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Do COVID-19 Survivors Experience Higher Rates of Brain Fog?

  • Authors: News Author: Marcia Frellick; CME Author: Charles P. Vega, MD
  • CME / ABIM MOC / CE Released: 12/17/2021
  • Valid for credit through: 12/17/2022
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This activity is intended for all primary care physicians, neurologists, infectious disease specialists, nurses, pharmacists, and other members of the healthcare team who care for patients with a history of COVID-19.

The goal of this activity is to evaluate the effects of COVID-19 on cognitive function.

Upon completion of this activity, participants will:

  • Assess long-term cognitive outcomes after severe illness
  • Analyze the effect of COVID-19 on cognitive function
  • Outline implications for the healthcare team


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News Author

  • Marcia Frellick

    Freelance writer, Medscape


    Disclosure: Marcia Frellick has disclosed no relevant financial relationships.

CME Author

  • Charles P. Vega, MD

    Health Sciences Clinical Professor of Family Medicine
    University of California, Irvine School of Medicine
    Irvine, California


    Disclosure: Charles P. Vega, MD, has disclosed the following relevant financial relationships:
    Served as an advisor or consultant for: Johnson & Johnson

Editor/CME Reviewer/Nurse Planner

  • Leigh A. Schmidt, MSN, RN, CMSRN, CNE, CHCP

    Associate Director, Accreditation and Compliance
    Medscape, LLC


    Disclosure: Leigh A. Schmidt, MSN, RN, CMSRN, CNE, CHCP, has disclosed no relevant financial relationships.

CE Reviewer

  • Esther Nyarko, PharmD

    Director, Accreditation and Compliance
    Medscape, LLC


    Disclosure: Esther Nyarko, PharmD, has disclosed no relevant financial relationships.

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Do COVID-19 Survivors Experience Higher Rates of Brain Fog?

Authors: News Author: Marcia Frellick; CME Author: Charles P. Vega, MDFaculty and Disclosures

CME / ABIM MOC / CE Released: 12/17/2021

Valid for credit through: 12/17/2022


Note: The information on the coronavirus outbreak is continually evolving. The content within this activity serves as a historical reference to the information that was available at the time of this publication. We continue to add to the collection of activities on this subject as new information becomes available. It is the policy of Medscape Education to avoid the mention of brand names or specific manufacturers in accredited educational activities. However, manufacturer names related to COVID-19 vaccines may be provided in this activity to promote clarity. The use of manufacturer names should not be viewed as an endorsement by Medscape of any specific product or manufacturer.

Clinical Context

Critical illness is an underrecognized risk factor for cognitive impairment well after hospital discharge, according to a study by Pandharipande and colleagues. These researchers followed 821 patients admitted for respiratory failure or shock to the intensive care unit. Study participants completed a battery of neurocognitive tests at 3 and 12 months after hospital discharge. The main study outcome was the comparison between participants’ cognitive scores and population-based norms after adjustment for potential confounders. The results of this research were published in the October 3, 2013 issue of the New England Journal of Medicine.[1]

Nearly three-quarters (74%) of the study cohort developed delirium during their hospital stay. At 3 months, 40% of participants had cognitive scores at least 1.5 standard deviations (SD) below the population mean, which is consistent with a patient presenting with moderate traumatic brain injury; 26% of participants had scores at least 2 SD below the mean, which is consistent with mild Alzheimer disease. The respective proportions of participants with these levels of cognitive dysfunction at 12 months were 34% and 24%, respectively. Cognitive dysfunction occurred at similar rates among participants regardless of age. Longer durations of delirium in hospital were predictive of worse long-term cognitive outcomes, but the use of sedating or analgesic drugs was not.

COVID-19 is known to cause “brain fog,” particularly among patients with post-acute sequelae of COVID-19. The current study by Becker and colleagues compares objective cognitive function among patients with a history of COVID-19 with population mean values.

Study Synopsis and Perspective

High rates of cognitive dysfunction or brain fog have been found an average of 7.6 months after patients have been treated for COVID-19, new data indicate.

The study of 740 people (mean age, 49 ± 14.2 years) with no prior history of memory problems included people treated in the outpatient setting as well as individuals who were admitted to a hospital or treated in emergency departments (EDs).

Jacqueline H. Becker, PhD, division of general internal medicine, Icahn School of Medicine at Mount Sinai, New York, New York, is first author of the study, which was published online Friday as a research letter in JAMA Network Open.[2]

She and the other authors wrote that, although older populations are well-known to be susceptible to cognitive impairment after a serious illness, this study has implications for younger people as well. Becker, a clinical neuropsychologist, told Medscape Medical News, "Many people believe that they will survive COVID and they'll be just fine and for the majority of the population I think that's true. But I think our paper suggests there are long-term cognitive repercussions from COVID that may impact individuals across various age groups and the spectrum of disease severity."

Most Common Impairments

The most commonly reported deficits were in processing speed (18%; n = 133), executive functioning (16%; n = 118), phonemic fluency (15%; n = 111), category fluency ([eg, tested by listing as many animals as you can in a minute]; 20%; n = 148), memory encoding (24%; n = 178), and memory recall (23%; n = 170); however, deficits varied by the treatment setting.

Hospitalized patients were more likely to have impairments in attention (odds ratio [OR] = 2.8 [95% CI: 1.3, 5.9]), executive functioning (OR = 1.8 [95% CI: 1, 3.4]), category fluency (OR = 3 [95% CI: 1.7, 5.2]), memory encoding (OR = 2.3 [95% CI: 1.3, 4.1]), and memory recall (OR = 2.2 [95% CI: 1.3, 3.8]) than those persons in the outpatient group.

Patients treated in the ED were more likely to have impaired category fluency (OR = 1.8 [95% CI: 1.1, 3.1]) and memory encoding (OR = 1.7 [95% CI: 1, 3]) than outpatients. No significant differences in impairments in other domains were observed between groups.

Study Highlights

  • Patients in the current study had data in a large health system in New York between April 2020, and May 2021. All participants had a positive test for SARS-CoV-2 or had serum antibody positivity against SARS-CoV-2. Analysis excluded patients with a history of dementia.
  • All participants underwent a battery of 4 cognitive tests. Researchers compared their results with age-, sex-, and education-adjusted norms. Researchers adjusted their final results for race/ethnicity, smoking history, body mass index, comorbid conditions, and obesity.
  • 740 adults ≥ 18 years participated in the study. The mean age of participants was 49 ± 14.2 years, and 63% were women. The cohort was diverse in terms of race/ethnicity.
  • The mean time since the diagnosis of COVID-19 was 7.6 ±2.7 months. 51% of participants were treated for COVID-19 as outpatients whereas 22% were treated in the ED. 27% of participants had been hospitalized with COVID-19.
  • Compared with standardized data, substantial proportions of participants with COVID-19 had deficits in the following cognitive domains:
    • Processing speed (18%)
    • Executive function (16%)
    • Phonemic fluency (15%)
    • Category fluency (20%)
    • Memory encoding (24%)
    • Memory recall (23%)
  • In adjusted analyses, the odds ratios for having impairment in specific cognitive domains were as follows:
    • 2.8 (95% CI: 1.3, 5.9) for attention
    • 1.8 (95% CI: 1, 3.4) for executive functioning
    • 3 (95% CI: 1.7, 5.2) for category fluency
    • 2.3 (95% CI: 1.3, 4.1) for memory encoding
    • 2.2 (95% CI: 1.3, 3.8) for memory recall
  • Processing speed and phonemic fluency were not affected by infection with COVID-19.
  • Treatment for COVID-19 in the ED was associated with worse outcomes for memory encoding and category fluency compared with treatment for COVID-19 as an outpatient.

Clinical Implications

  • In a previous study by Pandharipande and colleagues, 40% of patients admitted for respiratory failure or shock had substantial cognitive dysfunction at 3 months after discharge, with little improvement at 12 months.
  • The current study by Becker and colleagues, Becker finds high rates of cognitive dysfunction among adults with a history of COVID-19. This dysfunction was present in most domains, save processing speed and phonemic fluency.
  • Implications for the healthcare team: The healthcare team should monitor cognitive status among patients who recover from COVID-19.


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