New York Medical College Researchers Find Clear Evidence of Long-term Neuropsychiatric Issues in Patients Recovered from COVID-19
Patients complaining of ‘brain fog’ post-COVID-19 should be taken seriously
Respiratory, cardiac, gastrointestinal, neuropsychiatric and other symptoms persisting for months after infection with COVID-19 have given rise to the term “long COVID.” A new study by New York Medical College (NYMC) and Westchester Medical Center Health System (WMC Health) researchers has found persistent neuropsychiatric issues—diminished focus, forgetfulness and difficulty making decisions and multitasking—still present in some patients months after recovering from acute COVID-19 infection. The study, which was recently published in the Journal of the Academy of Consultation-Liaison Psychiatry, was conducted by a team of researchers made up of NYMC faculty, residents and students.
“Brain fog is a term that has been heard a lot recently. You have patients saying, ‘My thinking is fuzzy. I can't remember things. I have words on the tip of my tongue, but I can't think of them. I'm tired all the time.’ Prior studies indicate that when you test these patients with a neuropsychological testing battery, they really don't show significant deficits and are more likely to be anxious and depressed,” said Stephen Ferrando, M.D., the Har Esh Professor and Chairman of the Department of Psychiatry and Behavioral Sciences, who lead authored the study. “However, in the neuropsychological testing we conducted, we found that many of these individuals were in fact not thinking clearly, and it was not just about depression or medical comorbidities but something that the virus was doing in the brain that leads to residual cognitive problems. So, the takeaway message is that for patients who are complaining of post-COVID cognitive issues, there may very well be something there. These complaints are not imagined. They are not psychosomatic, and they need to be taken seriously.”
For the study, 60 participants underwent neuropsychological, psychiatric, medical, functional and quality-of-life assessments six to eight months after suffering from COVID-19. Those participants seeking care for cognitive complaints were compared with participants who were not seeking care for cognitive issues.
“One unique aspect of our study was that unlike other studies that were conducted online, we conducted this very detailed assessment in person,” said Dr. Ferrando. “Even during the height of the pandemic, we were seeing people face to face and testing them.”
After conducting an assessment battery of neuropsychological function that examined the ability to remember things, to focus, to think abstractly, to plan and organize, as well as psychiatric measures, the research team found differences between the two groups of participants that were both statistically and clinically significant. Those individuals seeking care for cognitive complaints and other post-COVID19 symptoms had diminished performance in multiple neurocognitive areas relative to age- and education-adjusted norms that were not present in the nonclinical group, including diminished attention, processing speed, memory and executive function. The clinical group also had high levels of clinically significant depression and fatigue and an overall diminished quality of life.
“Another somewhat novel aspect to our study is that the vast majority of the participants were not hospitalized. Our sample was primarily ambulatory,” said Dr. Ferrando. “And while we found that these types of cognitive problems are definitely correlated to how sick they were when they had COVID-19 (some described their illness as the ‘the worst flu they ever had’ for instance) none of these people were in the ICU.”
Though their first research study on the topic is just newly published, Dr. Ferrando and his team of researchers are already well along on further research with the same cohort. “I think the biggest next step is longitudinal,” said Dr. Ferrando. “We are now looking at whether these individuals have improved or not, and if not why? What are some predictors? In terms of their vaccination status, has that helped or hindered? We can also now look at work functioning, which is very important, because a lot of people took substantial time off work but are now back at work, and they're struggling.”
“Overall, for our group of researchers, for our Department, it has been a great interdisciplinary collaboration. We've engaged NYMC and WMC Health, the Departments of Psychiatry and Internal Medicine, medical students, residents and faculty in this important research. It's really been a collaborative effort from top to bottom and I look forward to more important research outcomes in the future as a result.”