Bay Area Doctors Are Looking For Answers

While driving recently, Cliff Morrison suddenly found himself lost in a forest.

He stopped, looked around, and realized he was actually on a tree-lined street half a mile from his home in the Oakland Hills on the way to the post office .

Morrison, 70, did not have dementia. He had COVID-19.

Since his diagnosis in April 2020, Morrison, a healthcare administrator, has suffered a mysterious and thankfully brief loss of guidance four or five times, the most recent around Labor Day, and always close to home. It no longer scares him. Now he’s just curious.

His doctors too.

“There are viruses that can cause cognitive problems in otherwise healthy people” – and COVID is clearly one of them, said Dr. Joanna Hellmuth, neurologist at UCSF.

Neurologist Dr. Joanna Hellmuth is the principal investigator of the UCSF Coronavirus Neurocognitive Study.

Barbara Ries / UCSF

A new study from the University of Oxford offers the disturbing suggestion that the coronavirus may not only shrink the brain, but also reduce “the thickness of gray matter”, damage tissue in areas associated with smell and cause over 60 other long-term changes to this vital organ.

The study, published Aug. 18, has yet to be peer reviewed. But it is attracting attention because researchers were able to compare hundreds of brain scans of the same people before and after the COVID hit. Of the 785 participants, 401 tested positive for the coronavirus before their second scan, giving researchers a unique opportunity to see how each brain may have changed as a result.

Surprisingly, the changes have occurred whether people have been hospitalized for COVID or have only had a mild case.

“In the general population, it is normal to see some change in the volume or thickness of gray matter over time as people get older, but the changes were larger than normal in those who had been infected with COVID-19, “Jessica Bernard, cognitive neuroscientist at Texas A&M who was not involved in the study, wrote in an essay reprinted last month in Scientific American.

Bernard noted that the affected brain regions were “all related to the olfactory bulb,” which sends signals from the nose to the brain. It also connects to the temporal lobe, the seat of the hippocampus, which is the key to memory and cognition.

She and other scientists declined to draw any conclusions from the preliminary study. But Bernard said other research has found a link between a reduced sense of smell and Alzheimer’s disease, which makes the new study even more intriguing.

The questions are always more numerous than the answers. Researchers wonder if the damage is due to the disease spreading elsewhere in the body or the virus entering the brain, perhaps through the nose? Neuroinflammation caused by infection – or something else? And can it be reversed?

15% to 36% of COVID survivors report memory loss, cognitive deficits or problems with concentration, according to an analysis of 13 studies from Stanford University, published in May in the publication’s JAMA Network Open. American Medical Association.

Other viruses use a variety of techniques to wreak havoc in the brain. Rabies and polio enter brain cells and attack from the inside, UCSF neurologist Dr Samuel Pleasure said. Shingles and herpes simplex are more devious, hibernating like a bear until intense stress wakes them up, often years later.

Dr. Sam Pleasure is a UCSF neurologist who studies how COVID-19 affects the brain.

Dr. Sam Pleasure is a UCSF neurologist who studies how COVID-19 affects the brain.

Marco Sanchez / UCSF

HIV uses yet another ruthless approach – better understood by people living longer with this disease – in which the virus enters the brain and lingers, slowly torturing its victim over time.

“HIV enters the brain and stays there,” Hellmuth said. “But it’s very difficult to find COVID in the brain. “

So what is going on?

A 30-year-old Connecticut man provides a clue.

Her story, co-written by Pleasure of UCSF, was published in August. Days after having a fever and being diagnosed with COVID, the man came to believe that a religious kidnapping was imminent and believed he was speaking with deceased relatives. He broke down a door. He jostled his mother. He was hospitalized, but was discharged after doctors found no reason for his sudden psychosis. He was back in less than two weeks, his face expressionless and his speech and thoughts dull.

A blood test identified elevated levels of two proteins, ferritin and D-dimers, hinting at a culprit: systemic inflammation.

This led his doctors to suspect that the coronavirus triggered the inflammation, which elicited an immune response which, instead of controlling the infection, “turned into a problem in itself,” Pleasure said. In this case, psychosis.

Doctors at Yale New Haven Hospital therefore chose treatment generally aimed at autoimmune diseases and injected the man with intravenous immunoglobulin. Composed of purified antibodies from thousands of people, it is believed to work by flooding the abnormal antibodies.

The illusions of man have disappeared. He returned to work and remained in good health.

At UCSF, Pleasure continues to investigate such COVID-induced autoimmunity. Beyond psychosis, the domino effect of COVID, inflammation and autoimmunity appear to cause other neurological complications, including encephalopathy (changes in brain function), encephalitis (inflammation of the brain ) and Guillain-Barré syndrome (muscle weakness due to inflammation of the peripheral nerves).

Learning more about COVID and autoimmunity may offer new treatment options, Pleasure said.

Insanity is not a typical post-COVID symptom. But it appears to be caused by inflammation and autoimmunity, so Pleasure and other experts wonder if the brain fog so many experience after COVID is a “weaker version of the same.” However, he said, “we don’t have the answer yet.”

For months after contracting COVID, Morrison often had to hold onto walls while walking because he felt like he was moving sideways. He suffered from headaches, forgetfulness, dizziness, and mood swings that made him verbally lash out one minute and cry the next.

Some “neurological stuff” persists, he said of the symptoms that have happened with COVID. Now he keeps a couch for restorative naps in his Castro Valley office and participates in UCSF’s neurocognitive coronavirus study, where Hellmuth is the principal investigator.

While there is a lot that doctors ignore, Hellmuth said Morrison’s confusion at the wheel was not a total mystery. “After COVID, many people are not able to handle a high load of information arriving at the same time,” as required by driving.

Hellmuth is working with the National Institutes of Health to develop a large post-COVID symptom study called Recover.

Recovery is what Morrison hopes for.

“I came right over and asked if me and people like me would ever make a full recovery,” he said. “But they won’t go that far. They say it is still too early to tell.

Nanette Asimov is a writer for the San Francisco Chronicle. Email: [email protected] Twitter: @NanetteAsimov

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