News Releases

'Brain fog' following COVID-19 recovery may indicate PTSD

Psychiatric disorders and brain damage can share similar symptoms but require different treatments.

10/06/2020

Erin Kaseda

A new report suggests that lingering "brain fog" and other neurological symptoms after COVID -19 recovery may be due to post-traumatic stress disorder (PTSD), an effect observed in past human coronavirus outbreaks such as SARS and MERS.

People who have recovered from COVID-19 sometimes experience lingering difficulties in concentration, as well as headaches, anxiety, fatigue or sleep disruptions. Patients may fear that the infection has permanently damaged their brains, but researchers say that’s not necessarily the case.

A recent paper co-authored by clinical professor and neuropsychologist Andrew Levine, MD, of the David Geffen School of Medicine at UCLA, and graduate student Erin Kaseda, of Rosalind Franklin University of Medicine and Science, in Chicago, explores the historical data on survivors of previous coronaviruses, which caused severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS).

The paper was published in The Clinical Neuropsychologist.

"The idea is to raise awareness among neuropsychologists that PTSD is something you might want to consider when evaluating persistent cognitive and emotional difficulties among COVID-19 survivors," said Dr. Levine.

"When we see someone for neuropsychological testing, we expect them to be at their best, relatively speaking," Dr. Levine said. "If we identify a psychiatric illness during our evaluation, and if we believe that condition's symptoms are interfering with their ability to perform at their best, we would want that treated first, and then retest them once it’s under control."

Dr. Andrew Levine

If the symptoms are due, even partially, to a psychiatric condition such as PTSD, treatment will help manage those symptoms, and provide a clearer view of any underlying brain issues.

"Once they have treatment, and hopefully have some remission of their psychiatric symptoms, if the cognitive complaints and the deficits on neuropsychological tests are still there, then that’s more evidence that something else is going on," Kaseda said. "It's going to be important for clinicians across the board to be keeping up with the literature that's coming out, to make sure they have the most up to date information as these survivors are starting to present for neuropsychological testing."

Kaseda began pursuing this question based on her experience working with patients with mild traumatic brain injury, such as concussion. "When these symptoms persist for months or years after the original injury, it's much more likely to be due to the presence of a psychiatric disorder," she said.

A review of data from the SARS and MERS outbreaks showed that those survivors had heightened risk for PTSD.

In the case of COVID-19, the symptoms of PTSD may arise in response to the invasive measures needed to treat the patients, including intubation and ventilation, which can be traumatic for fearful patients. Other times, delirium causes patients with COVID-19 to suffer hallucinations, and the memory of these terrifying sensations continues to plague the recovered patient.

In addition to patients who have been hospitalized, frontline health-care providers can be similarly affected due to the constant stress and fear they face at work. And for some people, the anxiety of living through a pandemic, being isolated from friends, and battling the constant fear of an invisible threat can deliver a similar blow to thinking and memory skills.

While a PTSD diagnosis might not sound like good news, there are many available treatments for the disorder, including psychotherapy and medications. By comparison, researchers are still working to understand the direct neurological effects of COVID-19. "Treatment options (for COVID) are still quite a way's out, because it's still an evolving situation," Kaseda said.

"We don't actually know anything yet from survivors of COVID-19," Kaseda said. "Until we have that data, it's very hard to say what actual percentage of patients are going to have cognitive complaints because of direct effects of the virus, because of medical intervention, or because of psychiatric concerns."

Media Contact

Marrecca Fiore
MFiore@mednet.ucla.edu

Latest News

Health and Behavior
UCLA researchers study genetics’ role in COVID-19 susceptibility, severity
10/26/2020
The scientists were brought together by their shared belief that genetics could be a key to finding better approaches to the pandemic.

Health and Behavior
Learning to see in 3-D
10/23/2020
Until now, scientists believed that learning in the newborn brain was achieved by pruning an over-wired neural circuitry. The traditional view was that genetic mechanisms laid down cortical connections in the womb and then sensory experience refined these connections to establish the ability to detect various visual features.

Health and Behavior
Making telemedicine more accessible to vulnerable, underserved populations
10/23/2020
Dr. Alejandra Casillas was first struck by the rise of digital health in 2016, when she returned to the United States from a four-year stint working in Europe. Casillas, now an assistant professor of medicine in the division of general internal medicine and health services research at the David Geffen School of Medicine at UCLA, has had a longtime interest in health disparities, with a particular focus on health communications among underserved and limited English proficient communities.

Health and Behavior
Antiretroviral therapy can’t completely stop accelerated cell aging seen in HIV
10/22/2020
Research brief: Even successfully treated HIV-infected adults are at increased of many diseases more commonly associated with aging.

Health and Behavior
Axillary surgery may not be necessary for all women with invasive breast cancer
10/22/2020
More women could potentially be spared an axillary lymph node dissection — the surgical removal of 10-20 lymph nodes — a procedure that causes disabling arm swelling in up to 25% of women, according to a UCLA study led by Dr. Maggie DiNome, chief of breast surgery at the David Geffen School of Medicine at UCLA.