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Severe COVID May Speed Up Cognitive Decline: Experts Explore Routes of Care

Therapist listening to patient

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Key Takeaways

  • New research into the cognitive effects of severe COVID-19 comparable to 20 years of aging.
  • Mental health practitioners see themselves as having a key role in supporting survivors
  • The disconnect between the timelines required for rigorous science and the material needs of patients puts health practitioners in a difficult position

The pace of COVID-19 research has been as dizzying as it has been vital in the current moment, but there is growing evidence that the effects of the illness can have long-lasting impacts on patients’ cognitive abilities.

Recent work by a team of British researchers, published in the journal eClinical Medicine, found that cognitive function loss was comparable to that typically seen as a person ages from 50-70 years old. But this is just the tip of the iceberg.

While those behind the study highlighted a number of areas of further inquiry, including tracking patients across a longer timeline, mental health practitioners and researchers say that their field has a significant role to play in supporting COVID-19 survivors. 

Mental Healthcare for COVID Survivors is Vital

The study, published in eClinical Medicine and publicly available from The Lancet, saw 46 patients undergo continued cognitive testing both during and after hospitalization in the early stages of the pandemic.

The results, in the words of the researchers, show that “severe COVID-19 illness is associated with significant objectively measurable cognitive deficits that persist into the chronic phase.” According to experts in the mental health field, psychological support is vital to survivors as their slow and uncertain recovery continues. 

Dr. Dean Aslinia, PhD, LPC-S, NCC, is an associate dean with the College of Social and Behavioral Sciences at the University of Phoenix. He says that with trauma existing on a “continuum,” a continuum that can be varied when it comes to the collective trauma of the pandemic, it’s important for practitioners and patients to begin by addressing any underlying or related mental health issues before they begin to build back cognitive function. He says it’s very rarely just COVID-19's direct bodily impact that is weighing on those who have survived the illness and are experiencing cognitive deficits. 

Dr. Jessica Borelli, PhD

I think people might assume ‘Okay, after the two weeks are up, after someone's symptoms are gone, the person's need for social support has reduced.’ But that's really a mistake. Because that's when the hard psychological work begins—when the acute physical symptoms end.

— Dr. Jessica Borelli, PhD

“The traumas, the anxieties, the depressions, the griefs, those need to be addressed first, then we move into the rebuilding. Because otherwise there are going to be hurdles and hindrances in that pathway. It's kind of like you're injured, but you're trying to get strong again. And that injury is going to keep popping itself back up because your body's not well enough to become stronger,” says Dr. Aslinia.

It’s a sentiment also held by Dr. Jessica Borelli, PhD, an associate professor of psychological science at the University of California-Irvine as well as a licensed psychologist. She says that we, as a society, often make false presumptions about when mental health care should begin and end, something that she says can actively harm people recovering from COVID, even if they appear past the direst symptoms. 

“I think people might assume ‘Okay, after the two weeks are up, after someone's symptoms are gone, the person's need for social support has reduced.’ But that's really a mistake. Because that's when the hard psychological work begins—when the acute physical symptoms end… in a sense, they need social support more than ever. So, having a withdrawal of social support at that time can be really, really, painful for a person.”

Timeframes and Politics Pose Challenges for Practitioners

Throughout the study, the researchers highlight that more work needs to be done in order to confirm the cognitive decline that they identified in the research subjects who were severely affected in the relatively early stages of the pandemic.

Dr. Steven Pratt, MD, a senior medical director for Magellan Health and the former executive medical director for behavioral health in the Minnesota Department of Human Services, says that these long timeframes present challenges for mental health practitioners because it takes a significant amount of time for what a professional may be seeing in a clinical setting to be reflected in the literature. 

“We have a lot that we don't know, and it's going to take us a while to have the scientific knowledge that verifies or doesn't verify what we’re hearing, anecdotally, from people's experiences,” says Dr. Pratt.

Steven Pratt, MD

We have a lot that we don't know, and it's going to take us a while to have the scientific knowledge that verifies or doesn't verify what we’re hearing, anecdotally, from people's experiences.

— Steven Pratt, MD

Another barrier that Dr. Pratt sees for practitioners is the politicization of public health that has coincided with the rise of COVID, particularly when it comes to prevention. He leans into the belief that “an ounce of prevention is worth a pound of cure,” but that for the prevention to be effective it must be a communal effort.

“Somebody who has arthritis, for example, might be on immunosuppressive drugs and we don't know who that is when we're standing in line in the grocery store. And so, the idea of attending to our communities' safety is, I think, a public health measure. Unfortunately, it became a political ideology during this pandemic.”

Mental Health Benefits for Survivors Require Continued Support

Despite the roadblocks to care, Dr. Borelli reiterates that mental health care is key to the recovery of COVID-19 survivors and for that care to be a continued practice. 

“The first thing I would say is that it's important to be actively assessing your own reaction to the experience. The reaction that you're having can be related to the severity of the symptoms that you're having. So, if you're really struggling in terms of your physical health, there might be a greater likelihood that you're also going to suffer in terms of your mental health.”

Dr. Pratt, meanwhile, suggests that what he calls “positive health practices,” the day-to-day health maintenance of doctor-suggested exercise, diet, and sleep, be combined with a heavy focus on social interaction. It’s an aspect of mental health that he feels has been neglected since the early days of the pandemic. 

“I think it was just such a disservice at the beginning of the pandemic when they said that what we needed to do was social distance. We didn't, we needed to physical distance and stay socially connected.”

Dr. Borelli says that one of the benefits of psychological support for COVID-19 survivors is to provide space and tools to be able to imagine different futures from the one that may feel both dire and inevitable. She feels this is especially true with the unknowns that come with ongoing research into the long-term cognitive effects of COVID-19.

“I think one of the things that can happen is when you start to feel like, ‘I've lost something, I'm locked into a future that's more dismal than what I had before. This loss is permanent and it's really depressing and dark.’ And what we can try to do, as clinicians, is try to present different ways of looking at the experience that the individual’s having.”

What This Means For You

While the research surrounding COVID-19 and cognitive decline is constantly evolving, current thinking points to the condition significantly impacting function. Meanwhile, mental healthcare practitioners see a significant role for their services when it comes to supporting survivors.

1 Source
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  1. Hampshire A, Chatfield DA, MPhil AM, et al. Multivariate profile and acute-phase correlates of cognitive deficits in a COVID-19 hospitalised cohorteClinicalMedicine. 2022;47:101417. doi:10.1016/j.eclinm.2022.101417