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新冠后遺癥“腦霧”到底怎么治?

Kristine Gill
2023-01-22

“腦霧”成因存在爭議,治療方法也有很大差異。

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圖片來源:NICK DOLDING—GETTY IMAGES

科比特·奧康納已經(jīng)感染了三次新冠病毒。第一次感染是在2020年4月,第二次感染是在一年之后,第三次感染是在2022年秋天。

但直到現(xiàn)在,這位土生土長的紐約人才感覺好些了。持續(xù)時間最長的癥狀——腦霧——終于消失了,他在建筑管理行業(yè)的新遠程崗位上表現(xiàn)良好。

奧康納說:“從我上次感染新冠病毒到現(xiàn)在,已經(jīng)快一年了。如今,通過身心兼治,我才開始感到自己擺脫后遺癥了?!?/p>

一些研究估計,腦霧可能會影響多達70%感染新冠的患者。如今,醫(yī)生們仍然在試圖了解腦霧,并嘗試各種不同的治療方法,這些治療方法可能會讓那些在感染新冠病毒幾個月后出現(xiàn)腦霧的患者的癥狀得到緩解。研究表明,與未感染新冠病毒的人相比,那些感染過新冠病毒的人出現(xiàn)腦霧的概率明顯上升——即使他們沒有注意到這一點——而且這些癥狀在6個月到9個月后就消失了。

關于是什么原因導致腦霧的理論仍然存在爭議,而治療方法也有很大差異。2022年夏天,奧康納向位于紐約市的Kellman Wellness Center的內科醫(yī)生兼功能醫(yī)學醫(yī)生拉斐爾·凱爾曼博士尋求治療。凱爾曼的治療方法基于這樣一種想法,即這些癥狀是由大腦炎癥引發(fā)的。

凱爾曼表示:“腦霧是一個非常突出的問題,患者記憶力下降,做事時心不在焉,而首要問題其實是慢性炎癥。這時,免疫系統(tǒng)還在工作,大腦還處于持續(xù)的高炎癥狀態(tài)?!?/p>

匹茲堡大學醫(yī)學中心(University of Pittsburgh Medical Center)的醫(yī)生們在2020年11月開辦了后新冠康復診所(Post-COVID-19 Recovery Clinic),采取各種不同的方法來治療患者。他們指出,感染新冠的患者出現(xiàn)腦霧的原因還尚未確定。醫(yī)生們反而專注于治療500多名罹患新冠后遺癥的患者。

匹茲堡大學后新冠康復診所的高級執(zhí)業(yè)醫(yī)師卡拉·約尼稱:“患者最常見的主訴可能是運動耐力下降,有時還伴有呼吸短促。其次,最常見癥狀可能是腦霧和疲勞。”

那些有腦霧癥狀的患者通常會被轉診,轉到語言治療師那里進行認知康復治療。在那里,患者要周復一周地進行一系列的大腦練習,以使大腦再次正常運轉。

約尼說:“我們專注于癥狀管理。最重要的是,在我們有足夠的全面數(shù)據(jù)之前,我們甚至無法推測腦霧是否是炎癥?!?/p>

新冠后遺癥腦霧癥狀

奧康納第一次注意到事情不對勁是在他回到工作崗位后。突然間,在結束一天的工作后,他唯一能夠做的就是回家睡覺。簡單的任務需要花費更長的時間才可以完成,同事們注意到奧康納總是丟三落四。

“就是一些相對來說很簡單的事情,比如我在電子郵件討論中遺漏了某個人,或者有人會說‘你是不是忘記發(fā)附件了?’”他說?!斑@很尷尬?!?/p>

工作之余,奧康納意識到自己的棋藝正在走下坡路。他經(jīng)常和兒子一起下棋,但在感染新冠病毒后,如果奧康納想贏一局,就需要對方讓子。

醫(yī)生說,腦霧的定義是短期記憶喪失和注意力不集中。有些人可能也會感到思維混亂。顧名思義,就像司機在大霧中行駛一樣,患者經(jīng)常覺得他們必須花費更多的時間和精力來完成同樣的任務。

凱爾曼說:“記憶力下降、想不起名字、思維混亂、注意力不集中等?!碑敾颊邅碚宜麜r,他們通常認為感染新冠就意味著相關癥狀出現(xiàn)了,但他指出,有許多患者在和疾病作斗爭,卻沒有意識到是什么引起了他們的癥狀。

他說:“有些人意識到他們是在感染新冠病毒后出現(xiàn)相關癥狀的,而有些人還沒有建立這種聯(lián)系。有時他們患有自身免疫性疾病,所以無法確定腦霧是否是感染新冠病毒引起的,但通常能夠通過時間線來確定?!?/p>

凱爾曼稱,簡而言之,新冠后遺癥和自身免疫性疾病之間有很多重疊的部分。他把這看成是一系列錯綜復雜的問題,再者,這一癥狀可能會被診斷為新冠后遺癥,也可能不會,這取決于患者對自己癥狀的了解程度。

加利福尼亞州紐波特比奇的Wave Neuroscience公司的總裁兼首席醫(yī)療官埃里克·翁博士說:“有時人們的主訴是處理事情速度變慢或更加健忘,難以集中注意力,這些都是典型的癥狀?!?/p>

是什么導致新冠后遺癥腦霧

一些醫(yī)生認為,腦霧是大腦出現(xiàn)炎癥導致的后果。當身體超負荷工作以抵御新冠病毒等病毒時,患者就會出現(xiàn)腦霧。目前還不清楚為什么有些人出現(xiàn)腦霧,有些人卻沒有,但許多有腦霧癥狀的患者被認為有炎癥。

凱爾曼指出,可以通過測試來確定大腦是否有炎癥,但其中許多測試都是昂貴且不必要的。一些測試尋找白細胞介素和細胞因子,即血液中由免疫系統(tǒng)產(chǎn)生的引起炎癥的小蛋白質。

他說,相反,許多醫(yī)生將腦霧作為炎癥來治療,這種治療方法會影響腸道中的微生物群,并導致自身免疫性疾病。

凱爾曼表示:“還存在根本問題,如果你解決了這些根本問題,他們的情況就能夠出現(xiàn)好轉——他們的情況確實可以出現(xiàn)好轉——你只需要知道發(fā)生了什么?!?/p>

約尼說,目前還不清楚原因是什么。相反,患者能夠自行到診所尋求新冠后遺癥治療,醫(yī)生將新冠后遺癥定義為首次新冠肺炎發(fā)作后持續(xù)兩個月以上的癥狀。在這段時間內,主訴是腦霧的患者首先會在診所接受甲狀腺和B12水平測試,以確認疲勞感等癥狀不是由另一大潛在問題引起的。那些有腦霧癥狀的人可能會接受認知測試來確認是否是某種缺陷導致的。許多患者還會接受核磁共振成像(MRI)檢查,但約尼表示,到目前為止,那些有腦霧癥狀的人還沒有出現(xiàn)腦損傷的跡象。

“好消息是,當患者來就診時,根據(jù)危險信號和癥狀,我們有時會在他們到神經(jīng)科就診之前安排頭部成像檢查?!奔s尼說?!拔覜]有發(fā)現(xiàn)患者大腦有結構性變化。目前腦CT和腦部核磁共振成像的結果都是正常的,這讓人們感到安心,但我不能以偏概全,說功能性掃描的結果也是正常的?!?/p>

約尼解釋道,功能性掃描可能會進一步顯示腦霧在大腦中的表現(xiàn)。

新冠后遺癥腦霧的治療方法

奧康納在2021年夏天,在他第二次和第三次新冠肺炎發(fā)作之間尋求了治療,此前他看到兒子醫(yī)生發(fā)來的一封電子郵件,在那封郵件里,醫(yī)生列出了一些新冠后遺癥癥狀。

凱爾曼讓他服用復方中藥和養(yǎng)生片劑,旨在減輕炎癥。

凱爾曼說,有證據(jù)表明紅外光也有助于減輕炎癥。

凱爾曼表示,接受他的治療方案的患者在幾周內就可以出現(xiàn)好轉。

“確實有療效。”奧康納說。

埃里克·翁采取了一種不同的治療方法,這是在研究了這種療法對患有“化療腦”的化療患者的療效后研發(fā)出來的,“化療腦”會引起類似的腦霧癥狀。他能夠通過腦電圖(EEG)檢測患者腦部是否有炎癥。

經(jīng)顱磁刺激(TMS)使用磁場來刺激這些神經(jīng)細胞,幫助其恢復功能。

“根據(jù)我們的經(jīng)驗,當神經(jīng)元活動變慢時,它們只是需要一些刺激?!卑@锟恕の瘫硎?。

凱爾曼相信假以時日,治療可以改善腦霧,但不相信患者自行重新訓練大腦能夠克服癥狀。

“減輕壓力是有幫助的,但以我的經(jīng)驗來看,這還不夠?!彼f。

埃里克·翁指出,良好的睡眠衛(wèi)生很重要,正念和冥想有時也大有裨益。此外,事實證明,進行日?;顒右部梢愿纳拼竽X健康。

他補充道:“與久坐一族相比,每周運動三次到四次,每次30分鐘的人能夠更快地恢復大腦功能?!?/p>

但希望病情隨著時間的推移而自行消失也是不可取的。

凱爾曼還說:“大腦炎癥會導致慢性問題,包括早期癡呆癥,而新冠肺炎和癡呆癥之間已經(jīng)存在某種聯(lián)系?!?/p>

因此,盡管他認為這種情況非常緊迫,事態(tài)也很嚴重,但他表示患者不應該感到氣餒。

“人們應該滿懷希望,因為我們有相應的治療方法?!眲P爾曼博士表示。

約尼稱,她的病人通常會被轉介給語言病理學家進行持續(xù)4周到12周的認知治療。在每周一次的療程結束之后,患者會再次接受測試,并與他們最初的基線測試結果進行比較,查看病情是否出現(xiàn)好轉。這些患者表示,治療過程中的練習可以幫助他們提高記憶力,增強注意力。

該診所將很快啟動一項臨床試驗,將比較認知療法的療效和為期三個月的阿德拉(Adderall)(聰明藥:Adderall,治療多動癥的處方藥,其主要成分為安非他明——譯注)療法的療效。

與此同時,約尼表示,對一些人來說,新冠后遺癥的癥狀能夠自行消退。但在診所尋求治療的患者通常已經(jīng)出現(xiàn)持續(xù)一年或更長時間的癥狀。(財富中文網(wǎng))

譯者:中慧言-王芳

科比特·奧康納已經(jīng)感染了三次新冠病毒。第一次感染是在2020年4月,第二次感染是在一年之后,第三次感染是在2022年秋天。

但直到現(xiàn)在,這位土生土長的紐約人才感覺好些了。持續(xù)時間最長的癥狀——腦霧——終于消失了,他在建筑管理行業(yè)的新遠程崗位上表現(xiàn)良好。

奧康納說:“從我上次感染新冠病毒到現(xiàn)在,已經(jīng)快一年了。如今,通過身心兼治,我才開始感到自己擺脫后遺癥了。”

一些研究估計,腦霧可能會影響多達70%感染新冠的患者。如今,醫(yī)生們仍然在試圖了解腦霧,并嘗試各種不同的治療方法,這些治療方法可能會讓那些在感染新冠病毒幾個月后出現(xiàn)腦霧的患者的癥狀得到緩解。研究表明,與未感染新冠病毒的人相比,那些感染過新冠病毒的人出現(xiàn)腦霧的概率明顯上升——即使他們沒有注意到這一點——而且這些癥狀在6個月到9個月后就消失了。

關于是什么原因導致腦霧的理論仍然存在爭議,而治療方法也有很大差異。2022年夏天,奧康納向位于紐約市的Kellman Wellness Center的內科醫(yī)生兼功能醫(yī)學醫(yī)生拉斐爾·凱爾曼博士尋求治療。凱爾曼的治療方法基于這樣一種想法,即這些癥狀是由大腦炎癥引發(fā)的。

凱爾曼表示:“腦霧是一個非常突出的問題,患者記憶力下降,做事時心不在焉,而首要問題其實是慢性炎癥。這時,免疫系統(tǒng)還在工作,大腦還處于持續(xù)的高炎癥狀態(tài)?!?/p>

匹茲堡大學醫(yī)學中心(University of Pittsburgh Medical Center)的醫(yī)生們在2020年11月開辦了后新冠康復診所(Post-COVID-19 Recovery Clinic),采取各種不同的方法來治療患者。他們指出,感染新冠的患者出現(xiàn)腦霧的原因還尚未確定。醫(yī)生們反而專注于治療500多名罹患新冠后遺癥的患者。

匹茲堡大學后新冠康復診所的高級執(zhí)業(yè)醫(yī)師卡拉·約尼稱:“患者最常見的主訴可能是運動耐力下降,有時還伴有呼吸短促。其次,最常見癥狀可能是腦霧和疲勞。”

那些有腦霧癥狀的患者通常會被轉診,轉到語言治療師那里進行認知康復治療。在那里,患者要周復一周地進行一系列的大腦練習,以使大腦再次正常運轉。

約尼說:“我們專注于癥狀管理。最重要的是,在我們有足夠的全面數(shù)據(jù)之前,我們甚至無法推測腦霧是否是炎癥。”

新冠后遺癥腦霧癥狀

奧康納第一次注意到事情不對勁是在他回到工作崗位后。突然間,在結束一天的工作后,他唯一能夠做的就是回家睡覺。簡單的任務需要花費更長的時間才可以完成,同事們注意到奧康納總是丟三落四。

“就是一些相對來說很簡單的事情,比如我在電子郵件討論中遺漏了某個人,或者有人會說‘你是不是忘記發(fā)附件了?’”他說。“這很尷尬?!?/p>

工作之余,奧康納意識到自己的棋藝正在走下坡路。他經(jīng)常和兒子一起下棋,但在感染新冠病毒后,如果奧康納想贏一局,就需要對方讓子。

醫(yī)生說,腦霧的定義是短期記憶喪失和注意力不集中。有些人可能也會感到思維混亂。顧名思義,就像司機在大霧中行駛一樣,患者經(jīng)常覺得他們必須花費更多的時間和精力來完成同樣的任務。

凱爾曼說:“記憶力下降、想不起名字、思維混亂、注意力不集中等?!碑敾颊邅碚宜麜r,他們通常認為感染新冠就意味著相關癥狀出現(xiàn)了,但他指出,有許多患者在和疾病作斗爭,卻沒有意識到是什么引起了他們的癥狀。

他說:“有些人意識到他們是在感染新冠病毒后出現(xiàn)相關癥狀的,而有些人還沒有建立這種聯(lián)系。有時他們患有自身免疫性疾病,所以無法確定腦霧是否是感染新冠病毒引起的,但通常能夠通過時間線來確定?!?/p>

凱爾曼稱,簡而言之,新冠后遺癥和自身免疫性疾病之間有很多重疊的部分。他把這看成是一系列錯綜復雜的問題,再者,這一癥狀可能會被診斷為新冠后遺癥,也可能不會,這取決于患者對自己癥狀的了解程度。

加利福尼亞州紐波特比奇的Wave Neuroscience公司的總裁兼首席醫(yī)療官埃里克·翁博士說:“有時人們的主訴是處理事情速度變慢或更加健忘,難以集中注意力,這些都是典型的癥狀。”

是什么導致新冠后遺癥腦霧

一些醫(yī)生認為,腦霧是大腦出現(xiàn)炎癥導致的后果。當身體超負荷工作以抵御新冠病毒等病毒時,患者就會出現(xiàn)腦霧。目前還不清楚為什么有些人出現(xiàn)腦霧,有些人卻沒有,但許多有腦霧癥狀的患者被認為有炎癥。

凱爾曼指出,可以通過測試來確定大腦是否有炎癥,但其中許多測試都是昂貴且不必要的。一些測試尋找白細胞介素和細胞因子,即血液中由免疫系統(tǒng)產(chǎn)生的引起炎癥的小蛋白質。

他說,相反,許多醫(yī)生將腦霧作為炎癥來治療,這種治療方法會影響腸道中的微生物群,并導致自身免疫性疾病。

凱爾曼表示:“還存在根本問題,如果你解決了這些根本問題,他們的情況就能夠出現(xiàn)好轉——他們的情況確實可以出現(xiàn)好轉——你只需要知道發(fā)生了什么?!?/p>

約尼說,目前還不清楚原因是什么。相反,患者能夠自行到診所尋求新冠后遺癥治療,醫(yī)生將新冠后遺癥定義為首次新冠肺炎發(fā)作后持續(xù)兩個月以上的癥狀。在這段時間內,主訴是腦霧的患者首先會在診所接受甲狀腺和B12水平測試,以確認疲勞感等癥狀不是由另一大潛在問題引起的。那些有腦霧癥狀的人可能會接受認知測試來確認是否是某種缺陷導致的。許多患者還會接受核磁共振成像(MRI)檢查,但約尼表示,到目前為止,那些有腦霧癥狀的人還沒有出現(xiàn)腦損傷的跡象。

“好消息是,當患者來就診時,根據(jù)危險信號和癥狀,我們有時會在他們到神經(jīng)科就診之前安排頭部成像檢查?!奔s尼說?!拔覜]有發(fā)現(xiàn)患者大腦有結構性變化。目前腦CT和腦部核磁共振成像的結果都是正常的,這讓人們感到安心,但我不能以偏概全,說功能性掃描的結果也是正常的?!?/p>

約尼解釋道,功能性掃描可能會進一步顯示腦霧在大腦中的表現(xiàn)。

新冠后遺癥腦霧的治療方法

奧康納在2021年夏天,在他第二次和第三次新冠肺炎發(fā)作之間尋求了治療,此前他看到兒子醫(yī)生發(fā)來的一封電子郵件,在那封郵件里,醫(yī)生列出了一些新冠后遺癥癥狀。

凱爾曼讓他服用復方中藥和養(yǎng)生片劑,旨在減輕炎癥。

凱爾曼說,有證據(jù)表明紅外光也有助于減輕炎癥。

凱爾曼表示,接受他的治療方案的患者在幾周內就可以出現(xiàn)好轉。

“確實有療效?!眾W康納說。

埃里克·翁采取了一種不同的治療方法,這是在研究了這種療法對患有“化療腦”的化療患者的療效后研發(fā)出來的,“化療腦”會引起類似的腦霧癥狀。他能夠通過腦電圖(EEG)檢測患者腦部是否有炎癥。

經(jīng)顱磁刺激(TMS)使用磁場來刺激這些神經(jīng)細胞,幫助其恢復功能。

“根據(jù)我們的經(jīng)驗,當神經(jīng)元活動變慢時,它們只是需要一些刺激?!卑@锟恕の瘫硎?。

凱爾曼相信假以時日,治療可以改善腦霧,但不相信患者自行重新訓練大腦能夠克服癥狀。

“減輕壓力是有幫助的,但以我的經(jīng)驗來看,這還不夠?!彼f。

埃里克·翁指出,良好的睡眠衛(wèi)生很重要,正念和冥想有時也大有裨益。此外,事實證明,進行日?;顒右部梢愿纳拼竽X健康。

他補充道:“與久坐一族相比,每周運動三次到四次,每次30分鐘的人能夠更快地恢復大腦功能。”

但希望病情隨著時間的推移而自行消失也是不可取的。

凱爾曼還說:“大腦炎癥會導致慢性問題,包括早期癡呆癥,而新冠肺炎和癡呆癥之間已經(jīng)存在某種聯(lián)系?!?/p>

因此,盡管他認為這種情況非常緊迫,事態(tài)也很嚴重,但他表示患者不應該感到氣餒。

“人們應該滿懷希望,因為我們有相應的治療方法。”凱爾曼博士表示。

約尼稱,她的病人通常會被轉介給語言病理學家進行持續(xù)4周到12周的認知治療。在每周一次的療程結束之后,患者會再次接受測試,并與他們最初的基線測試結果進行比較,查看病情是否出現(xiàn)好轉。這些患者表示,治療過程中的練習可以幫助他們提高記憶力,增強注意力。

該診所將很快啟動一項臨床試驗,將比較認知療法的療效和為期三個月的阿德拉(Adderall)(聰明藥:Adderall,治療多動癥的處方藥,其主要成分為安非他明——譯注)療法的療效。

與此同時,約尼表示,對一些人來說,新冠后遺癥的癥狀能夠自行消退。但在診所尋求治療的患者通常已經(jīng)出現(xiàn)持續(xù)一年或更長時間的癥狀。(財富中文網(wǎng))

譯者:中慧言-王芳

Corbett O’Connor has contracted COVID three times, beginning with his first bout in April of 2020. A year passed before his second case, and his third was in the fall of 2022.

But it’s only now that the New Yorker is feeling better. His longest lasting symptom—brain fog—is finally clearing up and he’s performing well at his new remote position in construction management.

“I’m coming up on a year out since the last time I had COVID and I’m just now really starting to mentally and physically feel like I’m getting beyond this,” he says.

Doctors are still trying to understand brain fog, which some studies estimate may affect up to 70% of COVID patients, and experimenting with treatments that may improve symptoms for those dealing with it months out from their illness. Studies show those who have had COVID demonstrate measurable increases in brain fog compared to their counterparts—even if they didn’t notice it—but also that those symptoms cleared up around six to nine months later.

Theories on what causes the feeling of brain fog are still up for debate, and treatments vary widely. O’Connor sought treatment from Dr. Raphael Kellman, an internist and functional medicine physician at Kellman Wellness Center in New York, last summer. Kellman treats patients based on the idea that inflammation of the brain causes these symptoms.

“Brain fog is a very prominent issue, recall, feeling out of it, and the number one issue is chronic inflammation,” Kellman says. “The immune system has just not shut off and it’s in a constant hyperinflammatory state.”

Doctors at the University of Pittsburgh Medical Center have taken a different approach with their Post-COVID-19 Recovery Clinic, launched in November of 2020. They say the cause of brain fog in COVID patients has not been determined with conclusive evidence. Doctors have instead focused on treating the symptoms in more than 500 patients with long-haul COVID.

“Probably the most common complaints we see patients for are for decreased exercise tolerance, sometimes with a shortness of breath,” says Karla Yoney, a Senior Advanced Practice Provider for the UPMC Post-COVID-19 Recovery Clinic. “Brain fog is probably second most common as well as fatigue.”

Those with brain fog are typically referred to speech therapists for cognitive rehab where patients go through a battery of brain exercises week after week to get things working smoothly again.

“We’re focusing on symptom management,” says Yoney. “Bottom line is we can’t even really speculate if it’s inflammation until we have enough data across the board.”

Long COVID brain fog symptoms

O’Connor first noticed something wasn’t right when he returned to work. Suddenly, all he could manage to do was put in a full day before coming home and heading to bed. Simple tasks took longer, and colleagues noticed he was missing things here and there.

“It was relatively simple things, like I’d leave somebody off of an email thread or someone would say ‘do you know forget to attach a document?” he says. “It was embarrassing.”

Outside of work, he realized his chess game was suffering. He often plays with his son but after contracting COVID, he needed a handicap if he wanted a shot at winning a game.

Doctors say brain fog is defined by short-term memory loss and trouble concentrating. Some might feel confused as well. Like the name suggests, patients often feel as if they’re having to take more time and effort for the same tasks the way a driver might when navigating a heavy fog on the roads.

“Memory, name recall, confusion, trouble concentrating, etc,” Kellman says. When patients come to him they’ve often identified COVID as marking the start of their symptoms, but he believes there are many patients out there struggling without realizing what kicked off their symptoms.

“Some realize they developed this after COVID and some don’t make that connection,” he says. “Sometimes they have an autoimmune disease and you don’t know if it developed from the COVID, but usually you can see the timeline.”

In short, there’s a lot of overlap between long COVID and autoimmune disorders, Kellman says. He looks at it as a web of issues, and depending on what the patient knows about their own symptoms it may or may not be diagnosed as long COVID.

“Sometimes people complain about processing speeds or being more forgetful, trouble with focus and attention and concentration—these are kind of the hallmark symptoms,” says Dr. Erik Won, president and chief medical officer at Wave Neuroscience in Newport Beach, California.

What causes Long COVID brain fog

Some doctors agree brain fog is the result of inflammation of the brain, which happens when the body works in overdrive to fend off viruses such as COVID. It’s unclear why some experience brain fog and others don’t, but many patients complaining of the symptoms are assumed to have inflammation.

There are ways to test for certain, but many of these tests are costly and unnecessary, says Kellman. Some tests look for interleukins and cytokines, small proteins in the blood produced by the immune system which causes inflammation.

Instead, many doctors opt to treat brain fog as inflammation, which can also affect the microbiome in the gut and lead to autoimmune disorders, Kellman says.

“So these are the underlying issues and if you address these people can get better—and they do—you just have to know what’s going on,” he says.

Yoney says the causes are still not clear. Instead, patients can self refer to the clinic for long haul COVID symptoms, which they define as symptoms lasting for more than two months after an initial bout of COVID. Patients who complain of brain fog during this time period are first tested at the clinic for thyroid and B12 levels to confirm that feelings of fatigue, for example, are not part of another underlying issue. From there, those with brain fog might undergo some cognitive tests to confirm deficiencies. Many patients also undergo an MRI, but so far Yoney says those with brain fog do not show signs of damage.

“The good news is when patients come in, depending on red flags and symptoms, we’ll sometimes order head imaging before they get to neurology,” Yoney says. “I have not found structural changes. These are normal head CTs and brain MRIs, which is reassuring for the population, but I can’t speak to functional scans.”

Yoney explains that functional scans might reveal more about how brain fog manifests in the brain.

Long COVID brain fog treatments

O’Connor sought treatment in the summer of 2021, between his second and third bout of COVID, after seeing an email from his son’s doctor listing some symptoms of long haul COVID.

Kellman started him on a course of herbal compounds and supplements aimed at reducing his inflammation.

Dr. Kellman says there is some evidence that infrared light can help reduce inflammation as well.

Patients on his regimen have seen improvement in a matter of weeks, he says.

“I definitely saw results,” O’Connor says.

Won performs a different kind of treatment on his patients, one developed after studying its effectiveness in chemo patients suffering from “chemo brain,” which causes similar feelings of brain fog. He can test for evidence of inflammation with an electroencephalogram, or EEG.

Transcranial magnetic stimulation (TMS) uses magnetic fields to stimulate those nerve cells, restoring function.

“When neurons slow down, in our experience, they just need some stimulation,” Won says.

Kellman believes time and treatment can help combat brain fog, but doesn’t believe there’s a way to retrain the brain on your own to overcome the symptoms.

“Stress reduction helps, but in my experience it’s not sufficient,” he says.

Won says good sleep hygiene is important, and mindfulness and meditation can sometimes help as well. Plus daily activity is proven to improve brain health.

“Thirty minutes of activity three to four times a week can help restore function faster than someone who is sedentary,” he adds.

But hoping that the condition resolves with time isn’t advised either.

“Brain inflammation can lead to chronic problems, including early dementia, and there is already a link between COVID and dementia,” Kellman adds.

So while he views the condition as both urgent and serious, he says patients shouldn’t feel discouraged.

“People should feel hopeful because there is treatment,” Dr. Kellman says.

Yoney says her patients are typically referred to a speech pathologist for cognitive therapy lasting between 4 and 12 weeks. After those weekly sessions, patients are tested again and compared to their initial baseline testing to show improvement. These patients say that the exercises they learn in therapy have improved things like memory recall and their ability to focus.

The clinic will soon launch a clinical trial comparing the effects of cognitive therapy to a 3-month treatment of Adderall to compare the effects of each.

In the meantime, Yoney says that for some, long-haul COVID symptoms can resolve on their own. But patients who seek out care at the clinic have typically been dealing with symptoms for a year or more.

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