Clouding Of Consciousness Research Articles

Current knowledge on the pathophysiology of idiopathic hypersomnia and potential mechanisms of action for low-sodium oxybate treatment.

To elucidate hypotheses for the pathophysiology of idiopathic hypersomnia and discuss the mechanisms by which low-sodium oxybate (LXB) improves idiopathic hypersomnia symptoms. Published literature on idiopathic hypersomnia sleep abnormalities, symptoms, treatments, and underlying pathophysiology was reviewed. Patients with idiopathic hypersomnia often show sleep architecture alterations, such as increased sleep efficiency and reduced slow-wave sleep, although the literature lacks consensus. The current understanding of pathophysiologic changes in idiopathic hypersomnia is sparse, but several hypotheses have been posited to explain specific symptoms. Long biological sleep clock, hypofunction of default mode network, dysregulated gamma-aminobutyric acid (GABA) signaling, inflammation, reduced physical activity, and immunologic abnormalities have been linked, to varying degrees, with the hallmark symptoms of idiopathic hypersomnia (excessive daytime sleepiness, sleep inertia, brain fog, dysautonomia). Treatment mechanisms may help elucidate pathophysiologic mechanisms. LXB effectively addresses idiopathic hypersomnia symptoms and is the only US-approved therapy for this indication. Oxybate, the active moiety in LXB, acts dose-dependently on GABA and gamma-hydroxybutyrate receptors, inhibits dopamine and noradrenaline signaling, and improves sleep architecture in people with narcolepsy. The effectiveness of LXB, a sleep-inducing treatment, on idiopathic hypersomnia symptoms suggests altered sleep architecture may contribute to this disorder. Idiopathic hypersomnia, a sleep disorder with potentially debilitating symptoms, remains understudied. The underlying pathophysiology of idiopathic hypersomnia needs defining; insights can be gleaned from contextualizing current knowledge about mechanisms of effective treatments, such as LXB.

Health information behavior during the life transition among people diagnosed with hypothyroidism

AbstractBeing diagnosed with a chronic illness can lead to a life transition that invokes new kinds of information behavior for an individual. This qualitative study focuses on information behavior—particularly information needs, use, and barriers—during the life transitions of people diagnosed with hypothyroidism. Ten interviews were conducted in 2022 with individuals who were diagnosed with hypothyroidism. The data were analyzed using qualitative content analysis. Based on the intermediate transitions theory by I. Ruthven, 2022 (An information behavior theory of transitions. Journal of the Association for Information Science & Technology, 73(4), 579–593), the process of transition includes phases of understanding, negotiating, and resolving, as well as processes of event, engaging, enacting, and establishing. Based on the findings, information needs, use, and barriers varied according to the stage of disease and in different stages of a life transition. Interviewees had a wide range of information needs related to disease and diagnosis, treatment balance, and disease monitoring. Information use included the promotion of personal well‐being through physical activity and improvement of information‐seeking skills. The most significant barriers to information acquisition included communication issues with health care providers and symptoms of hypothyroidism such as fatigue and brain fog. For information providers, the results provide important knowledge on information behavior during a life transition related to a chronic illness.

Association of glycemic control with Long COVID in patients with type 2 diabetes: findings from the National COVID Cohort Collaborative (N3C)

IntroductionElevated glycosylated hemoglobin (HbA1c) in individuals with type 2 diabetes is associated with increased risk of hospitalization and death after acute COVID-19, however the effect of HbA1c on Long COVID...

Post-COVID symptoms after SARS-CoV-2 omicron infection and the effect of booster vaccination: A population-based cohort study.

The impact of vaccination on the type and risk of specific post-COVID symptoms after Omicron infection is not clear. We aimed to investigate the excess risk and patterns of 22 symptoms 3-5months after Omicron infection, comparing uninfected and infected subjects with and without recent booster vaccination. We conducted a population-based prospective study based on four questionnaire-based cohorts linked to national health registries. Our study includes female and male participants aged 11-80years from The Norwegian Mother, Father, and Child Cohort Study, The Norwegian Influenza Pregnancy Cohort, The Senior Cohort, and The Young Adult Cohort. All participants registered presence of 22 COVID-related symptoms irrespective of infection and vaccination status. The study sample includes more than 31,000 uninfected and 26,000 Omicron infected subjects. Among infected subjects, 12% were vaccinated with two doses >130days before the primary infection (median 154days) but had not received a third dose, while 76% had received a third (booster) dose (median 40days before infection). Among those with two doses only, the excess risk for new symptoms after infection (vs. no infection) were up to 15% for women and 9% for men. Among infected subjects with recent booster dose, the corresponding excess risks were 7% among women and up to 5% among men. The largest risk differences after recent booster vaccination were seen for poor memory, brain fog, and fatigue. Post-COVID symptoms were more often detected among young and middle-aged adults than among adolescents and older age groups. Recent booster vaccination before infection substantially reduced both neurocognitive and cardiorespiratory symptoms occurring at least 3months after Omicron infection.

A single-cell RNA sequencing dataset of peripheral blood cells in long COVID patients on herbal therapy

Following the coronavirus disease 2019 (COVID-19) pandemic, the rise of long COVID, characterized by persistent respiratory and cognitive dysfunctions, has become a significant health concern. This leads to an increased role of complementary and alternative medicine in addressing this condition. However, our comprehension of the effectiveness and safety of herbal medicines for long COVID remains limited. Here, we present a single-cell RNA sequencing (scRNA-seq) dataset of peripheral whole blood cells derived from participants in a clinical study involving three commercially available herbal medicines, targeting fatigue and brain fog in long COVID. The dataset comprises 181,205 quality control (QC)-passed cells, along with clinical metadata, enabling a comparative analysis of immune cell populations before and after treatment. To ensure the technical validity of our dataset, we implemented rigorous quality checks throughout stages of the study, including sample preparation, sequencing, and bioinformatic data analysis levels. This transcriptomic data may serve as a resource to deepen our insights into the role of herbal medicines in management of long COVID.

Interrelationships Between Plasma Levels of Brain Natriuretic Peptide and Prolonged Symptoms Due to Long COVID

Objectives: Evidence for the usefulness of biomarkers that aid in diagnosis, assessment of severity, and prediction of prognosis in patients with long COVID is limited. The aim of this study was to clarify the characteristics of brain natriuretic peptide (BNP) in long COVID. Methods: We conducted a retrospective observational study of patients who visited the COVID-19 aftercare outpatient clinic at Okayama University Hospital from February 2021 to April 2024. Results: A total of 428 patients were enrolled in this study, and the patients were divided into a group with normal BNP (n = 314, ≤18.4 pg/mL) and a group with increased BNP (n = 114, >18.4 pg/mL). The long COVID group with increased BNP had a higher proportion of females (44.3% vs. 73.7%, p < 0.01) and an older median age (38 vs. 51 years, p < 0.01). Fatigue and brain fog were commonly manifested in both groups, while dyspnea was a more frequent complaint in the group with increased BNP. Various symptoms including fatigue, palpitations, and taste and/or olfactory disorders were associated with elevated BNP (23 to 24 pg/mL). Memory impairment was also linked to higher BNP (OR: 2.36, p = 0.05). In long COVID patients, plasma BNP elevation appears to be more pronounced in females and is often related to cardiogenic factors, in which inflammatory responses are also involved. Conclusions: Plasma BNP measurement may be useful for evaluating the severity of long COVID, especially in female patients and those with respiratory symptoms and/or memory impairment.

Clinical epidemiology of dengue and COVID-19 co-infection among the residents in Dhaka, Bangladesh, 2021-2023: A cross-sectional study

Abstract Background Co-infection of dengue and COVID-19 has increased the health burden worldwide. We found a significant knowledge gap in epidemiology and risk factors of co-infection in Bangladesh. Methods This study included 2458 participants from Dhaka city from December 1, 2021, to November 30, 2023. We performed Kruskal-Walli’s test and χ2 test. Multivariable logistic regression was also performed. Results Co-infection of dengue and COVID-19 was found among 31% of the participants. Co-prevalence of dengue and COVID-19 was found in higher frequency in Jatrabari (14%), and Motijhil (11%). Severe (65%, p-value 0.001) and very severe (78%, p-value 0.005) symptoms were prevalent among the participants aged >50 years. Long-term illness was prevalent among the participants with co-infection (35%, 95% CI 33%- 36%) and COVID-19 (28%, 95% CI 26%- 30%). Co-infected participants had a higher frequency of heart damage (31.6%, p-value 0.005), brain fog (22%, p-value 0.03), and kidney damage (49.3%, p-value 0.001). Fever (100%) was the most prevalent symptom followed by weakness (89.6%), chills (82.4%), fatigue (81.4%), headache (80.6%), feeling thirsty (76.3%), myalgia (75%), pressure in the chest (69.1%), and shortness of breath (68.3%), respectively. Area of residence (OR 2.26, 95% CI 1.96-2.49, p-value 0.01), number of family members (OR 1.45, 95% CI 1.08-1.87, p-value <0.001), and population density (OR 2.43, 95% CI 2.15-3.01, p-value 0.001) were associated with higher odds of co-infection. We found that coinfected participants had a 4 times higher risk of developing severe health conditions (OR 4.22, 95% CI 4.11-4.67, p-value 0.02). Conclusions This is one of the early epidemiologic studies of co-infection of dengue and COVID-19 in Bangladesh.

The prolonged health sequelae “of the COVID-19 pandemic” in sub-Saharan Africa: a systematic review and meta-analysis

BackgroundSurvivors of coronavirus disease 2019 (COVID-19) often face persistent and significant challenges that affect their physical, mental, and financial wellbeing, which can significantly diminish their overall quality of life. The emergence of new symptoms or the persistence of existing ones after a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) diagnosis has given rise to a complex clinical issue known as “long COVID-19” (LC). This situation has placed additional strain on global healthcare systems, underscoring the urgent need for ongoing clinical management of these patients. While numerous studies have been conducted on the long-term effects of COVID-19, our systematic review, and meta-analysis, is the first of its kind in sub-Saharan Africa, providing a comprehensive understanding of the situation in the region and highlighting the necessity for continuous clinical management.ObjectiveThis study aimed to systematically synthesize evidence on the persistent sequelae of COVID-19 and their predictors in sub-Saharan Africa.MethodsA thorough search was conducted across multiple databases, including PubMed/MEDLINE, Web of Science, Google/Google Scholar, African online journals, and selected reference lists, from the inception of these databases until January 12, 2024. A meta-analysis of proportions was conducted using the random-effects restricted maximum-likelihood model. The association between various factors was also analyzed to determine the pooled factors that influence long COVID-19 outcomes.ResultsOur comprehensive analysis of 16 research articles, involving a total of 18,104 participants revealed a pooled prevalence of COVID-19 sequelae at 42.1% (95% CI: 29.9–55.4). The long-term health sequelae identified in this review included persistent pulmonary sequelae (27.5%), sleep disturbance (22.5%), brain fog (27.4%), fatigue (17.4%), anxiety (22.3%), and chest pain (13.2%). We also found a significant association was observed between comorbidities and long COVID-19 sequelae [POR = 4.34 (95% CI: 1.28–14.72)], providing a comprehensive understanding of the factors influencing long COVID-19 outcomes.ConclusionCOVID-19 can have long-lasting effects on various organ systems, even after a person has recovered from the infection. These effects can include brain fog, pulmonary symptoms, sleep disturbances, anxiety, fatigue, and other neurological, psychiatric, respiratory, cardiovascular, and general symptoms. It is crucial for individuals who have recovered from COVID-19 to receive careful follow-up care to assess and reduce any potential organ damage and maintain their quality of life.Systematic review registrationClinicaltrial.gov, identifier CRD42024501158.

Tetrahydrobiopterin in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: A Friend or Foe?

Myalgic Encephalomyelitis or Chronic Fatigue Syndrome (ME/CFS) is a chronic multisystem disease characterized by severe muscle fatigue, pain, dizziness, and brain fog. The two most common symptoms are post-exertional malaise (PEM) and orthostatic intolerance (OI). ME/CFS patients with OI (ME+OI) suffer from dizziness or faintness due to a sudden drop in blood pressure while maintaining an upright posture. Clinical research has demonstrated that patients with OI display severe cardiovascular abnormalities resulting in reduced effective blood flow in the cerebral blood vessels. However, despite intense investigation, it is not known why the effective cerebral blood flow is reduced in OI patients. Based on our recent findings, we observed that tetrahydrobiopterin (BH4) metabolism was highly dysregulated in ME+OI patients. In the current review article, we attempted to summarize our recent findings on BH4 metabolism to shed light on the molecular mechanisms of OI.

Cerebromicrovascular mechanisms contributing to long COVID: implications for neurocognitive health.

Long COVID (also known as post-acute sequelae of SARS-CoV-2 infection [PASC] or post-COVID syndrome) is characterized by persistent symptoms that extend beyond the acute phase of SARS-CoV-2 infection, affecting approximately 10% to over 30% of those infected. It presents a significant clinical challenge, notably due to pronounced neurocognitive symptoms such as brain fog. The mechanisms underlying these effects are multifactorial, with mounting evidence pointing to a central role of cerebromicrovascular dysfunction. This review investigates key pathophysiological mechanisms contributing to cerebrovascular dysfunction in long COVID and their impacts on brain health. We discuss how endothelial tropism of SARS-CoV-2 and direct vascular infection trigger endothelial dysfunction, impaired neurovascular coupling, and blood-brain barrier disruption, resulting in compromised cerebral perfusion. Furthermore, the infection appears to induce mitochondrial dysfunction, enhancing oxidative stress and inflammation within cerebral endothelial cells. Autoantibody formation following infection also potentially exacerbates neurovascular injury, contributing to chronic vascular inflammation and ongoing blood-brain barrier compromise. These factors collectively contribute to the emergence of white matter hyperintensities, promote amyloid pathology, and may accelerate neurodegenerative processes, including Alzheimer's disease. This review also emphasizes the critical role of advanced imaging techniques in assessing cerebromicrovascular health and the need for targeted interventions to address these cerebrovascular complications. A deeper understanding of the cerebrovascular mechanisms of long COVID is essential to advance targeted treatments and mitigate its long-term neurocognitive consequences.

Imaging features associated with the susceptibility to brain fog: a major secondary complication observed in patients with ischemic stroke

Imaging features associated with the susceptibility to brain fog: a major secondary complication observed in patients with ischemic stroke

Navigating neurologic post-COVID-19 conditions in adults: Management strategies for cognitive dysfunction, headaches and neuropathies.

This review aims to describe the neurologic post-COVID-19 conditions (PCC, also known as "long COVID"), a complex array of diagnoses that can occur following recovery from acute COVID-19. The review also includes clinical considerations for the recognition, diagnosis and management of neurologic manifestations of PCC. Cognitive impairment ("Brain Fog"), headaches, and neuropathies are specifically reviewed.

More than “Brain Fog”: Cognitive Dysfunction and the Role of Occupational Therapy in Long COVID

Long COVID is a disabling condition which affects occupational performance and quality of life. It interferes with activities of daily living, work, and many meaningful life roles. Cognitive dysfunction is a frequently reported symptom, yet it is commonly overlooked. It is important that cognitive activity is considered when working with people with long COVID, particularly when identifying triggers of post exertional symptom exacerbation. There are many potential mechanisms that could be driving cognitive dysfunction in long COVID including neuroinflammation, viral persistence, vascular damage, and orthostatic intolerance. It is important to consider these to help guide intervention. The purpose of this clinical perspective is to highlight the debilitating impact of cognitive dysfunction in those with long COVID and share the key role of occupational therapists in this area. Cognitive dysfunction may be missed on standardized assessments as they may not be sensitive enough due to the episodic nature of symptoms. Occupational therapists can play a key role in this area as they are experts in assessing occupational performance and in providing safe cognitive assessment and rehabilitation.

Refinement of post-COVID condition core symptoms, subtypes, determinants, and health impacts: A cohort study integrating real-world data and patient-reported outcomes

Post-COVID-19 condition (PCC) affects millions of people, and is an essential component of the long-term impact of COVID-19 during the post-pandemic era. Yet, consensus on clinical case definition and core components of PCC remains lacking, affecting our ability to inform research and evidence-based management. Our study aims 1) to identify the most specific symptoms for PCC, and identify clinical subtypes; 2) to evaluate both virus- and host-related determinants of PCC, and 3) assess the impact of PCC on physical and mental health. We studied participants from UK Biobank who completed a health and wellbeing survey between June and September 2022. Participants reported the current conditions of the presence, duration, and functional limitations of 45 symptoms, using an online questionnaire designed specifically for COVID-19 research. SARS-CoV-2 infection status and disease history were obtained through linkage to surveillance data and electronic medical records, respectively. Participants reporting symptoms within 30 days after infection (acute phase) were excluded. The most specific PCC symptoms were defined using two criteria: statistical significance (P<0.05 after Bonferroni correction) and clinical relevance (absolute risk increase > 5%). Propensity score weighting was used to control for confounding. Subtypes of PCC were then defined based on the specific symptoms among the COVID-19 infected individuals. A multivariable regression was used to study pathogen- and host-related risk factors for PCC, and its impact on 13 physical and 4 mental health patient-reported functional outcomes. 172,303 participants (mean age 68.9, 57.4% female) were included in the analysis, of whom 43,395 had PCR-confirmed COVID-19. We identified 10 most specific symptoms and classified four PCC subtypes: ENT subtype (30.1%), characterized by alterations in smell, taste, and hearing loss; cardiopulmonary subtype (10.4%), characterized by shortness of breath, postural tachycardia, chest tightness, and chest pressure; neurological subtype (23.5%), characterized by brain fog and difficulty speaking; and general fatigue subtype (38.0%), characterized by mild fatigue. A higher PCC risk was observed for patients with Wild-type variant, multiple infections, and severe acute COVID-19 illness, consistently across the four PCC subtypes. In addition, a range of factors, including socioeconomic deprivation, higher BMI, unhealthy lifestyle, and multiple chronic health conditions, were associated with increased PCC risk, except for age and sex. Conversely, vaccination was associated with a largely reduced PCC risk, particularly for the cardiopulmonary subtypes. Individuals with PCC experienced a much worse physical and mental health. Specifically, the cardiopulmonary subtype had the most pronounced adverse impact on function impairments, followed by neurological, mild fatigue, and ENT subtype. The most affected functions included the ability to concentrate, participate in day-to-day work, and emotional vulnerability to health problems. PCC can be categorized into four distinct subtypes based on ten core symptoms. These subtypes appeared to share a majority of pathogen and host-related risk factors, but their impact on health varied markedly by subtype. Our findings could help refine current guidelines for precise PCC diagnosis and progression, enhance the identification of PCC subgroups for targeted research, and inform evidence-based policy making to tackle this new and debilitating condition. NIHR Senior Research Fellowship (grant SRF-2018-11-ST2-004).

Brain Rot

Many people suffer from a state of rot as an inevitable result of continuous viewing of phones or smart tablets, as continuous and crazy viewing of such devices contributes to creating a state of weakness in human perception of everything around him and puts him in a state of temporary coma in feeling material things as well as things with a moral dimension. Such a matter may make a person indifferent to what he is going through and make him live in a state of mental winter and brain fog that he may go through while awake or asleep. Such a matter may be closer to causing a person to suffer from a state of madness, loss of self-confidence and a feeling of alienation.

A Feminist Critique of the VA Rating Schedule

Fibromyalgia crept into Tina’s life, slowly stealing away her energy and inflicting pain on her body. She experienced a myriad of symptoms including severe and constant pain, fatigue, and memory issues; as she put it, “brain fog.” Her symptoms were so intense she could barely get out of bed, let alone engage in the activities she once loved. Doctors blamed her hormones, believed her pain was psychosomatic, or dismissed her as someone seeking drugs. After several years of severe symptoms and missing work, she was fired from her job. As a United States Air Force veteran who served in the Persian Gulf, Tina turned to the Department of Veterans Affairs (“the VA”) for help. The VA finally diagnosed her with fibromyalgia and determined that her illness was related to her military service in Southwest Asia. The VA gave Tina a 40% disability rating, a measure intended to reflect how her disability and its symptoms would likely impact her employment. Although grateful that her unrecognized condition was finally being seen, Tina did not understand how her experiences only amounted to a 40% rating when, in reality, she was physically unable to work. As she would later discover, 40% was the maximum rating for fibromyalgia.

Persistent COVID-19 symptoms and associated factors in a tertiary hospital in Thailand.

Coronavirus disease 2019 (COVID-19) is associated with long-term symptoms, but the spectrum of these symptoms remains unclear. We aimed to identify the prevalence and factors associated with persistent symptoms in patients at the post-COVID-19 outpatient clinic. This cross-sectional, observational study included hospitalized severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infected patients followed-up at a post-COVID-19 clinic between September 2021 and January 2022. Persistent symptoms, defined as lasting > 4 weeks after infection, were analyzed alongside symptom timing (28-90, 91-120, and > 120 days) and associated factors using multivariate analysis. Among 277 patients, mean (SD) age was 56 (16.6) years, and 58.5% were male. Of these, 80.9% reported at least one persistent symptom. Common symptoms included dyspnea (48.2%), insomnia (42.4%), and myalgia (42.1%). In multivariate analysis, being female [odds ratio (OR) 3.41; 95% confidence interval (CI) 1.5-7.76], and oxygen therapy (OR 3.39; 95% CI 1.3-8.81) were independently associated factors with persistent symptoms. High-sensitivity C-reactive protein (HsCRP) (> 75 mg/dL) was an independent risk factor for dyspnea (adjusted OR 2.29; 95% CI 1.28-4.12), and fatigue (adjusted OR 2.24; 95% CI 1.25-4). Oxygen therapy was an independent risk factor for neurologic symptoms, i.e. insomnia (adjusted OR 2.05; 95% CI 1.15-3.65), and brain fog (adjusted OR 2.02; 95% CI 1.14-3.58). There was a high prevalence of persistent COVID-19 symptoms. The most common symptom was dyspnea. Female gender and oxygen supplementation were independent associated factors. Continuous follow-up of these patients is still required.

Exploring the Role of Brain Fog, Fatigue, and Psychological Distress on Quality of Life in Individuals Living with Inflammatory Bowel Disease: A Cross-sectional Study.

Despite reports of brain fog in patients with inflammatory bowel disease (IBD), empirical research into this phenomenon has been lacking. This study aimed to validate a brain fog scale and explore the relationships between IBD symptom activity, brain fog, fatigue, psychological distress, and quality of life (QoL). A cross-sectional online study. Of the 170 adults with IBD (mean age 38.75 years, 85.9% female, 62.35% Crohn's disease), 94.10% percent reported experiencing brain fog, with the majority (53.75%) experiencing brain fog at least 2 times a week, with each episode lasting around 2 hours. A confirmatory factor analysis supported the first hypothesis, demonstrating validity and stability of the brain fog scale in an IBD sample. Correlation analyses supported the second hypothesis, revealing positive relationships between IBD symptom activity and brain fog, fatigue and psychological distress, and a negative relationship between IBD symptom activity and QoL. A structural equation model with excellent fit (CMIN/df=1.84, p=0.137, TLI=0.98, CFI=0.99, SRMR=0.03, and RMSEA=0.07), provided support for the third hypothesis in that the relationship between IBD symptom activity and QoL was fully mediated by brain fog, fatigue, and psychological distress. This is the first study to explore the lived experience of brain fog and to validate the brain fog scale in an IBD sample. The study provides evidence that like fatigue, brain fog is not only common in IBD cohorts but is also frequent and adversely impacts psychological distress and QoL.

Vaccination prior to SARS-CoV-2 infection does not affect the neurologic manifestations of long COVID.

Persistent symptoms after COVID-19 constitute the long COVID syndrome, also called post-acute sequelae of SARS-CoV-2 infection (PASC). COVID-19 vaccines reduce the gravity of ensuing SARS-CoV-2 infections. However, whether vaccines also have an impact on PASC remain unknown. We investigated whether vaccination prior to infection alters the subsequent neurologic post-acute sequelae of SARS-CoV-2 infection (Neuro-PASC). We studied prospectively the first consecutive 200 post-hospitalization Neuro-PASC (PNP) and 1100 non-hospitalized Neuro-PASC (NNP) patients evaluated at our neuro-COVID-19 clinic between May 2020 and January 2023. Among PNP patients, 87% had a pre-vaccination infection and 13% had a breakthrough infection post-vaccination. Among the NNP patients, 70.7% had a pre-vaccination infection and 29.3% had a breakthrough infection. Both PNP and NNP breakthrough infection patients had more frequent pre-existing depression/anxiety than their respective pre-vaccination infection groups, and NNP breakthrough infection patients also had more frequent comorbidities of headache, lung and gastrointestinal diseases than the NNP pre-vaccination infection group. An average of 10 months after symptom onset, the three most common neurological symptoms for PNP patients were brain fog (86.5%), numbness/tingling (56.5%) and headache (56.5%). Of all Neuro-PASC symptoms, PNP breakthrough infection more frequently reported anosmia compared to PNP pre-vaccination infection patients (69.2 versus 37.9%; P = 0.005). For NNP patients, the three most common neurological symptoms were brain fog (83.9%), headache (70.9%) and dizziness (53.8%). NNP pre-vaccination infection reported anosmia (56.6 versus 39.1%; P < 0.0001) and dysgeusia (53.3 versus 37.3%; P < 0.0001) more frequently than breakthrough infection patients. NNP breakthrough infection more frequently reported dizziness compared to NNP pre-vaccination infection patients (61.5 versus 50.6%; P = 0.001). Both PNP and NNP patients had impaired quality-of-life in cognitive, fatigue, sleep, anxiety and depression domains with no differences between pre-vaccination infection and breakthrough infection groups. PNP patients performed worse on National Institutes of Health Toolbox tests of processing speed, attention, executive function and working memory than a US normative population whereas NNP patients had lower results in processing, speed, attention and working memory, without differences between pre-vaccination infection and breakthrough infection groups. These results indicate that vaccination prior to SARS-CoV-2 infection does not affect the neurologic manifestations of long COVID in either PNP or NNP patients. Minor differences in neurologic symptoms between pre-vaccination infection and breakthrough infection groups may be caused by SARS-CoV-2 strains evolution. Patients developing Neuro-PASC after breakthrough infection have a higher burden of comorbidities, highlighting different risk factors warranting targeted management.

Fuzzy Cognitive Maps for Decision Support in Post-COVID Syndrome with Speech-Language Pathology-Related Problems

Detecting and managing speech-language pathology symptoms in patients with post-COVID syndrome (long COVID) presents a significant challenge, as the condition is marked by persistent and varied symptoms such as cognitive deficits, communication difficulties, and voice disorders. To address these challenges, a Fuzzy Cognitive Map Decision Support System (FCM-DSS) was developed to model causal relationships and integrate expert knowledge. A systematic review approach, though not comprehensive, was utilized to identify key symptoms and their prevalence from 19 studies, focusing on brain fog, attention deficits, memory problems, dyspnea, and swallowing difficulties. The weighted prevalence of these symptoms informed the development of the FCM-DSS model, designed to link symptoms to medical specialties and recommend specialist referrals. Preliminary testing on four case studies demonstrated the tool’s potential, but further validation through pilot studies is necessary.