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Fatigue, headache among top lingering symptoms months after COVID

Fatigue and headache were the most common symptoms reported by individuals an average of more than four months out from having COVID-19, investigators report.

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Fatigue and headache were the most common symptoms reported by individuals an average of more than four months out from having COVID-19, investigators report.

Muscle aches, cough, changes in smell and taste, fever, chills and nasal congestion were next in the long line of lingering symptoms.

“Our results support the growing evidence that there are chronic neuropsychiatric symptoms following COVID-19 infections,” Medical College of Georgia investigators write in the journal ScienceDirect

“There are a lot of symptoms that we did not know early on in the pandemic what to make of them, but now it’s clear there is a long COVID syndrome and that a lot of people are affected,” says Dr. Elizabeth Rutkowski, MCG neurologist and the study’s corresponding author.

The published study reports on preliminary findings from the first visit of the first 200 patients enrolled in the COVID-19 Neurological and Molecular Prospective Cohort Study in Georgia, or CONGA, who were recruited on average about 125 days after testing positive for the COVID-19 virus.

CONGA was established at MCG early in the pandemic in 2020 to examine the severity and longevity of neurological problems and began enrolling participants in March 2020 with the ultimate goal of recruiting 500 over five years.

Eighty percent of the first 200 participants reported neurological symptoms with fatigue, the most common symptom, reported by 68.5%, and headache close behind at 66.5%. Just over half reported changes in smell (54.5%) and taste (54%) and nearly half the participants (47%) met the criteria for mild cognitive impairment, with 30% demonstrating impaired vocabulary and 32% having impaired working memory.

Twenty-one percent reported confusion, and hypertension was the most common medical condition reported by participants in addition to their bout with COVID-19.

No participants reported having a stroke, weakness or inability to control muscles involved with speaking, and coordination problems were some of the less frequently reported symptoms.

Twenty-five percent met the criteria for depression, and diabetes, obesity, sleep apnea and a history of depression were associated with those who met the criteria. Anemia and a history of depression were associated with the 18% who met the objective criteria for anxiety.

While the findings to date are not surprising and are consistent with what other investigators are finding, Rutkowski says the fact that symptoms reported by participants often didn’t match what objective testing indicated, was surprising. And, it was bidirectional.

For example, the majority of participants reported taste and smell changes, but objective testing of both these senses did not always line up with what they reported. In fact, a higher percentage of those who did not report the changes actually had evidence of impaired function based on objective measures, the investigators write. While the reasons are not certain, part of the discrepancy may be a change in the quality of their taste and smell rather than pure impaired ability, Rutkowski says.

“They eat a chicken sandwich and it tastes like smoke or candles or some weird other thing but our taste strips are trying to depict specific tastes like salty and sweet,” Rutkowski says. Others, for example, may rely on these senses more, even when they are preparing the food, and may be apt to notice even a slight change, she says.

Either way, their data and others suggest a persistent loss of taste and smell following COVID-19, Rutkowski and her colleagues write.

Many earlier reports have been based on these kinds of self-reports, and the discrepancies they are finding indicate that approach may not reflect objective dysfunction, the investigators write.

On the other hand, cognitive testing may overestimate impairment in disadvantaged populations, they report.

The first enrollees were largely female, 35.5% were male. They were an average of 44.6 years old, nearly 40% were Black and 7% had been hospitalized because of COVID-19. Black participants were generally disproportionately affected, the investigators say.

Seventy-five percent of Black participants and 23.4% of white participants met criteria for mild cognitive impairment. The findings likely indicate that cognitive tests assess different ethnic groups differently. And, socioeconomic, psychosocial (issues like family problems, depression and sexual abuse) and physical health factors generally may disproportionately affect Black individuals, the investigators write. It also could mean that cognitive testing may overestimate clinical impairment in disadvantaged populations, they write.

Black and Hispanic individuals are considered twice as likely to be hospitalized by COVID-19 and ethnic and racial minorities are more likely to live in areas with higher rates of infection. Genetics also is a likely factor for their increased risk for increased impact from COVID, much like being at higher risk for hypertension and heart disease early and more severely in life.

A focus of CONGA is to try to better understand how increased risk and effects from COVID-19 impact Blacks, who comprise about 33% of the state’s population.

A reason fatigue appears to be such a major factor among those who had COVID-19 is potentially because of levels of inflammation, the body’s natural response to an infection, remain elevated in some individuals. For example, blood samples taken at the initial visit and again on follow up showed some inflammatory markers were up and stayed up in some individuals.

These findings and others indicate that even though the antibodies to the virus itself may wain, persistent inflammation is contributing to some of the symptoms like fatigue, she says. She notes patients with conditions like multiple sclerosis and rheumatoid arthritis, both considered autoimmune conditions that consequently also have high levels of inflammation, also include fatigue as a top symptom.

“They have body fatigue where they feel short of breath, they go to get the dishes done and they are feeling palpitations, they immediately have to sit down and they feel muscle soreness like they just ran a mile or more,” Rutkowski says.

“There is probably some degree of neurologic fatigue as well because patients also have brain fog, they say it hurts to think, to read even a single email and that their brain is just wiped out,” she says. Some studies have even shown shrinkage of brain volume as a result of even mild to moderate disease. 

These multisystem, ongoing concerns are why some health care facilities have established long COVID clinics where physicians with expertise in the myriad of problems they are experiencing gather to see each patient.

CONGA participants who reported more symptoms and problems tended to have depression and anxiety. Problems like these as well as mild cognitive impairment and even impaired vocabulary may also reflect the long-term isolation COVID-19 produced for many individuals, Rutkowski says.

“You are not doing what you would normally do, like hanging out with your friends, the things that bring most people joy,” Rutkowski says. “On top of that, you may be dealing with physical ailments, lost friends and family members and loss of your job.”

For CONGA, participants self-report symptoms and answer questions about their general state of health like whether they smoked, drank alcohol, exercised, and any known preexisting medical conditions. But they also receive an extensive neurological exam that looks at fundamentals like mental status, reflexes and motor function. They also take established tests to assess cognitive function with results being age adjusted. They also do at-home extensive testing where they are asked to identify odors and the ability to taste sweet, sour, bitter, salty, brothy or no taste. They also have blood analysis done to look for indicators of lingering infection like those inflammatory markers and oxidative stress.

Neuropsychiatric symptoms are observed in the acute phase of infection, but there is a need for accurate characterization of how symptoms evolve over time, the investigators write.

And particularly for some individuals, symptoms definitely linger. Even some previously high-functioning individuals, who normally worked 80 hours a week and exercised daily, may find themselves only able to function about an hour a day and be in the bed the remainder, Rutkowski says.

The investigators are searching for answers to why and how, and while Rutkowski says she cannot yet answer all their questions, she can tell them with certainty that they are not alone or “crazy.”  

One of the best things everyone can do moving forward is to remain diligent about avoiding infection, including getting vaccinated or boosted to help protect your brain and body from long COVID symptoms and help protect others from infection, Rutkowski says. There is evidence that the more times you are infected, the higher the risk of ongoing problems.

Rutkowski notes that their study findings may be somewhat biased toward high percentages of ongoing symptoms because the study likely is attracting a high percentage of individuals with concerns about ongoing problems.

SARS-CoV-2 is thought to have first infected people in late 2019 and is a member of the larger group of coronaviruses, which have been a source of upper respiratory tract infections, like the common cold, in people for years.

At least part of the reason SARS-CoV-2 is believed to have such a wide-ranging impact is that the virus is known to attach to angiotensin-converting enzyme-2, or ACE2, which is pervasive in the body. ACE2 has a key role in functions like regulating blood pressure and inflammation. It’s found on neurons, cells lining the nose, mouth, lungs and blood vessels, as well as the heart, kidneys and gastrointestinal tract. The virus attaches directly to the ACE2 receptor on the surface of cells, which functions much like a door to let the virus inside.

Experience and study since COVID-19 started both indicate immediate neurological impact can include loss of taste and smell, brain infection, headaches and, less commonly, seizures, stroke and damage or death of nerves. As time has passed, there is increasing evidence that problems like loss of taste and smell, can become chronic, as well as problems like brain fog, extreme fatigue, depression, anxiety and insomnia, the investigators write. Persistent conditions including these and others are now referenced as “long Covid.”

The research was supported by funding from the National Institute of Neurological Disorders and Stroke and philanthropic support from the TR Reddy Family Fund.

Read the full study.

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NewsMakers

How to help children build a growth mindset

Consider these three tips to help children build a growth mindset.

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A new year is a perfect time to consider the habits you want to keep and the ones you’d like to develop. One resolution to consider is helping your children develop a growth mindset this year.

“We know one of the greatest boosts to parents’ confidence over the past year came from knowing their children’s whole selves are being nurtured, and we want to see that trend continue,” said Carter Peters from KinderCare Learning Center’s education team. “A growth mindset helps children try new things despite fear of failure. It’s the kind of thinking that allows inventors and creative thinkers to get excited about trying something new and ensures they have the cognitive flexibility and problem-solving skills to work through hurdles.”

Adults can often easily spot when children are engaged in creative thinking and prideful of their work, but that confidence may be lost as failures turn into insecurities. By nurturing a growth mindset and showing children they can learn and develop new skills in any area, it better sets them up for long-term success.

Consider these three tips to help children build a growth mindset:

Photo by Markus Spiske from Unsplash.com

1. Praise effort

It’s easy to fall into the habit of praising successes. However, praising effort encourages children to try new things without the fear of failing. It also teaches children personal growth and achievement are possible, even if their overall effort wasn’t a success.

“Young children often get excited to try something new,” Peters said. “By praising effort and showing children they’ll still be loved and valued despite the outcome, you can reframe how they approach challenges and teach them that difficult doesn’t mean impossible.”

2. Encourage the process

People often withhold praise until there’s a result, which leads children to hurriedly scribble a picture to hold up for a “good job” instead of taking time to focus on their efforts. When children know adults will encourage them during the process, instead of only upon the achievement, they’re more likely to try new things or master a new skill. For example, try providing encouragement such as, “I can see you’re focused on drawing that tree. It looks so lifelike because you’re putting so much thought into what you’re doing.” Once their project is finished, continue the encouragement by hanging up their artwork or school projects in a prominent place.

3. Model a growth mindset

You can model a growth mindset for children by narrating your actions when you are facing a challenge: “I am having a difficult time putting this shelf together, but it’s OK. I’ll take a break then read the instructions again.” Remove negative words from your vocabulary, such as “I can’t” or “I’m stupid.” Even when you are joking, children may not be able to tell the difference. You can also ask your children to join you in problem-solving. Take time to hear their ideas and try them even if you think they won’t work. This not only supports the development of their growth mindset, but the quality time and encouragement reinforces their sense of self-worth and builds confidence.

For more tips to help children develop a growth mindset, visit kindercare.com.

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Signs of a Healthy Marriage

Although there are many different ways to define a healthy marriage, these three qualities are essential for any lasting and fulfilling relationship.

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A healthy marriage is built on trust, respect, and communication. Couples with these qualities in their relationship tend to be more satisfied with their marriage and overall life. They also report feeling closer to their partner and having stronger well-being. With 2.3 out of every 1000 people in the US experiencing divorce in 2022, it is important to frequently check in on the health of your marriage.

Although there are many different ways to define a healthy marriage, these three qualities are essential for any lasting and fulfilling relationship.

Signs of a Healthy Marriage

A healthy marriage is built on trust, communication, and mutual respect. If you and your partner can effectively communicate and share a mutual level of respect, then your relationship is off to a good start. Trust is also important in a healthy marriage, as it allows you and your partner to feel secure in your relationship and rely on each other.

Many other signs can indicate whether or not a marriage is healthy. For example, couples who can spend quality time together and enjoy shared activities usually do well. Couples who can openly discuss their relationship with each other and work through difficulties together are also more likely to have a happy and healthy marriage. Finally, marriages, where both partners feel like they can be themselves without judgment from their spouse tend to be the strongest and most lasting.

Freedom to be yourself

In a healthy marriage, partners feel free to be themselves. They don’t have to put on a facade or pretend to be someone they’re not. They can be open and honest with each other and feel comfortable sharing their thoughts, feelings, and desires.

Both partners should pursue their interests and hobbies without compromising or sacrificing for the sake of the relationship. There’s no need to agree on everything – in fact, it’s healthy to have some separate interests – but overall, both partners should feel like they’re able to be true to themselves within the relationship.

Lots of good communication

In a healthy marriage, partners can communicate effectively. It means expressing needs and wants and listening and responding to what the other person is saying. There are mutual respect’s opinions, even if there are disagreements. Couples in a healthy marriage feel comfortable communicating with each other about both the good and the bad.

Good sex life

A good sex life can be a major sign of a healthy marriage. A lack of sexual activity can be an early warning sign that something is wrong in the relationship. Often, couples who have a good sex life are more connected emotionally and physically. They are also more likely to trust each other and communicate openly.

Trust in each other

In any relationship, trust is essential. Without trust, there is no foundation for the relationship to grow. In a marriage, trust is even more important. Trusting your spouse means you feel confident in their ability to support you emotionally and financially. It also means that you feel safe sharing your innermost thoughts and feelings with them.

When you trust your spouse, you know they have your best interests. You feel comfortable being yourselves around each other and sharing your hopes, dreams, and fears. Openness and honesty in your relationship allow you to be vulnerable with each other. This vulnerable honesty creates a deeper level of intimacy in your marriage.

When you trust each other, you can be more forgiving when mistakes are made. You know that everyone makes mistakes and that nobody is perfect. You also understand that your spouse is human and capable of making mistakes like anyone else. If they make a mistake, you are more likely to forgive them because you know they are sorry and will try not to make the same mistake again.

Trust is one of the most important foundations of a healthy marriage. If you want your marriage to thrive, build trust in each other.

A successful, strong marriage takes work, but with communication, trust, respect, vulnerability, and affection as its core components, you can together create a partnership that will be long-lasting.

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Obesity linked to macular degeneration

Immune cells are also activated when the body is exposed to stressors such as excess fat in obesity, making being overweight the number one non-genetic risk factor for developing AMD, after smoking.

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A Canadian study published in the prestigious journal Science elucidates a new molecular mechanism that may cause age-related macular degeneration (AMD).

The research at Hôpital Maisonneuve-Rosement, in Montreal, shows how life stressors such as obesity reprogram immune system cells and make them destructive to the eye as it ages.

“We wanted to know why some people with a genetic predisposition develop AMD while others are spared,” said Université de Montréal ophtalmology professor Przemyslaw (Mike) Sapieha, who led the study by his postdoctoral fellow Dr. Masayuki Hata.

“Although considerable effort has been invested in understanding the genes responsible for AMD, variations and mutations in susceptibility genes only increase the risk of developing the disease, but do not cause it,” Sapieha explained.

“This observation suggests that we must gain a better understanding of how other factors such as environment and lifestyle contribute to disease development.”

AMD is a major cause of irreversible blindness worldwide and affected approximately 196 million people in 2020. It comes in two forms:

  • dry AMD, characterized by the accumulation of fatty deposits at the back of the eye and the death of nerve cells in the eye,
  • and wet AMD, which is characterized by diseased blood vessels that develop in the most sensitive part of the sight-generating tissue, called the macula.

Contact with pathogens

It is already known that the immune system in the eye of a person with AMD becomes dysregulated and aggressive. Normally, immune cells keep the eye healthy, but contact with pathogens such as bacteria and viruses can make them go awry.

At the same time, immune cells are also activated when the body is exposed to stressors such as excess fat in obesity, making being overweight the number one non-genetic risk factor for developing AMD, after smoking.

In their study, Sapieha and Hata used obesity as a model to accelerate and exaggerate the stressors experienced by the body throughout life.

They found that transient obesity or a history of obesity leads to persistent changes in the DNA architecture within immune cells, making them more susceptible to producing inflammatory molecules.

“Our findings provide important information about the biology of the immune cells that cause AMD and will allow for the development of more tailored treatments in the future,” said Hata, now an ophthalmology professor at Kyoto University, in Japan.

The researchers hope their discovery will lead other scientists to broaden their interest beyond obesity-related diseases to other diseases characterized by increased neuroinflammation, including Alzheimer’s disease and multiple sclerosis.

About this study

“Past history of obesity triggers persistent epigenetic changes in innate immunity and exacerbates neuroinflammation,” by Mike Sapieha and Masayuki Hata, was published in Science.

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