The new COVID-19 disease caused by the SARS-CoV-2 coronavirus has had an enormous health, economic and social impact. The arrival of the first large wave of positive individuals posed a healthcare challenge given the significant number of cases that developed severe respiratory complications, eventually leading to a fatal outcome.
Throughout the months that have accompanied this period of pandemic, both the capacity to react and the capacity for care, approach and treatment of this new disease have undergone a series of changes as a result of the accumulated knowledge.
What have we learned about COVID-19 in these months?
In general, we know that a significant percentage of cases are totally asymptomatic or have mild symptoms, similar to those of a cold or flu. In contrast, a not insignificant proportion of people develop a symptomatic picture that includes multiple manifestations of variable severity.
Symptoms similar to those of any influenza and/or respiratory process (fever, cough, muscle and/or joint pain, fatigue, dyspnea) are the most frequent, but another spectrum of symptoms can also be part of the manifestations associated with COVID-19. These include loss of smell and/or taste, extreme weakness and fatigue, headache, hair loss or alopecia, and even skin reactions, among other manifestations.
Finally, a smaller proportion of cases develop an extremely severe picture mediated by the inflammatory response, or cytokine storm, which may be associated with the need for mechanical ventilation, ICU admission, thrombosis and even death.
Apart from all these symptoms, which are now well known, the pandemic caused by SARS-CoV-2 has taught us, over time, other consequences derived from both the infection and the suffering of severe or very severe symptoms. These include the conditions currently known as NeuroCOVID and postCOVID syndrome. In both cases the pictures refer to the associated neurological and neurocognitive manifestations, both in the acute phase of the infection and in the phase following remission of the central symptoms, and also when the diagnostic tests are negative.
What do we know about neurological and neuropsychological problems in COVID-19?
Approximately 85% of people infected with SARS-CoV-2 may have neurological symptoms. The most common are headache, smell and taste disturbances, and muscle weakness. However, in other cases, more severe cases have been described, with significant involvement of the central and peripheral nervous system. This includes toxic metabolic encephalopathy, inflammatory encephalopathy, parkinsonisms, cerebrovascular accidents, polyradiculopathies, confusional syndromes or neuropathies, among others.
At the neurocognitive level, many of these conditions can have a significant impact on the normal functioning of different cognitive processes, thus associating possible manifestations in the form of alterations in memory, attention, concentration, motivation or mood, among others. These neurocognitive symptoms are not a direct consequence of SARS-CoV-2, but are sequelae of complications related to the disease.
At the same time, it is well known that patients who, for whatever cause, require long periods of admission to intensive care units, can present acute confusional symptoms characterized by the development of episodes of disorientation, hallucinations and disconnection from the environment and that, up to 6 months after discharge, they usually present significant complaints related to cognitive functioning.
On the other hand, the psychological follow-up of people who have overcome the disease has shown us that, with some relation to the severity with which they have suffered from COVID-19 (although not in all cases), many people persistently present (and once the disease has been overcome) a set of neurocognitive and affective manifestations that have a significant impact on daily functioning. In these cases we speak of the still little known post-COVID syndrome, which can be associated with an amalgam of cognitive symptoms of varying severity. These include memory loss (especially short-term memory), problems with attention span and distractibility, difficulty in starting new tasks, sleep disturbances or changes in character and mood.
Although to date we do not have a model that explains exactly how COVID-19 causes these symptoms, they must unquestionably be properly considered and evaluated for the sole purpose of determining the severity of these symptoms and implementing therapies aimed at rehabilitation and recovery of normal functioning.
What can we do about post-COVID neuropsychological symptoms?
It is very likely that, in most cases where these symptoms occur in a mild form, the passage of time and the reinstatement of daily habits, are related to a progressive resolution.
In cases where symptoms are more severe and/or persistent over time, neuropsychological evaluation will be a necessary tool to determine both the level of impairment or severity, as well as the set of cognitive processes that may be compromised. With this, neuropsychology professionals will be able to determine whether cognitive impairment is present. In addition, they will also be able to plan the necessary specific interventions aimed at trying to restore normal cognitive functioning as quickly and efficiently as possible.