COVID19 survivors reporting neurological & mental health issues

Neurocognitive testing, psychiatric evaluation, and diagnostic imaging of COVID19 survivors should be continued for at least six months even after recovery, writes Dr Dhanashri Chonkar

About Author: Dr Dhanashri Chonkar, Consultant Neurology, Fortis Hospital Mulund. Dr Chonkar completed her Internal Medicine training from Lokmanya Tilak Municipal Medical College & Hospital. With more than 25 years of experience, her areas of expertise include Brain, Spinal cord, nerve disorders such as Cerebrovascular Disease, Stroke and Demyelinating Diseases of the central nervous system.

It has been observed that COVID19 seems to have a greater long-term impact on brain health, especially among those on ventilator support and the elderly. A recent study published by the National Institute for Health Research (NIHR), Oxford, analyzed the data of 2,36,379 patients, which provided evidence of substantial neurological and psychiatric impact, six months after COVID-19 infection! The research also highlighted 17% patients displayed anxiety disorders, 14% showed mood disorders, 7% were prone to substance misuse disorders and 5% reported Insomnia!
Last year when the pandemic took its peak, quite a few patients with COVID19 whose symptoms were initially mild, developed long-term neurological problems that were referred to as ‘brain fog’. While there was no strong evidence at that time, researchers around the world continued to dig deep into this subject. Now there are several studies that have made the link between COVID19 and increased risk of neurological disorders.
This report has raised questions in the minds of the people on whether COVID19 will leave a permanent scar on their health, mind and body! I would like to highlight that people who have been in the ICUs for COVID19 treatment, and especially the elderly population affected by COVID19, have experienced neurological & mental health problems. I have seen at least 20% of my COVID19 patients reporting such problems and it is certainly a cause of concern. We have noticed brain strokes, post-COVID infection neuropathies (Guillian-Barre Syndrome). Worsening of pre-existing Dementia or worsening of Parkinsonism symptoms is commonly encountered; most times these patients make full recovery once the infection subsides, but often it prolongs.
How does a respiratory disease lead to neurological and psychiatric effect?
 According to reports, 86% of mild COVID19 patients experienced loss of smell. Besides the hallmark symptoms of COVID, such as fever, cough, shortness of breath, Diarrhea, etc., many people experience symptoms related to their brain & nervous system, including dizziness, headache, debilitating fatigue, and brain fog (which is trouble remembering), learning & concentrating While symptoms tend to go away once they recover, some COVID survivors experience long-term effects.
On the mental health front, these effects do not have direct manifestation but are more of the aftermath of the disease. With a COVID diagnosis, people tend to get stressed and anxious about their health & safety. Findings from the latest study emphasize the need for mental health services for the large number of people who may be experiencing symptoms. These symptoms are more pronounced in patients with Hypoxia (deprivation of oxygen).
How does one identify neuro and mental health symptoms in COVID recovered patients? 
The common neurological problems include:
  • Headaches
  • Dizziness
  • Impaired consciousness
  • Uncoordinated muscle movements
  • Seizures, and strokes
  • Post-Intensive-Care Syndrome, which comprises cognitive, psychological, and neurological symptoms
  • Anxiety
  • Sleep difficulties
  • Depression
  • Post-Traumatic Stress Disorder (PTSD)
Neurocognitive testing, psychiatric evaluation, and diagnostic imaging even after recovery should be continued, for at least six months.  Apart from this, there is a need for a strong support system for patients and their caregivers.
Living through a potentially deadly illness, especially in situations where the illness was severe or has required hospitalization, can provide some people with a renewed outlook on life. But care at home must be taken. Besides regular screening, medication and follow-up, there should be some amount of exercise prescribed to such patients. It is suggested if patients can involve them self in activities like gardening, aerobics, music therapy, watching comedy, or practice some yoga. The involvement of caregivers in this will matter the most. Isolation, prolonged and difficult illness does cause a lot of mental stress. If an exercise regime is prescribed this will help patients to overcome their physical and mental problems.