Do you feel as though your thinking is less sharp and your memory muddier today than it was before a COVID-19 infection during the pandemic? If so, you are not alone. This “brain fog” is one of the most common concerns that patients of all ages come to me with these days. There are many possible contributors, including post-COVID-19 syndrome (also called “Long Haul COVID”).

What is brain fog?

You can think of the brain fog as a networking problem, with communication between the various parts of the brain becoming compromised. This can leave you feeling confused, forgetful, and perhaps indecisive or unable to focus. Brain fog can be caused by stress, lack of sleep, an unhealthy diet, changes in hormones, medication, or a medical condition, including COVID-19. With COVID-19, the brain is compromised by either direct injury from the virus itself or from immune system overactivation that leaves a simmering but gradually fading inflammation behind in the brain.

COVID-19 causes changes in the brain

COVID-19 causes neurologic symptoms in two ways: by worsening pre-existing symptoms and by triggering entirely new symptoms. If a person already had nerve pain due to a neuropathy (a general term for nerve dysfunction) or spine injury, a case of COVID-19 was quite likely to aggravate the pain and leave it worse than before. Likewise, a person with mild memory impairment of aging will likely find themselves with a significant decline in thinking abilities for several months after recovering from the initial infection. Recent studies have found that entirely new, painful, small fiber neuropathies and new cognitive impairment can be triggered by COVID-19 infection in patients of any age, even in those that had only mild symptoms at the time of the infection. With perhaps 1 in 4 Rhode Islanders having been infected with COVID-19, this means that you or someone you know may be experiencing post-COVID-19 brain fog.What is post-Covid brain fog? A COVID-19 infection and its inflammatory aftermath jolt the intricately coordinated neural networks in the brain and disrupt the flow of information. Imagine a fleet of delivery trucks suddenly losing their central dispatch – the packages will probably still be delivered but perhaps not in the most efficient way. In real life situations, it might take you more repetitions to remember a person’s name or a new phone number than it did before, or you forget about assignments and appointments more now than before the infection. The information probably gets there eventually, but not as reliably as before the virus disrupted the network.

How long does brain fog last after COVID-19 is treated?

The good news is that the vast majority of patients with post-COVID-19 brain fog recover completely over the course of 6 to 9 months. There is a small segment of patients of all ages that experience brain fog persistently for up to 2 years (as of the time of blog post). Patients with pre-existing dementia or mild cognitive impairment are less likely to recover fully. While there is no cure and no breakthrough treatment that can speed post-COVID-19 recovery, there is much a person can do to maximize the chances of fuller recovery. This involves analyzing your lifestyle habits and discarding the ones hindering recovery and implementing ones that promote brain and nerve healing.

Things you can do to minimize brain fog

The tips below will help to reduce brain fog, no matter what causes it.

  • Quit tobacco use – smokers will never recover as fully as they might if they were to quit.
  • Minimize alcohol use – very light or occasional use is probably harmless but anything more will hinder recovery.
  • Exercise – Activity of any sort, including walking for 20 minutes per day, will increase blood flow and encourage maximal brain healing.
  • Improve your diet – fast food, processed foods, and sugary sweets and drinks all foster an inflammatory state and work against healing. A registered dietitian nutritionist (RDN) can help guide you.
  • Take Vitamin D supplementation of 1000 or 2000 IU once daily to support brain and nerve function.
  • Exercising the mind and memory - Exercise it just as you would your biceps. Do crossword puzzles or play card games or Sudoku or Wordle; read newspapers, magazines, novels or technical manuals. Anything and everything helps.

How can you recover from COVID brain fog?

The first several months after having COVID-19 should be spent trying to resume prior activities as much as possible. If there is a new physical or cognitive symptom post-COVID-19, be patient with yourself and gradually reintroduce the exercise or activity at a slower pace over several weeks. Remember that the brain heals over months, so try not to become frustrated. Implement the lifestyle changes discussed above and rest assured you are maximizing your potential recovery.

If cognitive symptoms are disabling to the point of being unable to work at all, or if symptoms persist beyond 6 months after COVID-19 infection contact your primary care provider or Newport Neurology to discuss your symptoms and a care plan.

 Preston W. Douglas, MD

Preston W. Douglas, MD

Dr. Preston Douglas is a board-certified neurologist with Newport Neurology. Dr. Douglas specializes in epilepsy and EEG; neuromuscular disease and electromyogram and nerve conduction studies (EMG/NCS); and stroke and vascular neurology.