-assn.org/delivering-care/public-health/what-doctors-wish-patients-knew-about-long-covid-19-brain-fog