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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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Drinking any amount of alcohol likely increases dementia risk

Even light drinking—generally thought to be protective, based on observational studies—is unlikely to lower the risk, which rises in tandem with the quantity of alcohol consumed.

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Drinking any amount of alcohol likely increases the risk of dementia, suggests the largest combined observational and genetic study to date, published online in BMJ Evidence Based Medicine.

Even light drinking—generally thought to be protective, based on observational studies—is unlikely to lower the risk, which rises in tandem with the quantity of alcohol consumed, the research indicates.

Current thinking suggests that there might be an ‘optimal dose’ of alcohol for brain health, but most of these studies have focused on older people and/or didn’t differentiate between former and lifelong non-drinkers, complicating efforts to infer causality, note the researchers.

To try and circumnavigate these issues and strengthen the evidence base, the researchers drew on observational data and genetic methods (Mendelian randomisation) from two large biological databanks for the entire ‘dose’ range of alcohol consumption.

These were the US Million Veteran Program (MVP), which includes people of European, African, and Latin American ancestry, and the UK Biobank (UKB), which includes people of predominantly European ancestry.

Participants who were aged 56–72 at baseline, were monitored from recruitment until their first dementia diagnosis, death, or the date of last follow-up (December 2019 for MVP and January 2022 for UKB), whichever came first. The average monitoring period was 4 years for the US group, and 12 for the UK group. 

Alcohol consumption was derived from questionnaire responses—over 90% of participants said they drank alcohol—and the Alcohol Use Disorders Identification Test (AUDIT-C) clinical screening tool. This screens for hazardous drinking patterns, including the frequency of binge drinking (6 or more drinks at a time).

In all, 559,559 participants from both groups were included in observational analyses, 14,540 of whom developed dementia of any type during the monitoring period:10,564 in the US group; and 3976 in the UK group. And 48,034 died: 28,738 in the US group and 19,296 in the UK group. 

Observational analyses revealed U-shaped associations between alcohol and dementia risk: compared with light drinkers (fewer than 7 drinks a week) a 41% higher risk was observed among non-drinkers and heavy drinkers consuming 40 or more drinks a week, rising to a 51% higher risk among those who were alcohol dependent. 

Mendelian randomisation genetic analyses drew on key data from multiple large individual genome-wide association studies (GWAS) of dementia, involving a total of 2.4 million participants to ascertain lifetime (rather than current) genetically predicted risks.

Mendelian randomisation leverages genetic data, minimising the impact of other potentially influential factors, to estimate causal effects: genomic risk for a trait (in this case, alcohol consumption) essentially stands in for the trait itself. 

Three genetic measures related to alcohol use were used as different exposures, to study the impact on dementia risk of alcohol quantity, as well as problematic and dependent drinking. 

These exposures were: self-reported weekly drinks (641 independent genetic variants);  problematic ‘risky’ drinking (80 genetic variants); and alcohol dependency (66 genetic variants). 

Higher genetic risk for all 3 exposure levels was associated with an increased risk of dementia, with a linear increase in dementia risk the higher the alcohol consumption. 

For example, an extra 1-3 drinks a week was associated with a 15% higher risk. And a doubling in the genetic risk of alcohol dependency was associated with a 16% increase in dementia risk.

But no U-shaped association was found between alcohol intake and dementia, and no protective effects of low levels of alcohol intake were observed. Instead, dementia risk steadily increased with more genetically predicted drinking. 

What’s more, those who went on to develop dementia typically drank less over time in the years preceding their diagnosis, suggesting that reverse causation—whereby early cognitive decline leads to reduced alcohol consumption—underlies the supposed protective effects of alcohol found in previous observational studies, say the researchers.

They acknowledge that a principal limitation of their findings is that the strongest statistical associations were found in people of European ancestry, because of the numbers of participants of this ethnic heritage studied. Mendelian randomisation also relies on assumptions that can’t be verified, they add.

Nevertheless, they suggest that their findings “challenge the notion that low levels of alcohol are neuroprotective.”

And they conclude: “Our study findings support a detrimental effect of all types of alcohol consumption on dementia risk, with no evidence supporting the previously suggested protective effect of moderate drinking. 

“The pattern of reduced alcohol use before dementia diagnosis observed in our study underscores the complexity of inferring causality from observational data, especially in ageing populations. 

“Our findings highlight the importance of considering reverse causation and residual confounding in studies of alcohol and dementia, and they suggest that reducing alcohol consumption may be an important strategy for dementia prevention.”

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Distribution of fat could influence cancer risk, study suggests

Obesity is usually measured using body mass index (BMI), but growing evidence – particularly from heart health research – suggests that BMI alone doesn’t capture the full picture when it comes to obesity-related health risks. However, the role of fat distribution in cancer risk has been relatively unexplored.  

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How fat is distributed in people’s bodies could make a difference to their risk of certain cancers, according to new research led by the University of Bristol.  The international study is published in the Journal of the National Cancer Institute (JNCI).

Scientists have already shown that having obesity increases a person’s risk of developing certain cancers. Obesity is usually measured using body mass index (BMI), but growing evidence – particularly from heart health research – suggests that BMI alone doesn’t capture the full picture when it comes to obesity-related health risks. However, the role of fat distribution in cancer risk has been relatively unexplored.  

Researchers in Bristol’s Integrative Cancer Epidemiology Programme (ICEP) investigated whether body fat at different locations across the body influences the risks of 12 obesity-related cancers – endometrial, ovarian, breast, colorectal, pancreas, multiple myeloma, liver, kidney (renal cell), thyroid, gallbladder, oesophageal adenocarcinoma, and meningioma.

They used a technique known as Mendelian randomisation, which uses statistics, computing and the natural variations in people’s genetics to identify patterns in large health data sets. 

The team found that fat distribution appears to influence cancer risk – but the relationship varies by cancer type. For some cancers, where fat is stored in the body seems more important than how much is stored; for others, the reverse is true; and, for some, both matter.  In cancers where distribution is important, the specific locations of body fat driving this seem to differ by cancer, meaning the overall picture is quite complex. 

Lead author, Dr Emma Hazelwood, who recently completed her PhD at the University of Bristol, explained: “These findings support the growing consensus that BMI, while useful for population-level trends, may be too simplistic for assessing individual health risks.

“Our results tell us that there is no ‘one-size-fits-all’ when it comes to cancer, meaning a more tailored approach to cancer prevention in people with obesity could be most effective.” 

The paper’s findings fit with recent calls for change, including the 2024 European Association for the Study of Obesity framework and the Lancet Commission on the future of obesity, which have emphasised that BMI is a flawed diagnostic tool and that fat distribution matters.  

In the future, a better understanding of how fat distribution across the body affects cancer risk could help identify those most at risk and guide more personalised approaches to obesity treatment and cancer prevention. 

The research team recommend further work is needed, using different approaches and studying non-European populations.

Dr Hazelwood added: “It is vital to understand the biological mechanisms that underpin these associations – particularly how and why different fat depots affect cancer development. In the longer term, we need to explore how obesity treatments – whether lifestyle or drug-based – influence these risk pathways.” 

Dr Julia Panina, Head of Research Funding at World Cancer Research Fund, added: “Our evidence-based Cancer Prevention Recommendations highlight the role of maintaining a healthy weight to reduce cancer risk. While this remains essential, growing scientific evidence shows that body composition – particularly how fat is distributed throughout the body – is also a crucial factor.  

“With support from our fantastic donors, we were able to co-fund the University of Bristol’s excellent team whose findings will help direct this exciting area towards possible new cancer prevention and treatments.” 

This study was funded by the World Cancer Research Fund (WCRF UK) and Cancer Research UK (Integrative Cancer Epidemiology Programme). This work was carried out at the MRC Integrative Epidemiology Unit (MRC IEU), which is supported by the Medical Research Council (MRC) and the University of Bristol. 

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Forget materialism, a simple life is happier: research

The commitment to simple living, or ‘voluntary simplicity’ as it is formally known, leads to wellbeing through providing more opportunities for personal interaction and social connection than conventional contexts of exchange, such as community gardens, sharing resources, and peer-to-peer lending platforms.

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In an age where billionaires and conspicuous consumption are increasingly on display, new Otago-led research shows a simple life really is a happier life.

The study led by University of Otago – Ōtākou Whakaihu Waka Department of Marketing researchers has recently been published in the Journal of Macromarketing.

After setting out to understand the relationship between consumption and wellbeing, the researchers found people are happier and more satisfied when adopting sustainable lifestyles and resisting the temptations of consumerism.

They analysed data from a representative sample of more than 1000 New Zealanders, made up of 51 per cent men and 49 per cent women, with a median age of 45 and a median annual household income of $50,000.

They found the commitment to simple living, or ‘voluntary simplicity’ as it is formally known, leads to wellbeing through providing more opportunities for personal interaction and social connection than conventional contexts of exchange, such as community gardens, sharing resources, and peer-to-peer lending platforms.

Women are more likely to adopt a simple life than men, although more research is needed to understand why.

Co-author Associate Professor Leah Watkins says consumer culture promotes happiness as being typically associated with high levels of income and the capability it affords to acquire and accumulate material possessions.

“However, research is clear that attitudes to, and experiences of, materialistic approaches to life do not lead to increases in happiness or wellbeing. Nor do they lead to sustainable consumption necessary for planetary health.”

Between 2000 and 2019, global domestic material consumption increased by 66 per cent, tripling since the 1970s to reach 95.1 billion metric tons.

Growing consumer affluence and higher living standards have resulted in warnings of alarming trends of environmental degradation from human consumption.

This, coupled with global warming and post-pandemic health and financial anxieties, has led researchers and policymakers to call for a better understanding of the links between simple consumer lifestyles and wellbeing.

But co-author Professor Rob Aitken says this isn’t a case of just throwing out all your worldly possessions.

“It’s not directly the commitment to material simplicity that leads to wellbeing, but the psychological and emotional need fulfilment that derives from relationships, social connection, community involvement and a sense of living a purposeful and meaningful life.

“In a world where billionaire weddings are treated like state occasions and private yachts are the new status symbols, voluntary simplicity offers a quiet, powerful counter-narrative — one that values enough over excess, connection over consumption, and meaning over materialism.”

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