Does Covid-19 affect the brain? Answer is a resounding yes…focus on nutrition, physical activity and positive outlook

Why Dr Srivastava: Since many patients experience persistent health problems even after recovering from COVID-19— including critical illnesses, severe headaches, and brain fog — have raised concerns about “long-term Covid.” As director of the AIIMS Neuroscience Center, Dr. Srivastava is at the center of the country’s efforts to identify the reasons, impact, and solutions for some of these long-term health problems related to COVID. The eminent neurologist is also known for pioneering the Acute Stroke Program (Code-Red), a medical initiative to support patients suffering from stroke and epilepsy.

We are learning about “long Covid” as we go. What has science learned so far about the impact of Covid-19 on the brain?

A lot. But we don’t yet have all the answers to all the questions; It is a work that is still in progress. The story is still unfolding. However, I think we have some definitive answers. If the question is, does Covid-19 affect the brain during the infection process and after the infection has subsided? So the answer is a resounding yes.

But beyond that, the spectrum of how the brain and nervous system are affected during covid infection, and even more so after infection, now known as “long covid,” is an evolving science. There has been a lot of interest and research on how it affects the brain and nervous system… There is also a conundrum of mental health problems, which can affect how a patient can present their complaints, and what is the spectrum of the diseases that can be. So, in the long term, how it’s going to be, in terms of memory and degeneration, is still under investigation. As of now, a very interesting type of information is being collected. It is a completely new platform. We have some answers about how it would affect the brain during infection and also after infection.

We have brain scans of “long covid” patients in the UK who had very mild disease revealing tissue damage and gray matter shrinkage. There is also some evidence of brain shrinkage. Do we know if these findings really mean anything for a patient’s quality of life?

At this point, I would say no. But then again, she would go back to the disclaimer that it’s still a work in progress. Actually, it is this group that we are trying to study over a period of time: six months, one year, two years from now. This research is not just in the UK or India. This is a multi-center, multinational effort, incorporating the caveats of race, ethnicity, and geographic uniqueness. It will help to better understand this spectrum.

Do they develop some memory problems later, do they develop any degenerative diseases? we don’t know Perhaps this hypothesis is wrong. But with that said, this is what is being investigated. Right now, however, this brain shrinkage means nothing. It doesn’t mean that person is going to end up with a major problem. We have no evidence to say that they would be affected. The process of understanding is still going on. Maybe we’ll find out a couple of years later.

Could these brain changes make Covid patients more prone to other neurological deficits or dementia in the future?

That is what is being investigated. I hope not. But the changes that are occurring clinically are correlating with long-term serial evaluations: are you still having headaches, are you still having memory problems? There are scales that have been developed to address these issues. There are certain clinical scales through which we will know if there are subclinical or very subtle memory problems. So, we’ll know the answers later. It’s too early to say that right now.

There are some articles that suggest an association between covid-19 and stroke, even in younger people. Can Covid-19 cause a stroke?

There is a vertical pathogenetic mechanism that suggests that Covid-19 infection can cause increased coagulation in the brain and thus cause clots in the arteries and stroke. This has been seen across the board, but generally in the elderly and in people who had comorbid conditions such as diabetes, hypertension, and chronic smokers.

But there have also been some case reports of young men, who had sudden clots in large vessels causing strokes, without any other vascular risk factors. In fact, at AIIMS we saw cases of people who had pneumonia or a fever, and who had just arrived with a stroke and turned out to be Covid positive. They had bleeding in the brain. There were ruptures of blood vessels. Some of them didn’t even have blood pressure.

We now have very large data that has come in from New York and Europe. There have been groups that have looked at this vast amount of data and found that yes, Covid-19 did cause a stroke. But overall, if you looked at the whole spectrum, it didn’t seem like a huge increase. It was not like that, it was the only predominant complication with Covid-19.

But the important thing is that there are now ways to prevent that from happening. That has evolved. There were some biomarkers… We found that if these levels are very high, we can anticipate things. We can institute some therapeutic mechanism such as an anticoagulant drug and overcome certain cases.

We have also come up with certain precautionary measures, in terms of how much physical activity you can do when inflammatory markers are high after Covid. All of these things have evolved and we can prevent these problems and ensure that a person has a normal recovery.

So when should you see a specialist?

So let’s talk about headaches. The common migraine is an extremely common phenomenon. What is important to note is when the character of the headache changes. If I go out in the sun, or if I haven’t eaten, my head hurts; that’s not the thing. But if there is a change in frequency and intensity, consult a specialist.

Second, see if there is an onset of a new type of vertigo. When you’re recovering from a viral illness and feel weak or fatigued, you probably need some supplements. There is also bodily fatigue. For this, you can only go to a general practitioner. But if the vertigo is such that every time you change position you have a lot of palpitations, you feel dizzy and almost want to fall and lose your balance, then see a specialist.

And if there is a kind of general feeling that I am not as sharp as I was before; I’m forgetting things… Generally, when there are complaints of forgetfulness, we dig deeper. If you tell me you’re not as smart as you used to be, you make a to-do list because you tend to forget. That’s usually not so much a disease process. When this forgetfulness is impacting your day to day life, especially financially, then you need to go to a specialist. That brain fog is probably different.

Any type of weakness, that is on one side, or anything that is abnormal in terms of loss of sensation, loss of power, loss of balance, then go to a specialist. Apart from that, you can be under the supervision of a general doctor and probably take some course of supplements, focus on nutrition, gradually increase your physical activity and maintain a positive attitude. That would help you get through the long Covid.

How do you manage the symptoms of brain fog?

Brain fog is a very vague term. It’s essentially a constellation of features that have prevented you from doing those tasks or sequences of tasks, or multitasking, or things you previously took for granted. Or you don’t have the attention span, foresight, or insight to figure things out. That is a kind of executive dysfunction, a kind of confusion. It is usually associated with some mental health problems and sleep problems.

First, if it impacts your daily life, go to a consultation because it is possible that we are missing something. You may need tests or neuroimaging. Second, doctors may give you some supplements along with your normal nutrition. Third, a little advice can help if the rest is fine. Because the brain and the mind are so intricately involved that sometimes it’s hard to tell them apart.

Fourth, it is a positive outlook. Being with friends, connecting, sleeping well, regularizing your lifestyle. These things will definitely pass. It’s just a matter of time.

You mentioned neuroimaging. There are people who undergo brain MRIs. Is that necessary? What are the tests you would recommend?

I generally don’t recommend too much testing. It really doesn’t make sense to embark on expensive, high-level investigations for every case. Many Covid infections would probably do nothing at all. But when they have complaints, as I’ve told you, some of the red flags that we just listed, the red flags where you need to go to a specialist… And when you actually go to a specialist, they may recommend neuroimaging after they examine you … For every headache, or every time you feel fatigued, you don’t need a barrage of tests; you do not need an MRI at all. It is only for certain specialized situations when there is a problem that has been detected.

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