Mild cognitive decline reported post-COVID, possibly COVID vaccine
Intro
I want to talk about a medical issue that I care about, because I have met people who have suffered through it, and it has probably affected me as well: Mild cognitive decline after COVID, maybe after the COVID vaccine.
To be more transparent, I myself had COVID in the earliest wave of the pandemic, around April 2020, and about that time I was a medical student studying for STEP 1, the first licensing exam, and I failed after studying for 4 months. I was not formally diagnosed, but I had extreme fatigue, myalgias, slight fever, and recovered after about 1-2 weeks, feeling as though I had a more severe form of the flu. I first noticed something was awry, or off, when I was running by the Charles River and I was slightly out of breath, I had coughed up a bit of green phlegm into the bathroom sink that morning, and for a moment I wondered if my exercise-induced asthma had returned from when I was a high schooler (which I never had recur after regularly doing exercise). I did not go to the hospital or seek any treatment as I did not want to get anyone else sick, so I quarantined at home). I have a history of PCOS (which may be associated with having a slight inflammatory state in the body).
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In the months after, subjectively, it felt as though my brain was like swiss cheese. I had a huge problem storing and recalling memories, and it felt as though the advice people gave me for studying for STEP I wasn't helping, even though it was good and sound advice.
My Scientific Background
My bachelor's degree is in Neuroscience (2015), and I did 5 years of research in neuroimaging, with my honors collegium research thesis on mild cognitive impairment or "chemofog" in breast cancer patients after chemotherapy.
From the brief Googling research that I've done, it appears as though the virus might travel through the nasal passages, through the cribiform plate, and affect the hippocampus. There is also evidence that it may cause some form of encephalitis, a kind of inflammation of the brain.
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Resources from Dr. Google, Important Quotes/Snippets
There is a study of about "740 patients (tested from April 2020-May 2021) age 18 or older who spoke English or Spanish, tested positive for SARS-CoV-2 virus, without history of dementia, who experienced a relatively high rate of cog impairment 7.6 months after patients had contracted the disease. With most common cognitive deficits (affecting nearly 1 in 4 patients) being: problem storing new memories, memory recall, processing speed, and executive functioning (initiating, planning, organizing, making judgments)."
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Resource: Many Covid patients have memory problems months later, new study finds (nbcnews.com)
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It also appears that the MoCA and MMSE which are traditionally used to screen for dementia types of decline are not sensitive enough, more sensitive tests include:
-Trail Making Test (TMT)
-Sign Coding Test (SCT)
-Continuous Performance Test (CPT) **
-Digital span Test (DST)
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**Continuous Performance Test being the most sensitive.
Resource: Special Report: Cognitive Screening After COVID-19 - Practical Neurology
Download PDF
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Case study: 65 year old man who had memory complaints, recovered fully, benefits of vaccination outweigh risks (Download PDF)
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Neuropsych analogy
Some say that unknown causes of psychological complaints are simply neurobiological correlates that haven't been found yet. For example, I read Brain on Fire by Susan Calahan in the late 2000s. Susan was initially hospitalized for psychiatric symptoms and was later found to have NMDA-Receptor encephalitis (a newly discovered disease at that time). Around 2021 or 2022, I found in one board practice question the mention of NMDA-R encephalitis, but it was never once mentioned in my first 2 years of medical school; the curriculum is simply too vast.
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My Rehabilitation/Solution
Before COVID, I was pretty good at managing my responsibilities, performing at a demanding academic level, the first 2 years of medical school I was enrolled in an MD/MBA dual degree program and juggling those responsibilities it felt so easy compared to STEP I -- but there were some psychosocial factors as well that affected my performance. I retook STEP I about a year after, and the only thing that worked was following a very structured lifestyle, very focused on my work and real priorities, being around nature, positive, supportive relationships, and keeping things fun and simple. I went through several spiritual awakenings. From the research that I've done on this issue, it appears that therapy or doing one's homework to recognize their cognitive strengths is the most recommended primary treatment. Weaknesses can also be recognized, which I like to positively frame as "areas I'd like to fill" or "want more of."
Disclosure on standardized testing
Granted, I was and am pretty functional, but when you're expected to perform at that level of professionalism, it was so apparent to me that my memory wasn't meeting that standard. Even at that level, it's difficult. I remember walking out of the testing room the 2nd time I took the MCAT, and feeling like I failed, and being shocked to discover in my score report in 2017 that I had scored in the 95th percentile. You're just functioning at such a high level of sensitivity or flow, or something.
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During 3rd year of medical school, I failed every clerkship exam on the first take, although some practice exams I had taken I had passed. It was bewildering because there seemed to be little correlation between what I studied and what appeared on the test. During my time in 3rd year, I know many students and residents who have similarly complained at how difficult these standardized tests are. I have met many a great physician on my journey to medical school, and it saddened me that so many that I would trust with my life and had decades of experience in their respective fields would still stress so much about standardized tests. It reminded me of growing up in a world of college preparatory standardized tests and hearing about how predatory these companies were on students. I also wondered if I was suffering from some kind of PTSD. I was extremely sensitized to every negative comment I had seen and heard in the hospital, including microaggressions that stacked up over time from moving to and living in the East Coast -- from Uber drivers, homeless people, classmates, other clinicians. Previously, microaggressions had no such effect on me, perhaps because I was so healthy, getting regular sleep, high-quality food and had such positive and abundant relationships. But then again, who wouldn't be a little traumatized working in such a demanding environment? It boiled over and I screamed my truths out into the Universe, left medical school during the pandemic, and the Universe rewarded me with a more gentle and kind life.
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If you are suffering, please do not lose hope. There are people who do care, people who are searching for these answers. I hope I have offered a stepping stone towards a solution.