Summary

Through reading related medical papers on long COVID memory loss so far, the author summarized the life performance of long-term COVID-19 amnesia, and provide an in-house self assessment form to help people judge whether they are suffering from long COVID memory loss.

Then, the author analyzed the mainstream pathogenesis of the long-term COVID memory loss, and concluded the approaches of western medicine treatment against post COVID memory loss. Due to the limitation of western medicine treatment against long COVID amnesia,this paper also recommended some traditional Chinese medicine, including Chinese medicine formula and acupuncture treatment, to treat the memory-related symptoms in the brain.

In addition, this paper made advises patients with long-term COVID-19 amnesia on taking health care products, as well as on exercise, diet, and sleep.

In the end, we hope that the treatment program for long-term COVID-19 memory loss suggested in this paper could benefit patients by improving their memory as soon as possible, and even eradicate their long-haul COVID memory loss symptoms.

Keywords: Long COVID, Post Covid-19 memory loss, long COVID amnesia, long COVID headache, long COVID-19 dizziness.

1.What are the manifestations of long COVID memory loss?

A large proportion of long COVID symptoms are related to the brain. In order to facilitate the unified classification and description of Long Covid symptoms related to the brain, the medical community uses a folk colloquial vocabulary, namely, brain fog. Brain fog has not been a medical or scientific term previously, but rather a colloquial description of a state in which people cannot think normally and clearly when they develop influenza or other diseases.

Common people describe problems arising in their usual cognition or thinking by picturing the fog in their brain, such as difficulty in concentrating, memory loss, thinking slower, inability to think acutely, without creativity, and difficulty in making plans. During rehabilitation after being infected with COVID-19, many patients said they experienced "brain fog". According to figures given in the study report, about 1% of patients infected with novel coronavirus would experience symptoms of brain fog.

At present, the medical community has accustomed to classifying memory loss or symptoms of amnesia caused by the novel coronavirus infection as long COVID-19 brain fog. According to statistics in the study report, patients with memory loss accounted for one-third of all patients with brain fog. That means about 0.3% of people infected with the coronavirus would experience memory loss or symptoms of amnesia. According to published medical papers on long COVID-19 memory loss, we conclude that the manifestations of memory loss are as follows:

(1) Memory loss: feel that one has a cognitive impairment; often unable to remember something; memory loss, forgetfulness; appear symptoms similar to senile dementia, Parkinson's disease.

(2) Language disorders: feel that it is not fluent and smooth when speaking; often forget to choose which words to express meaning. Slurred speech and flat speech tone with monotonous rhythm and no cadence.

(3) Attention disorder: feel that the brain is not in a state and mental trance; feel it is easy to distract and difficult to concentrate.

(4) Get lost: feel the brain often is in the state of vertigo; feel dull in discerning spatial directions.

(5) Early symptoms of Parkinson's disease: such as slow movement, walking disorders, body stiffness, and frequent dullness, etc.

(6) Early symptoms of Alzheimer's disease: memory and other cognitive loss, language disorders, disorientation (such as straying), temperament changes, etc.

2.How to judge whether people suffered the long-term COVID-19 memory loss?

What are Post-COVID Conditions? According to the definition of the World Health Organization, Post-COVID Conditions, also known as Long Covid, long-haul COVID, post-acute COVID-19, It refers to the patient who is infected with the new coronavirus, the first PCR test is positive, and after 3 months, there are still symptoms of physical discomfort. For more detailed information on the latest statistics on the incidence of long covid according to the time axis, please refer to the following figure.

Post Covid-19 Symptoms mainly concentrated in five aspects, including respiratory syndrome, cognitive system syndrome, chronic fatigue syndrome, chronic pain syndrome, and mental syndrome. Long-term COVID-19 brain fog is belonging to the cognitive system syndrome.

If you have a history of COVID-19, which means your previous result of PCR test showed positive, and before infection with the novel coronavirus, you didn’t suffer from the long COVID brain fog, but now you are presenting these symptoms mentioned in the above section, you are likely to afflict by Long Covid brain fog.

3.What are the causes of the long COVID memory loss?

According to the published medical papers on the long COVID-19 memory loss, we concluded that there are five conditions in the pathogenesis of amnesia after the patient was infected with COVID-19:

(1)Among patients infected with novel coronavirus, some people would experience novel coronavirus breaking through the blood-brain barrier and invading the brain. Studies have confirmed that the virus can break through the blood-brain barrier of the human body and infect cells in the brain, causing neurodegeneration to further develop into neuroinflammation in the brain. Novel coronavirus infection has also been reported to cause gray matter loss in the left hemisphere of the brain. It has also been reported that higher levels of IL-6, an inflammatory marker in the brain, can cause a decrease in hippocampal volume in the brain. These brain lesions can disrupt memory and cognition. Patients with long-term COVID-19 memory loss also developed brain damage as it appeared on the CT image when taking the test.

(2)For patients infected with novel coronavirus, sometimes the novel coronavirus in the body may not be cleared completely, with a small amount of the virus remaining. In this situation, when the virus was only temporarily suppressed by the immune system, and the remaining site was not in the nasopharyngeal region, PCR tests would show negative. The remaining virus would persistently infect endothelial cells of multiple organs of the human body, forming tiny thrombi between cells, which in turn produce a wide range of inflammatory responses. Inflammatory responses cause a rise in pro-inflammatory markers, including the increase of ferritin, coagulation protein VIII, and C-reactive protein (CRP), as well as the elevation of D-dimer. D-dimer levels are associated with acute ischemic stroke, especially cryptogenic stroke, and its increased level can easily cause nerve injury in the brain, leading to the onset of amnesia.

(3) For patients infected with novel coronavirus, if they had experienced severe symptom during the infectious period, they might have taken steroids and antibiotics, such as prolonged taken of glucocorticoids. But studies have reported that long-term use of glucocorticoid may alter the function and structure of the hippocampus, resulting in memory loss.

(4) For patients infected with novel coronavirus, if they had experienced severe symptom during the infectious period, such as hypoxia. Novel coronavirusl invade into the brain, causing blockage of the brain's microvessels, they would present the symptoms similar to minor ischemic strokes or hemorrhagic stroke, which can cause memory loss.

(5) Patients infected with novel coronavirus are likely to develop myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) with sudden or gradual onset of persistent incapacitating fatigue and post-exertional malaise (PEM). This can lower the metabolism of the patient's body, causing neuroinflammation in hypometabolic lesions. A PET study examining 7 patients with persistent cognitive and emotional disturbances 6 months after rehabilitation for COVID-19 encephalopathy found hypometabolism in the anterior cingulate and insular cortices and caudate cortex. This can also cause memory loss.

Through performing PET (positron emission tomography, which can determine the development of diseases by detecting the metabolic level of the human body) imaging analysis among the brains of 15 patients with novel coronavirus pneumonia who were in the subacute phase and presented abnormal olfaction and taste, the team of professor Jonas A. Hosp from the University Medical Center Freiburg in Germany found that 10 patients had decreased metabolic levels in the frontoparietal lobe.

The E Guedj team from the Department of Nuclear Medicine of University of Aixes-Marseille in France also applied PET to detect metabolic changes in the brain of two patients with novel coronavirus pneumonia to find reduced metabolic levels in some sites, including the olfactory/rectus gyrus, amygdala, hippocampus, and parahippocampus.

The Gwena ëlle Douaud team from the Wellcome Centre for Integrative Neuroimaging (WIN) of University of Oxford in the UK systematically analyzed brain imaging data from 401 patients with coronavirus infection before and after infection, finding that coronavirus infection caused a more reduction in gray matter thickness and tissue contrast in the orbitofrontal cortex and parahippocampal gyrus (associated with olfaction and memory), more tissue damage in areas associated with primary olfactory cortex function, and more reduction in brain volume. The findings were published online on March 8, 2022 in Nature.

4.How to treat the long COVID-19 memory loss?

At first, we need to take a thorough physical examination of our bodies, and besides taking routine examinations, we need to do another three examinations.

The first item: do several more PCR tests, and nasal and throat secretions should be dipped enough to see whether the result shows positive. If it shows positive, it means there is still some active novel coronavirus in the body.

The second item: perform a CT image of the brain to see whether there is imaging evidence of a brain scan that resembles Alzheimer's or Parkinson's symptoms.

The third item: test specifically whether the amount of p-tau217 protein in the blood exceeds considerably the person's average criteria. The result in excess means the brain is in the early stages of Alzheimer's disease.

Secondly, the results of the above comprehensive physical examination and three special examinations should be handed over to the doctor, and then the patient should communicate with the doctor to describe one’s own long COVID memory loss symptoms in detail.

Then, the doctor can design the best treatment for you. Because the situation varied from person to person, after the interview the treatment plan given by the doctor is also different, so we cannot give a general treatment plan in this article.

The rough ideas for designing the treatment plan are as follows:

(1) According to the results of the patient's comprehensive physical examination and three special examinations as well as the communication with the patient, find out the most likely pathogenesis of the patient's long COVID-19 amnesia.

(2) Prescriptions are prescribed for treatment according to the pathogenesis and the patient's physical condition.

(3)For the main direction of medication are: if novel coronavirus still remains in the body, antiviral drugs such as Paxlovid should be used as a priority. If there is no virus in the body, the drug is used from the perspective of reducing or eliminating the chronic inflammation of the patient, reducing the autoimmune phenomenon of the patient, eliminating microclots to improve the capillary microcirculation of the patient, improving the metabolic circulation of the patient, protecting the patient's brain nerves and repairing the patient's nerves.

(4) For the symptoms that can damage the work and life of patients, some drugs for improving the experience of symptoms can also be used according to the specific symptoms, such as drugs for invigorating the brain, refreshing the brain, stimulating the nerves, and other effects.

(5) Oxygen therapy and brain physical massage can also be tried, and studies have shown that these two methods are also beneficial in removing memory loss.

(6) If patients suffer from psychiatric symptoms such as insomnia, anxiety, and depression, they should seek help from psychologists and TCM to eliminate these psychological symptoms. This method is also helpful in removing long-term COVID-19 symptoms of memory loss.

5.How to treat Long COVID memory loss from a traditional Chinese medicine(TCM) perspective?

From the theory of syndrome differentiation and treatment of TCM, the treatment of long COVID-19 memory loss can obtain more accurate TCM syndrome differentiation and more suitable TCM formulas from the following three steps.

(1) Perform the observation, smelling, hearing, and inquiring of traditional Chinese medicine diagnosis, and consult the comprehensive physical examination report and four special examination reports of western medicine in the previous section at the same time. Only in this way can TCM doctors obtain the most detailed disease information of patients to support them to make the most accurate syndrome differentiation and treatment of patients' conditions.

(2) TCM doctors will classify and summarize the main symptoms, accompanying secondary symptoms, physical condition, and sick parts of the internal organs of the patients according to the most comprehensive disease information of the patients.

First, the main symptoms are the most unbearable symptoms of patients at present, such as chronic headache of long COVID brain fog, or memory loss of long COVID brain fog, and dizziness of long COVID brain fog.

Second, accompanying secondary symptoms are that suffered from the main symptoms, the patient is experiencing other uncomfortable symptoms, such as feeling fatigued in a short time when using the brain, suffering from insomnia, anxiety, depression, and so on.

Third, to find out the physical condition of the patient, which means the patient's current physical health status, belongs to which category in the TCM constitution. For example, yang-deficiency constitution, phlegm-dampness constitution, qi-deficiency constitution, blood stasis constitution, etc.

(3) TCM doctors, according to the above summary, combined with the internal organs and meridians related to symptoms, comprehensively use the theory and practical experience of TCM to make TCM prescriptions for patients. If acupuncture and moxibustion are required, these programs will also be prescribed.

Traditional Chinese medicine (TCM) theory is mainly based on: Zhang Zhongjing’s “Treatise on Febrile Diseases”, “Synopsis of Golden Chamber”, Huang Yuanyu's “Four Sacred Hearts Source”, “Typhoid Fever Suspension”, “Jinkui Suspension”, “Changsha Yao Jie”, Li Dongyuan 's “Treatise on the Spleen & Stomach”, and Zhang Jingyue' s “Jingyue Quanshu”.

Practical experience, which can be found in Google Scholar ( https://scholar.google.com/), and search for keywords for TCM treatment of long COVID symptoms. For example， COVID-19 Traditional Chinese Medicine, Long Covid Traditional Chinese Medicine. A large number of academic papers on medical research on the treatment of Long Covid by traditional Chinese medicine can be found in this way.

In order to make it easier for everyone to understand the treatment process of TCM, the following is a TCM treatment case of a patient with long-term COVID-19 symptoms of memory loss:

Case 1:

Name: Zhang, female, 55 years old, height 160cm, weight 70 kg.

MEDICAL HISTORY: PCR was positive for novel coronavirus in 2022, followed by typical symptoms of novel coronavirus infection: fever, cough, sore throat, sputum with blood streaks, ageusia, and anosmia. Two weeks later, the symptoms of novel coronavirus infection gradually relieved and disappeared. Later, long-term COVID-19 symptoms of amnesia appeared successively.

Physical examination report of western medicine: (1) The PCR test result of novel coronavirus showed negative again. (2) High blood glucose and early symptoms of type 2 diabetes appeared. (3) Brain PET (positron emission tomography, which can determine the occurrence and development of diseases by detecting the metabolic level of the human body) imaging analysis revealed images of decreased metabolic levels. (4) Proinflammatory markers were high and there was slight systemic chronic inflammation. (5) The content of p-tau217 protein in blood was five times higher than that in the average person.

Main symptoms: memory loss, forgetfulness, difficulty in concentrating, and frequent forgetting of words when speaking.

Accompanying secondary symptoms: soreness and weakness of the waist and knee, general weakness, anxiety, depression, and depressed mood.

TCM constitution: the body presents a phlegm-dampness constitution and yang-deficiency constitution.

TCM diagnosis evaluation: The body before the novel coronavirus was in a sub-health state, obesity, and after the infection with novel coronavirus, the sub-health state deteriorated, presenting phlegm-dampness congestion, forgetfulness, and other symptoms.

The prescription was given by the herbalist:

(1) Huanshaodan is used to remove phlegm and dampness, supplement yang qi, refresh the brain and strengthen the brain.

(2) Mailuotong capsules are used to dredge meridian vascular congestion.

(3) Chaihu plus Longgu oyster Tang are used to improve insomnia anxiety.

(4) Buzhong Yiqi Tang is used to replenish Yang Qi and reduce the symptoms of weakness and decline.

Acupuncture program given by the TCM: Using an electronic moxibustion device, moxibustion on the following acupoints.

(1) Baihui, Neiguan, Taixi, and Yongquan points are stimulated by moxibustion to improve cerebral blood circulation and metabolism.

6.Which kind of health products are beneficial to improving long COVID-19 amnesia?

Taking the patient above as an example, we give the following health product recommendations based on her condition:

(1) Omega 3 (Ω3) fatty acids, containing high amounts of DHA and EPA, are used to improve brain function and protect against cardiovascular and cerebrovascular diseases.

(2) Comprehensive vitamins, mainly VC, VD, and VB, are used to scavenge free radicals, anti-oxidation, and reduce systemic chronic inflammation.

(3) Curcumin is used to scavenge free radicals, anti-oxidation, activate NRF2, and reduce systemic chronic inflammation.

(4) Sulforaphane is used to scavenge free radicals, anti-oxidation, activate NRF2, and reduce systemic chronic inflammation.

(5) Melatonin is used to improve sleep quality.

(6) American ginseng is sliced for making tea or taken American ginseng capsules to replenish qi.

7.What exercises are beneficial to improving long COVID-19 amnesia?

Taking the patient above as an example, we give the following exercise advice based on her condition:

(1) Take moderate aerobic exercise at least three times a week, such as walking and square dancing to remove phlegm-dampness.

(2) With the utility of gym equipment, strength training is performed for the major muscle group to improve insulin activity and lower blood glucose.

(3) Play children 's puzzle games on mobile for 30 minutes every day.

(4) Assist head massage.

8.What is beneficial to improving long COVID memory loss in terms of diet and sleep ?

Taking the patient above as an example, we give the following diet and sleep advice based on her condition:

(1) Control carbohydrate intake, which means reducing the amount of staple food such as rice and noodle, to decrease fat intake while increasing vegetable and cellulose intake.

(2) Do not take any food after lunch, and have breakfast and lunch only a day. Losing weight at least more than 10% of body weight, which means losing 7 kg, reducing the degree of obesity.

(3) Bubble bathing until slightly sweating before sleeping, and lie in bed to do general muscle tightness and relaxation training, improving sleep quality.

9.Patients with long COVID memory loss are welcome to contact with our Long Covid Care Center

If there are similar symptoms among readers, contact our Long Covid Care

Center for assistance.

Phone: +852 5765 5768

Whatsapp: +852 5765 5768

WeChat: longcovidcarecenter

Email: support@longcovidcarecenter.org

【Disclaimer: The treatment of diseases is a very complex and professional affair. Due to the limitation, Long Covid Care Center can only carry out remote simple interviews, unable to face-to-face offline interviews and obtain comprehensive physical examination results. Therefore, the suggestions, guidance, protocols, and documents conveyed by our Long Covid Care Center to patients can only be used as a reference for patients to understand their diseases in many aspects, but cannot be directly used as a treatment plan. Patients must discuss their symptoms with doctors in local hospitals through face-to-face communication. After the patients completed the physical examination required by doctors, they would get a prescription issued by doctors and get the treatment under the guidance of doctors. Therefore, Long Covid Care Center hereby declares that our center is completely exempted from liability when any adverse consequences are caused by self-treatment of the patient for applying any contents convoyed by the center, that is, we do not bear any responsibilities.】