New Evidence Suggests Long COVID Could Be a Brain Injury

Medscape Medical News | By Sara Novak

Brain fog is one of the most common, persistent complaints in patients with long COVID. It affects as many as 46% of patients who also deal with other cognitive concerns like memory loss and difficulty concentrating. 

Now, researchers believe they know why. A new study has found that these symptoms may be the result of a viral-borne brain injury that may cause cognitive and mental health issues that persist for years.

Researchers found that 351 patients hospitalized with severe COVID-19 had evidence of a long-term brain injury a year after contracting the SARS-CoV-2 virus. The findings were based on a series of cognitive tests, self-reported symptoms, brain scans, and biomarkers. 

Brain Deficits Equal to 20 Years of Brain Aging

As part of the preprint study, participants took a cognition test with their scores age-matched to those who had not suffered a serious bout of COVID-19. Then a blood sample was taken to look for specific biomarkers, showing that elevated levels of certain biomarkers were consistent with a brain injury. Using brain scans, researchers also found that certain regions of the brain associated with attention were reduced in volume.

Patients who participated in the study were "less accurate and slower" in their cognition, and suffered from at least one mental health condition, such as depression, anxiety, or posttraumatic stress disorder, according to researchers.

The brain deficits found in COVID-19 patients were equivalent to 20 years of brain aging and provided proof of what doctors have feared: that this virus can damage the brain and result in ongoing mental health issues. 

"We found global deficits across cognition," said lead study author Benedict Michael, PhD, director of the Infection Neuroscience Lab at the University of Liverpool in Liverpool, England. "The cognitive and memory problems that patients complained of were associated with neuroanatomical changes to the brain." 

Proof That Symptoms Aren't 'Figment' of Patients' Imaginations

Cognitive deficits were common among all patients, but the researchers said they don't yet know whether the brain damage causes permanent cognitive decline. But the research provides patients who have been overlooked by some clinicians with proof that their conditions aren't a figment of their imaginations, said Karla L. Thompson, PhD, lead neuropsychologist at the University of North Carolina School of Medicine's COVID Recovery Clinic. 

"Even though we're several years into this pandemic, there are still a lot of providers who don't believe that their patients are experiencing these residual symptoms," said Thompson, "That's why the use of biomarkers is important, because it provides an objective indication that the brain has been compromised in some way."

Some patients with long COVID have said that getting their doctors to believe they have a physical ailment has been a persistent problem throughout the pandemic and especially as it relates to the sometimes-vague collection of symptoms associated with brain fog. One study found that as many as 79% of study respondents reported negative interactions with their healthcare providers when they sought treatment for their long-COVID symptoms.

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Medicare Advantage Headwinds Didn't Prevent Payers from Turning a Profit in 2023

Fierce Healthcare | By Paige Minemyer
 
Though a spike in utilization among seniors slammed payers last year, particularly in the fourth quarter, each of the six major national firms turned a profit in 2023.
 
Leading the way, as per the norm, was UnitedHealth Group, which brought in $22.4 billion in profit for the year. Its closest rival, CVS Health, earned $8.3 billion in 2023 profit, according to a Fierce Healthcare review of quarterly earnings reports.
 
Both of these firms represent major players in Medicare Advantage (MA): UnitedHealthcare and Aetna, respectively. And both felt the impacts of the higher-than-expected care use in the back half of the year, with CVS cutting its outlook for 2024 to compensate.
 
Humana, another of the largest MA plans in the country, was the most acutely effected by the utilization increase, given that the bulk of its insurance business is in the Medicare space. While it was profitable for the year, posting $2.5 billion, it reported a $541 million loss in the fourth quarter and set conservative guidance for 2024 amid "greater inherent uncertainty" in MA.

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How to Prescribe Physical Activity in Patients With Obesity

Medscape Medical News: Carla Nieto Martínez

Exercise should no longer be a mere "complement" or a standard recommendation within healthy lifestyle guidelines, say experts. Recent evidence confirms its physiological importance and endorses its beneficial and therapeutic effects on overall health, particularly in the case of obesity and its comorbidities. These findings emphasized the reasons to include exercise prescription in addressing this condition. This conclusion emerged from discussions among experts in Physical Activity and Sports Sciences during the XIX Congress of the Spanish Society for Obesity, where the role of physical exercise as a therapeutic strategy was analyzed from various perspectives.

Javier Butragueño, PhD, coordinator of the Exercise Working Group at the Spanish Society of Obesity, emphasized the need to "reposition" the role of exercise and the message conveyed to the population. "We must move beyond the typical recommendation to 'just walk' and rethink this message. When working with patients with obesity, you realize that, for example, the guideline of 10,000 steps per day makes little sense for those who weigh 140 kg, have been sedentary for a long time, and have not reached 2000 daily steps. Clinically, it becomes evident that current recommendations may not align with the needs of these patients," he said.

Precision Focus

Butragueño highlighted the necessity of shifting the central focus from weight-related variables alone. While weight is crucial, evidence suggests that it should be evaluated along with other strategies, such as nutrition and pharmacology.

"The approach must change to view exercise as a metabolism regulator," said Butragueño. "For specialists, this means educating the population about the need to stay active for overall health. This is a disruptive message because the prevailing idea, almost obsessive, associates exercise primarily with weight loss, a completely incorrect approach that can even be detrimental in some cases."

Butragueño emphasized the supportive role of physical exercise in interventions for these patients. "Data show that it is both an enhancer and a co-adjuvant in strategies that also include psychology and endocrinology. It should be part of the approach to obesity but individualized and phenotyped to give physical activity the necessary dimension in each specific case."

As an example of this adaptability in therapeutic strategy, Butragueño referred to addressing binge eating disorder. "In this case, specialists must acknowledge that sports are a third-line option, always behind the psychologist, who plays a primary role. Exercise is used to enhance the emotions triggered through its practice, considering that many of these patients maintain a very negative relationship with their bodies."

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Academy of Neurologic Physical Therapy (ANPT) Survey

Calling all physical therapy professionals! Are you a Physical Therapist (PT) or Physical Therapist Assistant (PTA) in the United States who is in the clinic or academia? We want to hear about your opinions and experiences with the new Movement Analysis of Tasks (Quinn et al 2021) and Movement Systems Diagnoses for Balance Dysfunction (Gill-Body et al 2021).

Please fill out this 15-minute survey on your experiences with these two frameworks to help guide the ANPT Knowledge Translation taskforce in products to assist in improving the applicability of these items. (Approved by Angelo State IRB #MOY-110923.)

Access the Qualtrics Survey HERE.

Email [email protected] for more information.