The long-term health outcomes, pathophysiological mechanisms and multidisciplinary management of long COVID

Signal Transduction and Targeted Therapy, Год журнала: 2023, Номер 8(1)

Опубликована: Ноя. 1, 2023

Abstract There have been hundreds of millions cases coronavirus disease 2019 (COVID-19), which is caused by severe acute respiratory syndrome 2 (SARS-CoV-2). With the growing population recovered patients, it crucial to understand long-term consequences and management strategies. Although COVID-19 was initially considered an illness, recent evidence suggests that manifestations including but not limited those cardiovascular, respiratory, neuropsychiatric, gastrointestinal, reproductive, musculoskeletal systems may persist long after phase. These persistent manifestations, also referred as COVID, could impact all patients with across full spectrum illness severity. Herein, we comprehensively review current literature on highlighting its epidemiological understanding, vaccinations, organ-specific sequelae, pathophysiological mechanisms, multidisciplinary In addition, psychological psychosomatic factors underscored. Despite these findings diagnostic therapeutic strategies based previous experience pilot studies remain inadequate, well-designed clinical trials should be prioritized validate existing hypotheses. Thus, propose primary challenges concerning biological knowledge gaps efficient remedies well discuss corresponding recommendations.

Язык: Английский

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Efficacy and safety of transcranial magnetic stimulation on cognition in mild cognitive impairment, Alzheimer’s disease, Alzheimer’s disease-related dementias, and other cognitive disorders: a systematic review and meta-analysis

International Psychogeriatrics, Год журнала: 2024, Номер 36(10), С. 880 - 928

Опубликована: Фев. 8, 2024

We aim to analyze the efficacy and safety of TMS on cognition in mild cognitive impairment (MCI), Alzheimer's disease (AD), AD-related dementias, nondementia conditions with comorbid impairment. Systematic review, Meta-Analysis SETTING: searched MEDLINE, Embase, Cochrane database, APA PsycINFO, Web Science, Scopus from January 1, 2000, February 9, 2023. RCTs, open-label, case series studies reporting outcomes following intervention were included. Cognitive measured. Risk Bias for RCTs MINORS (Methodological Index Non-Randomized Studies) criteria used evaluate study quality. This was registered PROSPERO (CRD42022326423). The systematic review included 143 (n = 5,800 participants) worldwide, encompassing 94 43 open-label prospective, 3 retrospective, series. meta-analysis 25 MCI AD. Collectively, these provide evidence improved global specific measures across diagnostic groups. Only 2 (among 143) reported 4 adverse events seizures: deemed unrelated another resolved coil repositioning. Meta-analysis showed large effect sizes (Mini-Mental State Examination (SMD 0.80 [0.26, 1.33], p 0.003), Montreal Assessment 0.85 1.44], 0.005), Disease Scale-Cognitive Subscale -0.96 [-1.32, -0.60], < 0.001)) AD, although significant heterogeneity. reviewed favorable all groups safe well tolerated infrequent serious events.

Язык: Английский

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Neurovascular coupling impairment as a mechanism for cognitive deficits in COVID-19

Brain Communications, Год журнала: 2024, Номер 6(2)

Опубликована: Янв. 1, 2024

Abstract Components that comprise our brain parenchymal and cerebrovascular structures provide a homeostatic environment for proper neuronal function to ensure normal cognition. Cerebral insults (e.g. ischaemia, microbleeds infection) alter cellular physiologic processes within the neurovascular unit contribute cognitive dysfunction. COVID-19 has posed significant complications during acute convalescent stages in multiple organ systems, including brain. Cognitive impairment is prevalent complication patients, irrespective of severity SARS-CoV-2 infection. Moreover, overwhelming evidence from vitro, preclinical clinical studies reported SARS-CoV-2-induced pathologies components are associated with impairment. Neurovascular disruption alters coupling response, critical mechanism regulates cerebromicrovascular blood flow meet energetic demands locally active neurons. Normal processing achieved through response involves coordinated action cells (i.e. neurons glia) cell types endothelia, smooth muscle pericytes). However, current work on COVID-19-induced yet investigate as causal factor. Hence, this review, we aim describe SARS-CoV-2's effects how they can impact decline disease. Additionally, explore potential therapeutic interventions mitigate Given great both individuals public health, necessity effort fundamental scientific research application becomes imperative. This integrated endeavour crucial mitigating deficits induced by its subsequent burden especially vulnerable population.

Язык: Английский

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Intervention modalities for brain fog caused by long-COVID: systematic review of the literature

Neurological Sciences, Год журнала: 2024, Номер 45(7), С. 2951 - 2968

Опубликована: Май 2, 2024

Язык: Английский

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Management of cognitive impairment associated with post-COVID-19 syndrome: recommendations for primary care

Frontiers in Pharmacology, Год журнала: 2024, Номер 15

Опубликована: Апрель 22, 2024

Introduction: Although post-COVID-19 syndrome (PCS) with cognitive impairment is increasingly encountered in primary care, evidence-based recommendations for its appropriate management are lacking. Methods: A systematic literature search evaluating the diagnosis and treatment of associated PCS was conducted. Practical PCS-associated care summarized, based on an evaluation pharmacological plausibility clinical applications. Results: Currently, pathology remains unclear no high-quality data to support targeted interventions. Existing approaches directed towards symptom relief where counseling chronicity disease regular reassessments at 4- 8-week intervals considered reasonable. Patients should be informed encouraged adopt a healthy lifestyle that centers around balanced nutrition physical activities. They may also benefit from intake vitamins, micronutrients, probiotics. The administration Ginkgo biloba extract could offer safe potentially beneficial option. Other non-pharmacological measures include physiotherapy, digitally supported training, and, if indicated, ergotherapy or speech therapy. In most patients, symptoms improve within 8 weeks. If serious, ambiguous, when new occur, specialized diagnostic such as comprehensive neurocognitive testing neuroimaging initiated. Very few patients would require inpatient rehabilitation. Conclusion: debilitating condition affect daily functioning reduce work productivity. Management multidisciplinary approach, centering physical, cognitive, therapies.

Язык: Английский

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Prevention and early intervention strategies for perinatal mental health disorders mediated by neuroimmune modulation and anti-inflammatory mechanisms through non-invasive transcranial magnetic stimulation: A narrative review

Brain Behavior and Immunity Integrative, Год журнала: 2025, Номер unknown, С. 100103 - 100103

Опубликована: Янв. 1, 2025

Язык: Английский

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A Narrative Review of the Efficacy of Long COVID Interventions on Brain Fog, Processing Speed, and Other Related Cognitive Outcomes

Biomedicines, Год журнала: 2025, Номер 13(2), С. 421 - 421

Опубликована: Фев. 10, 2025

In the years following global emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), or COVID-19, researchers have become acutely aware long-term symptomology associated with this disease, often termed long COVID. Long COVID is pervasive symptoms affecting multiple organ systems. Neurocognitive are reported by up to 40% patients, resultant effects loss daily functioning, employment issues, and enormous economic impact high healthcare utilization. The literature on effective, safe, non-invasive interventions for remediation cognitive consequences scarce poorly described. Of specific interest narrative review identification potential COVID-associated neurocognitive deficits. Articles were sourced from PubMed, EBSCO, Scopus, Embase Preferred Reporting Items Systematic Reviews Meta-Analyses (PRISMA) guidelines. published between dates January 2020 30 June 2024 included in search. Twelve studies review, including a feasibility study, pilot case series, an observational addition three randomized clinical trials four interventional studies. Overall, treatment such as training, brain stimulation therapy, exercise rehabilitation, targeted pharmacological intervention, other related paradigms show promise reducing issues. This highlights need more rigorous experimental designs future needed fully evaluate persistent deficits

Язык: Английский

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rTMS for post-covid-19 condition: A sham-controlled case series involving iTBS-300 and iTBS-600

Brain Behavior & Immunity - Health, Год журнала: 2024, Номер 36, С. 100736 - 100736

Опубликована: Фев. 5, 2024

Post-Covid-19 Condition (PCC) is a syndrome comprised of symptoms persisting 3 months or more beyond SARS-CoV-2 primary infection. It typically characterized by fatigue, cognitive problems and psychiatric symptoms, as well cardiac that contribute to exercise intolerance in many. Despite the high prevalence PCC among those with prior infection, there currently no widely accepted rehabilitation treatment, many pre-existing modalities are based on exercise. Non-invasive brain stimulation methods such repetitive transcranial magnetic (rTMS) may have some potential alleviate affective without reliance The purpose present study was explore feasibility tolerability using rTMS treat "brain fog" disturbance living PCC, case series design. We enrolled four individuals following confirmed at least after resolution infection randomized them 4 sessions active 2 sham intermittent theta-burst (iTBS). Two intensities iTBS were evaluated: iTBS-300 iTBS-600. No adverse events occurred stimulation; participants reported tingling sensation scalp but other issues. Trends suggested improvements interference, quality life, anxiety majority participants. In summary, this tolerated PCC; , associated positive trends symptom clusters compared stimulation. Future studies should examine effects context preclinical experimental controlled trials.

Язык: Английский

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Decoding Post-Viral Fatigue: The Basal Ganglia’s Complex Role in Long-COVID

Neurology International, Год журнала: 2024, Номер 16(2), С. 380 - 393

Опубликована: Март 28, 2024

Long-COVID afflicts millions with relentless fatigue, disrupting daily life. The objective of this narrative review is to synthesize current evidence on the role basal ganglia in long-COVID discuss potential mechanisms, and highlight promising therapeutic interventions. A comprehensive literature search was conducted using PubMed, Scopus, Web Science databases. Mounting from PET, MRI, functional connectivity data reveals disturbances exhaustion, including inflammation, metabolic disruption, volume changes, network alterations focused striatal dopamine circuitry regulating motivation. Theories suggest inflammation-induced signaling could impede effort/reward valuation, disrupt cortical–subcortical motivational pathways, or diminish excitatory input arousal centers, attenuating drive initiation. Recent pilots targeting abnormalities show provisional efficacy. However, heterogeneous outcomes, inconsistent metrics, perceived versus fatigue discrepancies temper insights. Despite growing research, gaps remain understanding precise pathways linking dysfunction validating treatment Further research needed advance ganglia’s contribution neurological sequelae offer hope for improving function across expanding affected population.

Язык: Английский

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RECOVER-NEURO: study protocol for a multi-center, multi-arm, phase 2, randomized, active comparator trial evaluating three interventions for cognitive dysfunction in post-acute sequelae of SARS-CoV-2 infection (PASC)

Trials, Год журнала: 2024, Номер 25(1)

Опубликована: Май 17, 2024

Abstract Background Post-acute sequelae of SARS-CoV-2 infection (PASC) symptoms have broad impact, and may affect individuals regardless COVID-19 severity, socioeconomic status, race, ethnicity, or age. A prominent PASC symptom is cognitive dysfunction, colloquially referred to as “brain fog” characterized by declines in short-term memory, attention, concentration. Cognitive dysfunction can severely impair quality life impairing daily functional skills preventing timely return work. Methods RECOVER-NEURO a prospective, multi-center, multi-arm, phase 2, randomized, active-comparator design investigating 3 interventions: (1) BrainHQ an interactive, online training program; (2) PASC-Cognitive Recovery rehabilitation program specifically designed target frequently reported challenges among with brain fog; (3) transcranial direct current stimulation (tDCS) noninvasive form mild electrical stimulation. The interventions will be combined establish 5 arms: BrainHQ; + Recovery; tDCS-active; (4) tDCS-sham; (5) Active Comparator. occur for 10 weeks. Assessments completed at baseline the end intervention include testing patient-reported surveys. All study activities delivered Spanish English. Discussion This test whether alleviated use pragmatic established different mechanisms action prior evidence improving function patients neurocognitive disorder. If successful, results provide beneficial treatments PASC-related dysfunction. Trial registration ClinicalTrials.gov NCT05965739. Registered on July 25, 2023.

Язык: Английский

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