Brain Fog: a Narrative Review of the Most Common Mysterious Cognitive Disorder in COVID-19

Aghajani Mir, Mahsa

doi:10.1007/s12035-023-03715-y

Cited by 10 publications

(3 citation statements)

References 149 publications

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“…Both neurological as well as non-neurological symptoms persist after subsidence of the infection in a considerable number of patients, a syndrome known as post acute sequelae of COVID-19 (PASC), or simply post-COVID or long-COVID (Goldstein, 2024; Nalbandian et al, 2021; Song et al, 2021; Steardo, Steardo, Verkhratsky, & Scuderi, 2021). Recent investigations found an increased risk of incident neurological sequelae such as stroke, migraine, seizures, mental health disorders, Guillain-Barre syndrome and encephalitis in long-COVID patients and late effects of COVID-19 may become a major health issue in the future (Aghajani Mir, 2023; Brown et al, 2023). Therefore, understanding the molecular and cellular consequences of the viral infection within the central nervous system is inevitable to develop treatment of long-COVID.…”

Section: Introductionmentioning

confidence: 99%

Microgliosis, astrogliosis and loss of aquaporin-4 polarity in frontal cortex of COVID-19 patients

Beiersdorfer,

Rotermund,

Schulz

et al. 2024

Preprint

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The severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2), causing human coronavirus disease 2019 (COVID-19), not only affects the respiratory tract, but also impacts other organs including the brain. A considerable number of COVID-19 patients develop neuropsychiatric symptoms that may linger for weeks and months and contribute to “long-COVID”. While the neurological symptoms of COVID-19 are well described, the cellular mechanisms of neurologic disorders attributed to the infection are still enigmatic. Here, we studied the effect of an infection with SARS-CoV-2 on the structure and expression of marker proteins of astrocytes and microglial cells in the frontal cortex of patients who died from COVID-19 in comparison to non-COVID-19 controls. Most of COVID-19 patients had microglial cells with retracted processes and rounded and enlarged cell bodies in both gray and white matter, as visualized by anti-Iba1 staining and confocal fluorescence microscopy. In addition, gray matter astrocytes in COVID-19 patients were frequently labeled by intense anti-GFAP staining, whereas in non-COVID-19 controls, most gray matter astrocytes expressed little GFAP. The most striking difference between astrocytes in COVID-19 patients and controls was found by anti-aquaporin-4 (AQP4) staining. In COVID-19 patients, a large number of gray matter astrocytes showed an increase in AQP4. In addition, AQP4 polarity was lost and AQP4 covered the entire cell, including the cell body and all cell processes, while in controls, AQP4 immunostaining was mainly detected in endfeet around blood vessels and did not visualize the cell body. In summary, our data suggest neuroinflammation upon SARS-CoV-2 infection including microgliosis and astrogliosis, including loss of AQP4 polarity.

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Section: Introductionmentioning

confidence: 99%

Microgliosis, astrogliosis and loss of aquaporin-4 polarity in frontal cortex of COVID-19 patients

Beiersdorfer,

Rotermund,

Schulz

et al. 2024

Preprint

View full text Add to dashboard Cite

show abstract

Section: Introductionmentioning

confidence: 99%

“…Brain fog is a term used to describe individuals’ experiences when their cognitive functions are not as sharp as usual [ 1 , 2 ]. This condition is characterized by mental fatigue, memory loss, confusion, anxiety, decreased concentration, tiredness, injury, and impaired cognitive functions [ 2 , 3 , 4 ]. Although brain fog is generally known as a long-term symptom of COVID-19 [ 5 ], it can also be caused by other diseases such as chronic fatigue syndrome [ 6 ], cancer [ 7 ], celiac disease [ 8 ], systemic lupus erythematosus [ 9 ], hypoparathyroidism [ 10 ], and postural tachycardia syndrome [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

Adaptation and Validation of the Turkish Version of the Brain Fog Scale

Bas,

Kahriman,

Gencalp

et al. 2024

IJERPH

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Brain fog is a condition that is characterized by poor concentration, memory loss, decreased cognitive function, and mental fatigue. Although it is generally known as a long-term COVID-19 symptom, brain fog has also been reported to be caused by many other diseases. Thus, it is necessary to assess this condition in certain populations. This study aimed to evaluate the reliability and validity of the Brain Fog Scale in a Turkish population. We conducted the study in two phases. In a pilot study including 125 participants, we confirmed the suitability of the scale for validity analyses and then conducted exploratory (n = 230) and confirmatory factor analyses (n = 343). The Cronbach’s alpha value of the 23-item Brain Fog Scale was 0.966. In addition, the 23-item and three-factor structure was confirmed as a result of the analyses. These three factors are mental fatigue, impaired cognitive acuity, and confusion. We also found that participants previously diagnosed with COVID-19 had higher brain fog scores. This finding indicates that brain fog is an important condition that can accompany COVID-19. Furthermore, this validated construct has an acceptable fit and is a valid and useful tool for the Turkish population.

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Intervention modalities for brain fog caused by long-COVID: systematic review of the literature

Gorenshtein,

Liba,

Leibovitch

et al. 2024

Neurol Sci

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Individuals suffering from long-COVID can present with “brain fog”, which is characterized by a range of cognitive impairments, such as confusion, short-term memory loss, and difficulty concentrating. To date, several potential interventions for brain fog have been considered. Notably, no systematic review has comprehensively discussed the impact of each intervention type on brain fog symptoms. We included studies on adult (aged > 18 years) individuals with proven long- COVID brain-fog symptoms from PubMed, MEDLINE, Central, Scopus, and Embase. A search limit was set for articles published between 01/2020 and 31/12/2023. We excluded studies lacking an objective assessment of brain fog symptoms and patients with preexisting neurological diseases that affected cognition before COVID-19 infection. This review provided relevant information from 17 studies. The rehabilitation studies utilized diverse approaches, leading to a range of outcomes in terms of the effectiveness of the interventions. Six studies described noninvasive brain stimulation, and all showed improvement in cognitive ability. Three studies described hyperbaric oxygen therapy, all of which showed improvements in cognitive assessment tests and brain perfusion. Two studies showed that the use of Palmitoylethanolamide and Luteolin (PEA-LUT) improved cognitive impairment. Noninvasive brain stimulation and hyperbaric oxygen therapy showed promising results in the treatment of brain fog symptoms caused by long-COVID, with improved perfusion and cortical excitability. Furthermore, both rehabilitation strategies and PEA-LUT administration have been associated with improvements in symptoms of brain fog. Future studies should explore combinations of interventions and include longer follow-up periods to assess the long-term effects of these treatments.

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Brain Fog: a Narrative Review of the Most Common Mysterious Cognitive Disorder in COVID-19

Cited by 10 publications

References 149 publications

Microgliosis, astrogliosis and loss of aquaporin-4 polarity in frontal cortex of COVID-19 patients

Microgliosis, astrogliosis and loss of aquaporin-4 polarity in frontal cortex of COVID-19 patients

Adaptation and Validation of the Turkish Version of the Brain Fog Scale

Intervention modalities for brain fog caused by long-COVID: systematic review of the literature

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