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First you get COVID, then you get forgetful

Where do problems with concentration and memory following recovery from a COVID infection come from? What are their characteristics and how do they progress? An in-depth study examines those affected in order to be able to answer these questions.

A woman sitting in front of a doctor at his office
© pur.pur

Julius Rave uses special neuropsychological test procedures to characterise brain functions such as attention, concentration or systematic thinking. The detailed examination takes about two and a half hours.

Forgetful, unable to concentrate or exhausted – a coronavirus infection can leave behind traces in the brain from which those affected can suffer for months and even years. Julius Rave, who works as an assistant physician in the Department of Neurology at the University Medical Center Schleswig-Holstein (UKSH), Campus Kiel, is familiar with a number of these cases. "We see lots of people with noticeable disorders in our memory clinics. Each week around five to seven individuals visit our special outpatient clinic. These are not just individuals who had been seriously ill with COVID. They include patients who only had mild symptoms, recovered as outpatients and said that following the acute infection they noticed cognitive problems that significantly restrict their everyday life." Among those mentioned were reduced concentration and attention spans, trouble finding words as well as disruption to short-term memory or the ability to plan. "We hear about ‘slow thought processes’ and ‘brain fog’ relatively often in the memory clinic. And those affected are very worried that they will no longer be able to function as they did before," said Rave, who completed his doctoral degree in the Forschungsgruppe für Demenz, Gedächtnisstörungen und Neuroplastizität (research group for dementia, memory disorders and neuroplasticity, led by Professor Thorsten Bartsch) and is undertaking further training as a neurologist within the Clinician Scientist Program in Evolutionary Medicine (CSEM, led by Professor John Baines) funded by the German Research Foundation (DFG) – see box. The structured programme offers the young neurologist scope for clinical research alongside his work in the clinic.

In view of the large number of people affected turning to the outpatient clinic for help with cognitive disorders, the research group initiated a study in April 2021 to conduct further research into these complaints. For this purpose, at least 100 patients were examined using clinical and neuroradiological procedures and special neuropsychological tests at several intervals following a COVID-19 infection. "Firstly, our objective is to determine the exact characteristics of the cognitive disorders of the post-COVID syndrome. Secondly, we are interested in establishing whether there is a specific group that is particularly affected. And, of course, we are also looking at progression, in other words, when recovery or improvement occurs," explained Rave, who was granted the CANTAB research scholarship 2021 to fund the study. The scholarship was funded by the company Cambridge Cognition, which develops and sells tests for precise and objective measurement of cognitive function. These special tests are used, for example, to find out which areas of the brain are affected and whether the memory disorder is due to a problem with attention and concentration or whether there is also damage in other areas such as the hippocampus, which is critical to memory formation.

"We have put together an extensive series of tests for the patients that test brain functions such as attention, concentration or the ability to plan. We also use standardised questionnaires to assess fatigue and emotional control. Testing takes around two and a half hours per patient," said Rave. Two doctoral researchers, Sarah Brouzi and Henrik Winter, are involved in conducting the tests. Neuropsychologist Dr Annika Hanert evaluates the results. Selected patients then go on to have a magnetic resonance tomography (MRT) scan of the brain. The type of damage and its location can be traced using the MRT images. "If the localisation of the disorder is clear, it is useful to check whether it is a functional disorder or structural damage. In other words, whether it is the ‘software’ or the ‘hardware’ that is damaged," explained Rave.

The crucial question for those affected, whether the brain function will be completely restored at some point, cannot be answered yet, he said. And how long the disorders will go on for is also unclear, said Rave. "Some had the complaints for three to five months, others were affected very early on in the pandemic and have only experienced a very slight subjective improvement one and a half years later."

Author: Kerstin Nees

CSEM advanced training programme

CSEM stands for Clinician Scientists in Evolutionary Medicine. This training model supports the research careers of doctors in evolutionary medicine. It is organised jointly by the Faculty of Medicine at Kiel University, the University Medical Center Schleswig-Holstein (UKSH), the Max Planck Institute for Evolutionary Biology in Plön and the LungenClinic Großhansdorf and is funded by the German Research Foundation.

The programme is designed for doctors in specialist medical training. It offers them specialist training and an independent research career in an innovative field of medicine unique to Germany. The principles of evolutionary thought and research are applied to the fields of antibiotic resistance, oncology, neurology, skin barriers, inflammation, the microbiome and research into ageing. Goals include improving medical training, and in particular the further entrenchment of evolutionary-biological principles in medical research. (ne)

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