‘I seem to have lost IQ points’, says neurologist who researches and suffers from long-term Covid

While preparing to recruit dozens of people for a long-term scientific research on Covid in the coming months, neurologist Clarissa Yasuda divides these professional commitments with a routine of her own to deal with the consequences of the disease, which she had in August 2020, in your brain.

“I didn’t go back to normal, I didn’t go back to my pre-Covid from a cognitive point of view, involving attention, agility, flexibility… After a year and a half, I think I recovered 30% to 40% of what I lost. But I didn’t recover 100 %, I’m not the same person. Looks like I lost some IQ points [quociente de inteligência]”, says the 46-year-old neurologist, professor at the Faculty of Medical Sciences at the State University of Campinas (Unicamp).

“It’s a very thankless disease. After a year and a half, with a lot of effort, a lot of discipline, combining a lot of things, I got a little better. I have an anxiety that I won’t fully recover (cognitive abilities), but I’m resigning myself to that possibility.”

Yasuda acknowledges that her work allows her to “notice very subtle differences” in her cognitive abilities and functions. “I’m seeing both sides”, summarizes the neurologist, referring to her professional and personal experience in facing the long Covid.

“Cognitive dysfunctions” are one of the manifestations of Covid-19 according to the definition of the World Health Organization (WHO) for “post-Covid”, another name given to this set of consequences of Covid-19 – which can also include fatigue and lack air, among others.

Also according to the WHO definition, these symptoms usually appear within three months of the onset of Covid-19 and last for at least two more months.

“Symptoms can recur after initial recovery from the acute phase, or persist from the initial illness (Covid-19). They can also fluctuate or recur over time,” says the WHO.

Researchers around the world have been dedicated to understanding specifically how and why Covid-19 can leave consequences on the nervous system, even in people who were fully healthy before the disease and who had mild cases.

Studies, including some in which Yasuda participated as a co-author, have demonstrated this neurological impact through patient reports, imaging tests, cognitive tests, and autopsies (read more below).

a new routine

Yasuda says that when he had Covid-19 in 2020, the disease was mild, without respiratory symptoms, but with dehydration and gastrointestinal problems.

The discomfort came even later, with daytime sleepiness, fatigue, memory difficulties and difficulties in performing the same volume of tasks that she was used to doing before.
Faced with these new challenges, the neurologist says she has been trying to respect her limits and make adaptations, such as sleeping from 1 to 1:30 hours more than she did before Covid-19, as she has been feeling much more tired.

When he knows that he will need to do an activity with a very high intellectual demand, like working with statistics, Yasuda prepares for it — ensuring that he arrives refreshed and with plenty of time to complete the task.

The doctor also says she “believes that physical activity helps the brain”, so she intensified her exercise routine. She currently practices pilates, weight training and swimming, as well as running occasionally.

Swimming, which she has “always practiced”, is now part of her training with a snorkel. The doctor warns that this is an experiment that she is doing individually and that it still needs more scientific studies, but she starts from the hypothesis that hypoxia (decreased oxygen) can improve the activity of the hippocampus, a part of the brain essential for memory, among other functions.

Yasuda has also been exchanging information and ideas with a psychiatrist friend who is also suffering from the cognitive changes of the long Covid, in addition to imposing some challenges and goals for the day.

For a few weeks, she used the Lumosity app, which has memory and math games and also a book of logic puzzles bought in the United States.

Yet the neurologist feels frustrated with her current situation. “Before, I could do several things at once. Now, I have to finish one task to start another one,” she laments.
“I’ve been missing a lot, projects that I wanted to finish writing and that I can’t.”

What the studies say

In late January, two neurologists published in the scientific journal Science a review of what is known about the effects of Covid-19 on the nervous system.

Avindra Nath, from the US National Institute of Neurological Disorders and Stroke, and Serena Spudich, from the Yale School of Medicine, pointed to problems with concentration, headache, sensory disturbances (such as loss of of smell and taste), depression and “even psychosis”.

The authors also stated that it is “uncertain” how long these problems can last over the years.
The article cites some studies that performed tests on the so-called cerebrospinal fluid (CSF) and found evidence that the brain is affected by the new coronavirus more by an exacerbated response of the body, in inflammation and antibody production, than by the direct attack of the virus on the body. organ.

MRI analyzes also showed that some people with covid-19 had ruptures in the small vessels that supply blood to the brain, while CT scans showed a reduction in metabolic activity in patients with long-term covid.

In December 2021, Clarissa Yasuda and colleagues from Unicamp published an article in pre-print (that is, without the review of other scientists) with the analysis of the situation of 87 patients treated in Campinas (SP) who had mild Covid-19 .

Two months after infection, the most reported symptoms by patients were fatigue (43.7% of respondents), headache (40%) and memory difficulties (33%).

In the neuropsychological assessment, carried out through tests and questionnaires, the researchers detected symptoms of depression in 18% of the participants and anxiety in 29%.

Analyzing MRIs, the researchers also found changes in the brain (more specifically in the so-called fractional anisotropy, which has to do with the displacement of water molecules in the white matter tracts) associated with problems with attention and cognitive flexibility.

These are just initial results of investigations by Yasuda and his team into the impact of long-term Covid on the nervous system – they have already evaluated more than 500 people, have partnerships with research groups in Europe and estimate that their studies on the subject will extend over the next few years. five years.

The neurologist recently had a project approved to test rehabilitation protocols, but is awaiting confirmation of funding from the federal government. Volunteer recruitment should start soon.

The concern that Yasuda already had about the impact of long-term Covid on the workforce and on the demand for assistance and rehabilitation has increased because of the omicron, a highly transmissible variant that has been causing new records of infection in the pandemic around the world.

“I hope that this mild picture of the onomicron does not have any late involvement of neurological manifestation, because if it does, the number (of people impacted) will be very large.”