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Key points
- Brain fog can be draining, frustrating, and debilitating.
- Studies indicate neuroinflammation may be the culprit behind brain fog.
- There are strategies COVID long haulers can use to function better despite their brain fog.
It’s bad enough feeling exhausted all the time. But my brain feels broken. I can’t follow through on things or even focus when there’s too much going on. On top of that, I can’t remember anything that happened after I got sick. It’s all gone. I see the looks on people’s faces when I don’t remember what they’re talking about. It feels like someone else is living my life, and I’m two steps behind, trying to catch up.
Recent studies indicate upward of 22 percent of those infected with COVID-19 report cognitive dysfunction after recovering from the initial infection. Most refer to this dysfunction as "brain fog," a lay term typically used to describe the fuzzy thoughts, word-finding difficulties, and profound mental fatigue they experience.
But the cognitive problems associated with long-haul COVID are more far-reaching than that. Attention, memory, and even executive functioning can be impaired, leaving many to feel helpless, vulnerable, and unable to live their lives as they used to. This is true whether they were hospitalized and placed on a ventilator or simply had a mild case of COVID-19.
How COVID-19 May Cause Brain Fog
While science hasn’t revealed a definitive reason for the cognitive difficulties observed in long-haul COVID, research has provided us with several possible explanations. Neuroinflammation is one of the leading hypotheses as to why long haulers experience such debilitating brain fog.
Inflammation is a common consequence of many infections. For an unknown reason, COVID-19 provokes a particularly strong inflammatory response. Specifically, several studies demonstrate that those with long-haul COVID display an increased presence of inflammatory cytokines and microglial reactivity in the brain.
The production of cytokines is a normal immune response to an infection. When a pathogen like the virus that causes COVID-19 invades a person’s body, cytokines initiate the body’s immune defense against the pathogen. Similarly, the activation of microglial cells is also a normal reaction to inflammatory or toxic stimuli. Microglial cells function like the brain’s guards and play a vital role in the central nervous system. They monitor their environment and actively seek out harmful stimuli.
Studies show that because COVID-19 elicits such an extreme reaction in our immune system, it causes these natural responses to pathogens to malfunction. This results in an excessive uncontrolled neuroinflammatory reaction, disrupting neurological functioning and leading to the development of brain fog.
Strategies for Coping With Brain Fog
The cognitive impairments experienced by long haulers are not only frustrating and frightening, but they can also be severely debilitating. Unfortunately, no one-size-fits-all solution will eliminate these difficulties. Despite this, rehabilitative strategies exist that can help long haulers reduce the impact brain fog has on their lives. Presented below are six easy-to-implement strategies long haulers can use to improve brain functioning.
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Sleep better. Good sleep hygiene is always important, but especially for those struggling with long-haul COVID. Establishing a regular sleep schedule can go a long way to improving one’s sleep. Reduce screen time before going to bed and eliminate, as much as possible, any blue light in your bedroom. While getting enough sleep is important, it’s also helpful to establish a sleep routine that enables you to wake up when you’re in light sleep because this will make you feel more rested than if you’re waking up from deep sleep.
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Exercise matters. Physical activity isn’t just good for your body, it’s also good for your brain health. It helps increase neural connectivity and brain function, as well as promotes improved sleep and mood. Those with long-haul COVID, however, must be mindful of healthy activity pacing to not exacerbate fatigue or post-exertional malaise.
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Eat brain-healthy foods. Obviously, eating healthy is important regardless of your health status. But when one is struggling with long-haul COVID, it can also be incredibly beneficial to include brain-friendly foods. Foods like salmon, flaxseed, edamame, and soybean oil that are high in omega-3 fatty acids are essential for brain health. You may also benefit from adding foods that help fight inflammation; examples of such foods include olive oil, turmeric, ginger, dark-green leafy vegetables, and citrus.
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Enjoy brain games. Yep, you read that right—playing somewhat challenging brain games, especially those with a memory-based component, can help promote brain recovery. Games like Boggle, tangrams, logic puzzles, and sudoku can be helpful. The key to these games, however, is to not give up even if you’re feeling discouraged. It can be tempting to quit when your ability to do this type of activity is worse than it used to be. Stay motivated and keep working on your recovery.
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Stay engaged. It’s natural for long haulers to isolate themselves. This can happen for a lot of different reasons, not the least of which are depression and fatigue. But staying connected and socializing can be helpful. Social ties are crucial to our mental health; we are social animals after all! Social activities are also beneficial for our brain health. Socializing stimulates attention and memory, and even strengthens our neural networks. In fact, research suggests when people are lonely and socially isolated, their risk of dementia increases by upward of 40 percent.
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Set the stage for success. Having brain fog makes even doing the simplest tasks draining and difficult. It’s important to set yourself up for success. One of the most helpful things you can do is work on your "to-do" list when you’re most alert and have the most energy. Working on things when you’re already exhausted and drained will be counterproductive. Set reminders or alarms on your phone to keep track of things. Take notes or use the camera on your phone to capture visual information (e.g., where you parked). Minimize distractions when you’re trying to concentrate; this may include keeping your living space neat, using soft lighting, or wearing noise-canceling headphones.
Conclusion
Many long haulers report tremendous anxiety about the cognitive difficulties they experience. It can feel like a switch has been flipped and your brain just isn’t working as it should or as it used to. Some wonder if they’re experiencing early onset dementia. Many ask whether this will get better and, if so, when.
For now, we must wait for the science to catch up with the lived experience of those with long-haul COVID. Until researchers can determine an effective treatment strategy, it remains imperative that long haulers stay engaged with their health care. In addition to following the strategies described above, those experiencing cognitive impairments should talk to their doctors to see what other options may be helpful (e.g., referrals to neurology, occupational therapy, or a neuropsychologist).
