The COVID‐19 pandemic, a respiratory disease with a hidden time bomb in the brain: Impact on reserve and resilience

Abstract

BackgroundWe present an overview on the potential impact of COVID19 infection on cognitive reserve and resilience capacity. The presence of RNA virus in the brain and a pathognomonic symptom, the loss of smell and taste, suggest a long‐term brain impact that could directly affect cognitive reserve. A wide range of neurological manifestations associated with SARS‐CoV‐2 have been described and the list is still increasing, consistent with multiple pathogenic pathways as post‐infectious and immunity reactions. It includes stroke, brain haemorrhage or memory loss.MethodSuch events have already been observed in the course of other viral diseases. In addition, preventive actions to stop the exponential progression of the virus have been adopted by most of countries (masks, physical distancing, lockdowns or curfews), with a common impact: the reduction of our social and physical relationships. Thus, this dramatic stop of human interactions, known as the most effective brain stimulation, may also severely impair cognitive reserve and resilience. The global spread of the pandemic suggests that tens of thousands of individuals may have had cerebral symptoms. Hence, we must take actions to predict the consequences of COVID19 on cognitive reserve and brain resilience.ResultsAged and frail people are especially concerned: (1) due to their ages, they are at a very high risk of severe forms; (2) as the specific containment imposed to retirement home residents precluded any social relationships for long periods of time. This double punishment had tragic immediate and long‐term consequences on their cognitive reserve and survival. We now need to actively find ways to estimate and limit the brain health impact of the COVID19 pandemic by: (1) helping elderly to resist to social distancing by promoting public health tools as the COVID‐SCORE French experience; (2) setting long term international cohorts to follow‐up the largest numbers of COVID19 patients for their cognitive reserve evolution; (3) Improving cognitive reserve in COVID19 patients by launching prevention programs,ConclusionThe implementation of such an action plan will allow reducing the third possible consequence of the virus and the lockdown, i.e. a decrease of the cognitive reserve and resilience in older adults.