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UAB Trial Studying Technique To Clear ‘Brain Fog’ After COVID-19

Post by Brianna Hoge for Alabama NewsCenter

Even after their bodies have cleared the virus that causes COVID-19, many patients experience long-term effects. One of the most troubling is a change in cognitive function – commonly called “brain fog” – that is marked by memory problems and a struggle to think clearly. A new clinical trial at the University of Alabama at Birmingham is testing a proven rehabilitation method to remedy that.

A report on 120 patients in France, published in October, found that more than one-third had memory loss and 27% had cognitive difficulties months after recovering from COVID-19. In another study, a hospital network in Chicago reported that, among 509 patients, nearly a third experienced altered mental function; of these, 68% were unable to handle routine daily activities such as cooking or paying bills. This “brain fog” can be debilitating. “It feels as though I am under anesthesia,” one patient said.

A new clinical trial at UAB aims to improve cognitive function in patients with “brain fog” and other lingering cognitive symptoms after they have recovered from COVID-19. (UAB)

Therapy used around the world

There are no current treatments for brain fog attributed to COVID-19. But a new clinical trial at UAB is testing a proven rehabilitation method with a record of success in restoring lost function. Known as constraint-induced therapy, it was developed by Edward Taub, director of the Constraint-Induced Movement Therapy Research Group, in collaboration with colleagues at UAB. CI therapy is used around the world to help stroke patients regain limb function and language abilities.

In a host of studies – including patients with stroke, multiple sclerosis and cerebral palsy – Taub and his longtime collaborator, Gitendra Uswatte, professor in the Department of Psychology, with other members of their research group, have demonstrated the effects of CI therapy.

Using MRI scans, they have shown that the therapy rewires the brain following two weeks of intensive training in the clinic and ongoing practice at home. The improvement in function that results remains even after years have passed, Taub said.

Some 97% of the thousands of stroke patients who have taken part in CI therapy have seen meaningful improvement, and the average patient uses his or her affected limb five times more post-therapy than pre-therapy.

Tackling persistent cognitive impairment

Now, Uswatte explained, “we have turned our attention to patients with persisting cognitive impairment after recovering from COVID-19.”

Brain scans showing significant rewiring after CI therapy had long since convinced Taub and Uswatte that the technique could restore cognitive function in the same way it restored a person’s ability to move their arms or legs. “We found in the motor rehabilitation work that the therapy is effective for a number of different types of brain damage,” Uswatte said.

‘Playing Scrabble again’

In a recently completed pilot study of six participants with cognitive difficulties after stroke, CI cognitive therapy brought significant improvements in the participants’ everyday lives, Taub said.

Although the results have not yet been published, several of those patients have made “very substantial improvements in carrying out cognitive tasks in their daily life” that are still being maintained as long as 11 months after completing training, Taub said.

“The patients’ improvements on cognitive tasks during training was not surprising given our past work in the motor and speech domains,” Taub said. “What is exciting is what has happened since the end of training – the participants have kept improving.”

Uswatte (left) and Taub are helping COVID-19 patients regain cognitive function through the use of CI. (Steve Wood/UAB)

“Participants tell us they have been able to go back to work, to start preparing food in the kitchen again, to start playing Scrabble again, that type of thing,” Uswatte said. “The therapeutic principles are not specific to a particular condition or type of damage. We would expect that similar mechanisms apply in stroke and COVID-19.” Many patients with COVID-19 appear to have suffered strokes or mini-strokes, Uswatte said.

Clinical trial details

With pilot funding from UAB’s Integrative Center for Aging Research, Taub and Uswatte will recruit at least 20 adult patients – anyone age 18 or older who has recovered from COVID-19 but is experiencing memory loss, brain fog or other cognitive issues. Participants will receive the training at no cost.

It involves 35 hours of therapy in the clinic, including the computer-based speed-of-processing training and a component called shaping, which involves training simulated cognitive activities in the clinic that are made progressively harder over time.

Transferring gains to everyday life

Typically, the training is spread across two weeks. Participants often have caregivers who work or have other obligations, so the training can be conducted during a longer period in some cases, Taub said. At the end of each session, participants are assigned 10 homework tasks “that patients use in their everyday lives to focus on transferring the gains they have made in the lab,” Uswatte said. “These are tasks that are important to the person or their quality of life and are going to challenge their cognitive skills.”

The activities might include “cooking a meal with more than three ingredients, starting a conversation, remembering medication, doing the laundry or making out a shopping list,” Taub said. “There are perceived – and often real – barriers to carrying out cognitive activities. Part of the requirement of the program is that participants have a caregiver or person who lives with them who can prompt them to do this homework when they are at home. We also call them once a week for the first month after the end of training and then once a month for the next 11 months to help participants hold onto their gains.”

The challenge of adapting CI therapy to a new condition is exciting, Taub and Uswatte said.

“This is not our first rodeo,” Taub said. “We have proved that the therapy works in other conditions. What got us interested here was the fact that current brain-training techniques that aim to help with brain fog work fine in the lab or in the training setting, but they do not transfer robustly to real-life situations. And if it does not transfer to life situations, why bother?”

People who think they can benefit are welcome to contact the project directly at 205-934-9768 or learn more about the study at uab.edu/citherapy.

This story originally appeared on the University of Alabama at Birmingham’s UAB News website.

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