Numerous studies have been performed to investigate the aftermath COVID19 has on the brain in terms of cognition, emotions, executive and motor functioning.  Research was done and published by The NIH National Institutes of Health; National Institute of Neurological Disorders and Stroke (NINDS); The Journal of the American Medical Association (JAMA), and others.

 Dr David Cantor researched the effect of Neurofeedback therapy (NF) on the general condition of post-COVID-19 patients and describes a direct and indirect pathway the brain is infected.

  1. The direct infection occurs through the blood-brain barrier, which disintegrates due to inflammation.  According to Dr Zabner, there is an activation of the immune system that persists for months and affects neural connections in the brain which places the brain in a “fight mode”  or “defensive mode”, impacting effective brain functioning.  Researchers believe that cognitive deficits are a byproduct of the inflammatory processes.

According to Dr Sarah A Kremen, (Director of the Neurobehaviour Program at the Jona Goldrich Center for Alzheimer’s and Memory Disorders) a virus can enter the nasal passage directly where it access nerves that lead into the brain. When the virus reaches the olfactory bulb, it can travel along the olfactory pathways to different areas in the brain.

  • Dr David Cantor asserts that the brain is affected indirectly via Neuro-inflammatory mechanisms through various organs via the vagus nerve often causing ischemia.  

The COVID-19 patients report emotional, cognitive, and motor deficit functioning:

Emotional symptoms are reported and include depression, fatigue, insomnia, elevated anxiety, an increase of depression,  and an impact on general mental health. COVID-19 patients’ emotions are destabilized, and their interaction and the way they think of others and themselves are impacted.

Cognitive symptoms as an aftermath of COVID-19 have been identified and include confusion, memory impairment, slow thinking and cognitive processing speed, difficulty with concentration, and the ability to focus. Most frequent neurologic symptoms include headache, numbness/tingling, a disorder of taste and smell,  muscle pain, dizziness, general pain, blurred vision, and tinnitus.

The experience of brain fog is often noted, probably resulting from inflammation in the brain.  (Risks of mental health outcomes in people with COVID-19: cohort study Yan Xie, Evan Xu, Ziyad Al-Aly (2022) & Dr Sanchez Vald’Hebron Hospital Barcelona)

Research published by Faith M Gunning indicated a decrease in processing speed and a decline in immediate recall.  This disposition places significant demands on a person’s working- and delayed memory. 

Neurological changes were noted in terms of the thickness of grey matter in the frontal and temporal lobes and volume loss of the brains of post-COVID-19 patients.

Brain pathology as an aftermath of COVID-19 includes strokes, spindling beta activity seen on the routine EEG recordings, a mix of fast and slow activity, edema, ischemia or insufficient oxygen supply to the blood, headaches, encephalopathy, and vascular change.  Cardiac problems were reported in 58% of post-COVID-19 children ( JAMA Pediatricians). Disfunction of the RAS (Reticular Activation System) results in confusion and attenuation of their wakefulness.

Boldrini notes that some long-term COVID-19 symptoms mirror those caused by the various chronic brain- and personality-altering conditions, including other viral infections, traumatic brain injuries, and neurodegenerative diseases such as Parkinson’s, Alzheimer’s, and Huntington’s disease.  These brain- and personality-altering conditions change the way individuals think, their experience of reality, and the way they interpret and understand the world.

The findings suggest that people who survive the acute phase of COVID-19 are at increased risk of mental health disorders.

Deficit motor functions:

Scientists found persisting and prolonged effects of COVID-19 including a loss of basic motor skills and the ability to walk, resulting in prolonged periods of recovery. According to Dr Judith Sanchez COVID-19 patients that had several strokes could as a result have the inability to move their extremities and could have difficulty performing other executive functions.  It particularly impacts verbal fluency and an inability to talk.  This suggests the negative effect COVID-19 has on expressive language impacting Brodmann areas Wernicke and Broca which are the expressive and receptive language areas.

In addition, Dr. Sanchez noted neurological and respiratory difficulties such as shortness of breath, motor-  and psychological deficits.  This would later manifest in fear, anxiety, and panic. She reported patients spending weeks in ICU due to blood clots in their lungs, resulting in strokes.


Neurofeedback  (NF) which is a non-invasive method of optimizing brain functioning has been proved to be an effective alternative method of therapy to address difficulty with concentration; attention; focus; hyperactivity; depression; anxiety, and sleep disorders by implementing instantaneous visual and/or auditory feedback regarding what is happening in the brain.  NF is a form of operant conditioning and assists a person to move from one brain state to another to accommodate each new task, to improve academic performance, enhance mood, behaviour, and thought. The most important aspect NF enhances is neuronal self-regulation. 

Neurofeedback meets the criteria specified by the American Psychological Association to be classified as an evidence-based intervention.

It is important to perform a  quantitative EEG  prior to commencing NF to identify patterns of brain wave dysfunction that may be related to a variety of problems, such as learning and behavioural issues, emotional disorders, brain injury, and many others.  

Successful post-COVID-19 NF was indicated on the q EEG such as a change in the slow frequencies which resulted in improved concentration and memory. Improvements have been reported by patients after NF in terms of sleep onset and sleep maintenance; level of activity; ability to work for longer hours; attention; concentration; improved physical activity; being more observant; decrease in depression and anxiety; being more patient; better self-insight and self-awareness.

Changes on the routine and Q EEG have been reported some of which include slow activity and hypo and hyper coherence which have normalized and the severity level of the z scores reportedly improved.

Other forms of treatment include Brain Working Recurrent Therapy, Brainspotting, CPT (Cognitive Processing Therapy), and others. 

Annemie Pechė

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