Long COVID brain fog clears up in the majority of people who have it, but lifestyle practices can help, Dr. McAlpine says. For instance, “exercise is one thing we know boosts cognition in most individuals, even in patients with dementia,” she says.
But it’s important to approach exercise carefully, especially for people with certain conditions, including myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) [a neuroinflammatory, neuroimmune illness most commonly triggered by infection, causing severe fatigue and other symptoms]. “Individuals with ME/CFS after COVID-19 can also experience brain fog and should take precautions when exercising, most importantly avoiding post-exertional malaise [PEM] by pacing and working closely with their physical therapy and medical teams,” she says. (PEM is fatigue and worsening of symptoms after physical and mental exertion.)
“There is also a mood component, which is important,” Dr. McAlpine adds, explaining that many people with brain fog symptoms also experience depression or anxiety, and those who had mental health conditions before may notice them getting worse. “But, if a mental health problem is diagnosed, it needs treatment.”
In addition, Dr. McAlpine says many of her patients have responded well to two medications—N-acetylcysteine (NAC) and guanfacine.
In 2020, Arman Fesharaki-Zadeh, MD, PhD, a Yale Medicine behavioral neurologist and neuropsychiatrist, discovered that the medications could help Long COVID patients with brain fog, when he realized that one of his Long COVID patients was having cognitive symptoms that were similar to patients with a history of traumatic brain injury (TBI) who were suffering from post-concussive syndrome. NAC was being tested for the treatment of TBI and also helped with cognitive deficits. He added guanfacine, which was developed by Yale neuroscientist Amy Arnsten, PhD, and had been used to treat ADHD.
The two published a small study in the Nov. 2023 issue of Neuroimmunology Reports, and now researchers are hoping for funding for larger clinical trials. In the meantime, NAC is available over-the-counter, and patients may be able to get a prescription for guanfacine off-label from their doctor.
“There has also been evidence of COVID vaccines helping with Long COVID symptoms like brain fog, but there are no guarantees,” Dr. McAlpine says. “We had many patients in our first wave of COVID who had bad brain fog after COVID, and their symptoms improved with their first vaccination. But I’ve seen that happen less lately, possibly because more people are vaccinated. That may have been more of a ‘first wave’ phenomenon.”
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