Brain fog is an umbrella term that is used to describe trouble concentrating and memory problems to more severe neurological complications such as dementia and psychotic disorders. Brain fog has also linked to COVID-19 infections.
Anyone is at risk of developing brain fog, but the risks are higher in people with comorbidities or cognitive decline.
Video game therapy is an accessible and easy-to-understand alternative to conventional therapy that may improve COVID-induced cognitive deficits.
A small percentage of people seem to never fully recover from COVID-19. Dubbed ‘long-haulers,’ these patients continue to experience symptoms such as loss of taste and smell, fatigue, insomnia, and headaches, for weeks—if not months—after infection. Some people also have trouble with memory and concentration. While there’s been limited research on the causes of this effect of COVID-19, there’s been even less on how to treat it.
But a collaboration between start-up company Akili Interactive and a series of research institutions, including Vanderbilt University Medical Center, is intended to address the gap in an innovative way: by using video game therapy to improve cognitive impairments—or "brain fog"—in post-COVID long-haulers.
What Is Brain Fog?
The Centers for Disease Control & Prevention (CDC) defines brain fog as having difficulty thinking or concentrating, and lists it as a possible lingering symptom after recovering from COVID-19 infection.1
But Jim Jackson, PsyD, Director of Behavioral Health at The ICU Recovery Center at Vanderbilt and co-investigator on the video game study, tells Verywell it can be more than that. Brain fog can also include confusion and a slowed ability to process of information. Part of the challenge is there's no official definition for what constitutes brain fog and what dose not, making it difficult to diagnose and treat the condition clinically.
Some people with COVID-19 demonstrate cognitive impairments. A February study published in the journal Neuropsychopharmacology found that 81% of hospitalized COVID patients exhibited cognitive symptoms after recovery.2 A more recent study published in The Lancet Psychiatry in April found that about 1 in 3 people will develop a neuropsychiatric condition within six months of having COVID.
“People show up at the clinic thinking they understand what's being said, and they might think their issue is memory problems, but it could also be attention deficits," Jackson says. "So, we're beset by a lot of imprecision when people use the term.”
How Can Video Games Help?
Using video games for therapy isn’t a novel concept—it's also been used to treat ADHD. The new research, however, is the first to use video game therapy for COVID-induced brain fog.
Ninja Reflex is effective for treating attention and processing speed, which is why we are transitioning a population experiencing similar symptoms after having COVID-19.
How It Works
AKL-T01 is a digital therapeutic that is already approved by the U.S. Food and Drug Administration (FDA) with additional European certification for use in children with ADHD. The researchers are now looking into testing it out in patients with brain fog. The technology is delivered through a video game on an iPad where patients are given sensory stimuli and motor challenges that activate different parts of the brain that are involved in attention.
We're hoping that this training will leverage processes of neuroplasticity in helpful and powerful ways. — JIM JACKSON, PSYD
Each patient will have an individualized treatment experience based on computer algorithms. The primary outcome that the researchers will evaluate is cognitive function, which will be measured by changes in patients' attention and processing speed.
One concern with using technology-driven therapy is that some populations might not take to it as easily as others. For example, older adults may not be as adept at using video games as their younger counterparts and might exhibit severe cognitive decline related to age.
If brain fog is a problem of the magnitude that we think it is, there is absolutely no way that we could equip enough occupational therapists, rehabilitation psychologists, and speech and language pathologists.
“It is a challenge and something we will have to address to make sure people in the study are sufficiently capable of handling the technology," Jackson says. "We want to test people who can participate fully in the intervention. If they cannot conceive of how to participate in the intervention, then they aren’t necessarily the people we want to study.”
Why Does SARS-CoV-2 Affect the Brain At All? Researchers are still trying to figure out exactly what the SARS-CoV-2 virus—which causes COVID-19—does to the brain, as well as how it does it. While the research is ongoing, several studies have proposed possible explanations for the neurological symptoms some people with COVID develop:
A study published in the New England Journal of Medicine back in February suggests that the SARS-CoV-2 virus indirectly affects the brain through the body’s overreactive inflammatory response and blood vessel injuries.4
A study published in Neuroscience Letters in January showed a lack of oxygen to the brain in the autopsies of people with COVID-19.5
While the research has not consistently shown that the COVID virus has a direct impact on the brain, scientists are not ruling it out. A study published in the Journal of Experimental Medicine in January found evidence of SARS-CoV-2’s presence in the cerebral cortex of three people who died from COVID-19.6
Who Is at a Higher Risk for Brain Fog?
Any person can develop neuropsychiatric effects from COVID-19, but people with a severe infection that requires ICU admission might have a greater risk of developing neurological problems such as delirium.
“People with decreased cognitive reserve [such as people with early Alzheimer’s disease] are probably at higher risk," Jackson says. "But they are by no means the only people at risk. People with preexisting psychiatric issues are, are at higher risk."
Jackson says that COVID-19 can exacerbate symptoms of PTSD, depression, and anxiety disorders, which trickles down to cognitive problems. Additionally, people who have chronic conditions such as diabetes, heart disease, and lupus may have health complications that could erode their cognitive abilities, leaving them more vulnerable to brain damage.
“Unfortunately, many of those preexisting medical comorbidities contribute to preexisting cognitive vulnerabilities," Jackson says. "So, when those people develop COVID-19, they're coming to it with a brain that is already vulnerable.”
Are There Long-Term Risks?
There is not much evidence yet, but Jackson says that experts are skeptical that previously healthy and young people who experience brain fog will manifest long-term neurological disorders such as Alzheimer’s.
However, COVID-19 could be more problematic for older people who are at risk for experiencing cognitive decline—such as people with Alzheimer’s or other forms of dementia—because it can accelerate cognitive impairments.
“I think there’s reason to be concerned for people who are already in the process of declining or have cognitive impairment that has been percolating," says Jackson. "But it hasn't been identified yet following exposure to COVID-19 and critical illness."
Jackson adds that for people who were already at risk, "the [cognitive decline] process was moving slowly and could be ramped up considerably. Dementia that would otherwise have taken a long time could now be fast-tracked.”
The Future of Brain Fog Treatment
Jackson is optimistic about the benefits that video game treatment could offer for people with COVID-induced cognitive impairments at different levels of severity.
“We're hoping that this training will leverage processes of neuroplasticity in helpful and powerful ways,” says Jackson. “And we're hoping that people will experience an acceleration in their symptom improvement and a decrease in their cognitive impairment.”
Beyond video games, Jackson's team is also planning its first cognitive skills group with COVID-19 survivors with brain fog for next month. The sessions are designed as a peer support group and will take place virtually, increasing accessibility for people worldwide. The goal is to address common issues and work together to find solutions for cognitive improvements, as well as to provide a supportive community.
What This Means For You Brain fog is a broad term that is being used to denote cognitive impairments after COVID-19 infection. Anyone, regardless of age and health status, is vulnerable to brain fog. However, the effects are more pronounced in people with preexisting health conditions and those who are already experiencing cognitive decline. If you are recovered from COVID-19 but still have trouble with mental clarity, are unable to concentrate, or have poor memory, talk to your healthcare provider about your symptoms.
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