Abstract
Objective: We speculate that COVID-19 brain fog is a post-viral syndrome of chronic inflammation that overlaps in clinical characteristics and possibly etiology with similar syndromes in other fields. By studying this group with detailed clinical and research tools borrowed from other fields, we hope to further syndrome characterization, treatment modalities, and understanding of the underlying pathophysiology.
Background: There are emerging reports of a post-COVID-19 syndrome characterized by "brain fog" -- symptoms are diverse and include fatigue, poor concentration, worsened memory and receptive language, difficulty with executive function, insomnia, migraine, orthostasis, neuropathic symptoms, insomnia, among others. Post-COVID brain fog in critically ill COVID-19 patients may evolve from mechanisms such as deconditioning or PTSD. However, reports of COVID-19 brain fog after mild COVID-19 active infection are quickly emerging but remain poorly characterized.
Design/Methods: A Clinical Patient Registry is in development. This registry intends to first clinically characterize the range of clinical phenotypes. The approach includes a cross-disciplinary collaboration with particular interest in reconciling some symptomatic and pathophysiological similarities with myalgic encephalomyelitis/chronic fatigue syndrome (post-viral syndromes), dysautonomia, postural orthostatic tachycardia syndrome, attention deficit hyperactivity disorder, migraine, cognitive dysfunction in neuroinflammatory diseases, persistent post-concussive symptoms, Gulf War Illness, and migraine.
Results: The Patient Registry approvals are in progress. Data accumulation is expected to begin November 2020. Collaboration has been established with ME/CFS, dysautonomia, sleep, and headache divisions, with further input from post-concussive syndrome. Clinical assessments include cross-disciplinary symptom inventories, exam techniques, and studies.
Conclusions: With more than 7 million American survivors of COVID-19 infection, identifying the clinical characteristics and spectrum of post-COVID brain fog is a necessary and important first step towards defining its epidemiology, pathophysiology, and potential treatment paradigms. Aggregate data from the registry may justify future research funding and is a useful tool for academic and private practices to connect COVD-19 brain fog patients with future potential studies.
Disclosure: The institution of Dr. Nordvig has received research support from National Institute on Aging. Dr. Noble has received stock or an ownership interest from NoMo Diagnostics. The institution of Dr. Noble has received research support from National Institute on Aging.
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