Ruminations

Blog dedicated primarily to randomly selected news items; comments reflecting personal perceptions

Wednesday, June 24, 2020

Neurological-Degeneratve Brain Effects of COVID

"...If we're ever going to understand this, this is something we need to do, now."
"We can't wait a year from now when potentially we'll have eight million or more people who have survived COVID-19."
"We're going to see many, many people with profound cognitive impairment a year from now. We have enough experience that we know that this is going to produce cognitive deficits. Many different things are likely to contribute to the cognitive profile of people coming out of this."

"...There are plenty of reports of people reporting what in a clinical context we refer to as delirium.There are people coming out of the ICU recovering from COVID and saying they don't feel themselves. They've got fuzzy thinking. They can't really concentrate. And this is sort of the typical profile that we know goes on to produce long-term consequences."
"I do most of my work with ICU clinicians, and they'll often tell you, no one leaves the ICU in good shape, cognitively."
"The priority, and this is not specific to COVID, the priority in most ICUs around the world is to get the patient out the door alive. They're not trying to get them out making sure they're cognitively intact and they have no memory impairments. People are typically fighting a battle between life and death. Cognitive deficits might not be a high priority at that point."
"You don't want to put all your eggs into giving people memory training if it's not fundamentally a memory problem that people have."
"It's important we understand exactly what the problems are: Is this something that affects people's memory? Their concentration? Their ability to make high-level decisions?"
Dr.Adrian Owen, neuroscientist, Western University

Under normal circumstances, Dr.Owen focuses on studying the minds of people who have suffered severe physical trauma that has resulted in severe brain trauma; his specialty is 'understanding' severely injured brains, analyzing and interpreting what has occurred and whether -- although it appears that the individual with the brain trauma is no longer in possession of a functioning brain, by carefully studying the brain's neural responses -- he can detect brain activity however suppressed it is.

His studies and experiments came to a screeching halt, however, with the presence of SARS-CoV-2, the virus that results in COVID-19 contagion. "I have a whole team of people sitting in my lab, unable to directly assess patients", he said. With the escalation of the crisis and heroic protocols undertaken to save peoples' lives in hospital ICUs with the use of respirators, the invasive methods have produced a situation made to measure for investigation by one of the world's top neuroscientists.

What the medical community began to realize was that some patients stricken with COVID-19, receiving life-saving treatment, emerge from that treatment with neurological consequences not quite foreseen when those protocols were embarked upon. He has launched a huge study for the purpose of investigating the impacts COVID-19 infections have on the brain, called COVID-19 Brain Study, an online study hoping to recruit 50,000 participants.

Ideally, people who were given a confirmed, positive diagnosis of the novel coronavirus. With the use of questionnaires and pop-down menus, Dr.Owen and his colleagues plan to collect information "completely anonymized and secure" while enquiring about medical history of participants, of any underlying heart, lung or other health issues, and what happened to them following their COVID-19 diagnosis.''

Participants will be asked to perform cognitive games to assess memory, decision-making, planning the problem-solving, with results to be compared against an immense database of millions of tests that had been completed by a healthy, normal population. Stroke neurologist Dr.Rick Swartz of Sunnybrook Hospital in Toronto has partnered with Dr.Owen both anticipating a large and diverse group involvement of a study available in English, French and Spanish.

With an anticipated 50,000 participants, the hope is that sufficient statistical power will emerge to enable them to identify "all of these little nuances", giving answer to questions such as are there certain proportions of the population more vulnerable to developing cognitive deficits such as fuzzy thinking, brain fog, problems concentrating, and are there differences identifying with men and women? The elderly and the young? Does cognitive impairment only strike those who were placed on ventilators, is this an issue that everyone emerges with?

A recent article appears to have raised the question of whether SARS-CoV-2 is neurotropic -- toxic to brain tissues -- and to what extent the virus may impact on the central nervous system. In an earlier coronavirus invasion with SARS in early 2002-03, survivors commonly saw long-term neurological complications and since the novel coronavirus shares some of the same features of its predecessor, both using spike proteins to bind to a protein called ACE2 on the host, the fact that some scientists have discovered ACE2 receptors scattered through the brain offers a clue.

It is known that delirium, a type of brain dysfunction capable of leading to a serious state of confusion and paranoid delusions, can result with the use of high doses of some sedatives in the ICU. One-third of COVID-19 patients of all ages and two thirds of those with severe disease show signs of delirium, according to Harvard Medical School researchers; recognized as early evidence of a correlation.

 Spending time on ventilators leads patients to experience cognitive deficits which result from uneven delivery of oxygen to the brain, explains Dr.Owen. Use of the study's data to design therapeutic strategies "to work out what we need to do to deal with this", represents the hope that spurs this research.
The COVID-19 Brain Study looks to recruit 50,000 individuals who received a confirmed positive diagnosis of the virus in order to answer pressing questions about the disease’s direct and indirect effects on the brain.

"Is this something that's going to affect ten million in a year's time, in which case that is a massive social and economic problem."
"Or is this something that's going to affect 20,000 people a year from now, in which case it's something much more manageable."
Dr.Adrian Owen

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