Many people who have recovered from Covid-19 infection are still experiencing cognitive impairment more than seven months later, according to new research.
The study, which describes the the kinds of cognitive problems experienced by patients who had been treated at the Mount Sinai system in New York, adds to the growing evidence that Covid "long haulers" can experience myriad ailments weeks and months after recovering from the initial illness. As many as 24 percent of people who have recovered from Covid-19 continue to experience some sort of cognitive difficulties, including problems with memory, multitasking, processing speed and focusing, researchers at the Icahn School of Medicine at Mount Sinai reported Friday in JAMA Network Open.
“We’re seeing long-term cognitive impairment across a range of age groups and disease severity,” said study author Jacqueline Becker, a clinical neuropsychologist and associate scientist at the Icahn School of Medicine at Mount Sinai.
For the research, tests were given to 740 patients who had signed up to be part of a registry run by Mount Sinai, one of the largest hospital systems in New York that has been treating Covid patients since the early days of the pandemic. The patients, who were tested between April 2020 and May 2021, were 18 or older, spoke English or Spanish, tested positive for the SARS-CoV-2 virus and had no history of dementia. Results showed a relatively high rate of cognitive impairment 7.6 months after patients had contracted the disease.
The most common cognitive deficit — affecting nearly in 1 in 4 patients — was a problem with storing new memories, followed by issues with memory recall. Other challenges reported were deficits in processing speed and executive functioning, which includes the ability to initiate, plan, organize and make judgments.
While hospitalized patients were more likely to have cognitive impairments, patients who were only treated in the emergency department also had developed thinking problems.
Other hospitals are seeing similar complications. At Northwestern Medicine, some Covid patients ended up with such severe cognitive deficits that they could not care for themselves after being discharged, neurologist Dr. Igor Koralnik, chief of the division of neuro-infectious disease and global neurology, told NBC News.
“This study confirms what we have also seen at Northwestern, that cognitive problems are persistent both in patients who were previously hospitalized and also in patients who had only mild respiratory symptoms,” Koralnik said.
Young adults at risk of Covid brain problems
While cognitive issues are not surprising to find in those who were so sick they were put on ventilators in the hospital, it's not clear why young patients who had a mild illness would be affected, he added. Moreover, no one knows when, or if, any of these patients will get back to where they were before they got Covid-19, Koralnik said.
Because even younger patients who had a mild case of the disease reported cognitive difficulties, Becker recommended post-Covid screening for mental impairment as a standard of care, regardless of age of the patient.
Seeing severe mental deficits in patients in their 20s, 30s and 40s is "heartbreaking," said Dr. Helen Lavretsky, a professor of psychiatry and director of the UCLA Post-Covid Clinic. Some say "they cannot function; they can’t think; their memory is impaired; they get confused when they drive places, that they don’t know how they got there."
While there have been reports that vaccination helps Covid long-haulers, UCLA has seen mixed results. Some people improve, while others stay the same or get worse, Lavretsky said.
The scale of the problem is immense. More than 45 million coronavirus cases have been confirmed in the U.S. While most people who have been infected with Covid recover within weeks, far too many are coping with lingering symptoms.
“Twenty to 30 percent will have this prolonged reaction,” Lavretsky said. “In any school situation or complex work environment, this can really impair performance. If a person is lucky, they may be able to function at a lower level.”
Currently, therapy that helps people work around their deficits is the only treatment, said Tracy Vannorsdall, an associate professor of psychiatry and behavioral sciences at Johns Hopkins Medicine.
Therapists ask patients about their strengths and weaknesses and then design a program that will teach the patients how to use their strengths to compensate for their weaknesses, Vannorsdall said.
“These folks expect to return to their work, family and community and to engage in activities that are meaningful,” Vannorsdall said. “They want to be at their cognitive best.”
CORRECTION (Oct. 24, 2021, 1:45 p.m. ET): A previous version of this article misspelled the last name of the director of the UCLA Post-Covid Clinic. She is Dr. Helen Lavretsky, not Levretsky.
CORRECTION: (Oct. 26, 11:34 a.m. ET): A previous version of this story misstated Dr. Igor J. Koralnik’s affiliation. He is a neurologist with Northwestern Medicine, not Northwestern Medical Center.