“While this latest study is a cohort study with factors that remain unmeasured, the convergence of evidence for the importance of the kynurenine pathway in long COVID, and the associated brain fog, is not by chance,” says A/Prof.
In addition, the immune precursor of the kynurenine pathway was shown to be associated with persistent chest and fatigue symptoms in a previous paper also part of the ADAPT study, published last year in Nature Immunology. The team decided to investigate the activation of the kynurenine pathway based on previous experience of studying the pathway in other infectious diseases. “At each of these points, the patients went through lots of tests, including on their mental health, physical health, and cognitive health, and patients also had tests for various blood biomarkers on four occasions.” Cysique’s research, the cohort was followed up at two, four, and 12 months. Hence the results are still relevant, especially in the context of reinfection,” says A/Prof. “With vaccination, many of us will still experience mostly mild symptoms. While this study included only unvaccinated patients, because the testing was conducted before patients received their first vaccine, the majority of people in the study had long COVID as a result of mild COVID-19 infection. Hence, these types of deficits can affect work efficiency to some degree and probably contribute to the economic impact of the pandemic.” Monitoring Long-term Effects of COVID “And, we are talking of mostly working-age people. “With a little introspection, we can all imagine how long-term flu-like physical and mental fatigue would impact everyday function,” says A/Prof. Cysique explains, the best descriptor of brain fog would be a flu-like physical and mental fatigue lasting months, although with some fluctuations. This is associated with short-term memory problems, difficulty in multi-tasking or concentration over long periods of time.Īs A/Prof. The cognitive dysfunctions experienced by those with long COVID manifest most often as a lack of mental focus or clarity, or mental fatigue that is unusual compared to one’s previous capacity, especially after a cognitively demanding task (for example reading complex instructions, participating in a meeting that demands high concentration level, watching a documentary on a topic that is new and complex). “However, we now know that besides fatigue, cognitive changes are the most common symptoms associated with long COVID.” This is not surprising as the immune system is involved across all body functions,” says A/Prof. “Long COVID is a multi-organ disease, so people are differently affected across several of their body functions. In fact, over 200 different symptoms have been recorded as part of the long COVID disease profile. Understanding Long COVID and ‘Brain Fog’Ĭurrent evidence compiled by the World Health Organisation (WHO) suggests approximately 10–20 percent of people experience a variety of mid and long-term effects after they recover from their initial illness. “These findings lay the foundation for the kynurenine pathway as a potential diagnostic and monitoring marker, as well as a possible therapeutic target,” A/Prof. The discovery opens up possibilities for identifying and treating people who are experiencing the cognitive effects of long COVID and perhaps long COVID in general. Our study speaks to the contrary, that there is a real biological mechanism behind long COVID brain fog,” A/Prof. “I think when patients go to the doctor’s with brain fog, it may be dismissed as a psychological problem. The study, published recently in Annals of Clinical and Translational Neurology, helps demonstrate that there is a biological change underlying brain fog in people who have long COVID as a result of mild acute COVID-19 infection. “The current study specifically found that an important metabolic pathway – the kynurenine pathway – is linked to the cognitive changes we’re seeing in this group of patients.” “Together, this study and a previous study in the ADAPT program show that long COVID brain fog is associated with a dysregulation of the immune response,” says Associate Professor Lucette Cysique, lead author of the study. Patients who participated in this study had mild to moderate acute COVID-19 and were enrolled in the St Vincent’s COVID-19 ADAPT study, a longitudinal study led by Professor Gail Matthews.
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