5 Things to Know About Long COVID and the Brain

by Staff Writer
March 13, 2023 at 12:30 PM UTC

5 things to know about Long Covid and the brain

Clinical Relevance: The neuropsychiatric symptoms of long COVID can be debilitating

  • The cause of neurological disruptions from long COVID are poorly understood.
  • More than 40 percent of people with COVID have experienced at least one resulting neurological symptom.
  • Long COVID is associated with high rates of mental health problems including depression, anxiety, and brain fog.
  • Many people with long COVID have a hard time returning to work.
  • It’s still early days for effective treatments.

Medical experts lay the blame on long COVID for a wide range of health complications, but neurological symptoms seem to be among the most prolonged and debilitating. Symptoms can last weeks, months, or even years after infection, according to the Centers for Disease Control and Prevention (CDC). Sometimes issues can even go away or come back again.

As we cross into the third year of living with the novel coronavirus, here are five things to know about how long COVID affects the brain. 

(1) Scientists are still working out exactly what causes the neurological symptoms of long COVID. One theory is that coronavirus changes the structural or functional operations in the brain. A Nature study found that people with long covid had reduced gray matter volume in regions involved in memory, emotion regulation, and smell processing compared to healthy controls. Another study out of China found that people with long COVID had altered connectivity patterns in brain networks involved in attention and executive function. Yet another line of thinking blames a dysfunctional immune system.


(2) The constellation of neurological disruptions attributed to COVID-19 is staggering. Overall, COVID-19 has contributed to more than 40 million new cases of neurological disorders worldwide, said Ziyad Al-Aly, MD, a clinical epidemiologist at Washington University, and the senior author of a paper on long COVID published in the journal Nature Medicine. The odds of experiencing any type of neurological problem shot up 42 percent among COVID survivors, the study found. For example, risk of ischemic stroke was 50 percent higher in people infected with the virus compared to non-infected individuals. The odds of having a memory problem increased by 77 percent, and the chances of Alzheimer’s disease doubled. More than 37 percent of COVID patients reported at least one neurological symptom six months after hospital discharge, a recent BMJ study determined. 


(3) Long COVID is a long haul for patients, psychologically speaking. According to the CDC’s Household Purse Survey, 43 percent of people diagnosed with long term COVID experience difficulty performing daily activities because of fatigue, pain, brain fog, and other symptoms, and 36 percent reported increased anxiety or depression. High rates of PTSD and even psychosis have been established as well. There also seems to be a reciprocal relationship with prior mental health status. People reporting depression, anxiety and stress before a COVID infection were 50 percent more likely to report long COVID symptoms.

Long COVID has hit the workforce hard. In the first two years of the pandemic, about 71 percent of people suffering from long COVID required ongoing medical treatment or had been unable to find work for at least six months, a
New York State Insurance Fund analysis found. More than a year after infection, 18 percent of long haulers had still not returned to work. Even more worrisome:

  • Greater than two-thirds of the people unable to rejoin the workforce were under age 60
  • Female workers were 11 percent more likely to be affected than men
  • More than one-third had symptoms so severe they were unable to return to their jobs.

The annual cost of those lost wages alone is around $170 billion a year –and potentially as high as $230 billion–according to the latest Census Bureau stats.

(5) Some therapies show promise for reducing the burden of long COVID. A recent
JAMA study suggested lifestyle changes, such as a good diet and regular exercise, may be beneficial. But an Italian investigation showed favorable results for cognitive behavioral therapy (CBT) compared to workouts or general healthcare for improving cognitive function, lifting mood, reducing fatigue, anxiety, and depression. As for medications, one very small study by Yale researchers demonstrated improvement in COVID’s neurological symptoms, especially brain fog, using a combination of the α2A-adrenoceptor agonist guanfacine and the anti-oxidant N-acetylcysteine (NAC.) However, most experts agree reliable treatments have yet to emerge.

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