Cognitive Impairments, Memory problems, during pandemic COVID-19
When the COVID-19 pandemic hit, everyone worldwide was affected. A lot of individuals across all industries lost their jobs because companies could not afford to retain them. Most companies and businesses had to close down their premises and work from home, while others had to close their business entirely.
Many individuals who got sick with the virus are experiencing brain fog months after recovery from infection. Many lost their lives to the virus, which took a toll on us both mentally and emotionally. There was also a spike in burnout rate with people working from home, and many individuals' mental health was affected. For those individuals with dependents, working from home became extremely challenging. The new normal became wearing masks in public spaces, observing social distancing, restriction of movement, and many countries had to close their borders for a while. The global pandemic affected every aspect of everyday life. Real-world data is now emerging demonstrating rapid cognitive decline during lockdown (Ismail et al. 2021, Geron and Ger Med)
Cognitive functioning refers to several mental abilities such as attention, learning, decision making, thinking, problem-solving, reasoning, and remembering. Essentially, it is your overall mental process. Discussed below is how the overall cognitive functioning of individuals was affected by the global pandemic.
When the global pandemic hit, people worldwide had to isolate themselves to curb the spread of the virus. While isolation was necessary, it had its downsides on people's mental health. Isolation happened in different ways for different individuals. For instance, individuals infected were in hospitals alone since their families were not allowed to visit them, and others had to work from home and could not meet up with their family, colleagues, or friends.
Being isolated from friends, family, and colleagues resulted in people feeling depressed and lonely. Even worse was the uncertainty of what would happen next, anxiety that one may lose their job or loved ones. So many individuals lost family members and could not even be with them on their death bed, and some could not bury their loved ones. Several steps are fundamental to the mourning process, and not being able to go through those steps increased the pain of death. This inevitably led to higher rates of depression.
Isolation also created a spike in the rate of domestic violence since couples were confined in the same space for extended periods. This also led to a high rate of divorce cases. Isolation and loneliness contributed to more people being depressed, and others turning to drugs and alcoholism.
Less Social Stimulation
Everyone requires social stimulation for proper cognitive functioning. This is why isolation affected a lot of individuals' mental well-being. Before the pandemic, the norm was going out with friends, spending time with family, and working with colleagues. Essentially, social stimulation has several benefits, like having a community you can confide in, a sense of safety and belonging, and better mental health since you feel happier when you are around people you love and enjoy spending time with.
Naturally, human beings are social species, so this took a toll on the overall cognitive functioning of individuals because everything changed overnight. When the virus outbreak first happened, there was a lot of news coverage throughout the world about it, but most people did not think they would be affected by it. Therefore, when it became a global pandemic and the virus started spreading, more people realized how much this would affect their everyday lives.
Then came the COVID-19 safety rules and restrictions. Everyone had to wear a mask when going out in public places, international travel had to be banned, businesses had to close, and essential workers are the only people who had to go to work. In contrast, everyone else was required to work remotely. This huge shift in dynamics made it impossible for individuals to interact socially since public gatherings were banned.
Suddenly, everyone went from seeing their friends and family every day and physically interacting with them to only communicating on the phone. Les social interaction took a toll on a lot of individuals' mental health. Most people had a hard time navigating life during the global pandemic.
Face-to-face contact is essential since it can lower your stress. A simple gesture of shaking hands, a high-five, or getting a hug releases oxytocin. Dopamine is also generated during social interactions, but most people were affected by loneliness and depression since there were fewer social interactions. There was also a shift from an everyday social interaction at work with colleagues, filled with conversations and laughter, to working from home. This segues to how cognitive functioning was affected by zoom meetings.
Individuals who were lucky enough to retain their jobs had to work remotely from home. This concept affected a lot of individuals' mental well-being. Working remotely is one of the main causes of burnout in a lot of employees. You would expect that it would be easier since you will have reduced the time spent commuting to and from work. On the contrary, it just meant more workload for some individuals.
For instance, most individuals had to work overtime, and their entire day was spent on screen conducting zoom meetings. The workload increased, and there were also more deadlines individuals had to hit. Most people put in more work and more hours because they did not want to be laid off from work, so other than facing burnout, they were also facing anxiety.
Face-to-face meetings are excellent for an individuals' overall cognitive function because you can exchange knowledge, are more at ease, and it also help create relationships or rapport with people you are working with. On the other hand, zoom meetings are exhausting and take a toll on individuals because zoom meetings increase one's cognitive load. With zoom meetings, you miss out on body language. You are consciously anxious that the kids might walk in, and looking at your face can be quite stressful.
It is also worth mentioning that you are constantly on the edge when there is silence when you are on a zoom meeting. This is because you are not sure if you are frozen or if people are listening to you, but if you were to have a face-to-face conversation, you would not have any of these worries because everything will flow with a specific rhythm.
Speaking of zoom meetings, during the global pandemic, working from home also meant you are constantly spending your time on screens. Humans should have in-person interactions because it is essential to their overall well-being. A lot of screen time affected the overall cognitive functioning of individuals during the pandemic.
For instance, other than working from home and not having any human interaction, especially for people living alone, the only other way to see friends and family was on video calls. While the thought of being able to talk to your loved ones was comforting, it was still hard not to be able to see them face to face, hold them, laugh with them, and enjoy a meal with them. Even harder was the fact that if a loved one was going through a hard mental or emotional time, you could only console them over the phone.
There are specific things that the mind cannot process over a screen, yet that is all individuals had. Seeing a loved one grieving and not being there to comfort them, especially because you are probably in a different country. Being unable to get through the grieving process fully and heal from it because travel restrictions prevent you from sending off your loved one.
Not forgetting that most kids could not grasp the concept of the virus. One day they are on the playground with their friends, and the next, they can only see their friends on a screen and can no longer go outside to play with other kids. Overall, constantly being on a screen and being the only way to connect with anyone made many individuals exhausted. No amount of screen time can compare to how good it feels and how good it is for your mind when you interact with someone in person and hold a lengthy stimulating conversation.
Going into a different room while at work to grab a coffee or drink water can be energizing. Having a conversation while walking into a meeting also enhances your creativity and can refresh your memory. It can also help your brain process information and have a good grasp of that information. Not forgetting that the environment you meet in is a cognitive scaffold.
However, with the global pandemic hitting and most people staying home, life became more sedentary. For instance, people working remotely most likely had to sit in one position for an extended period attending one meeting after the other. There is no time to take a walk or go into a different room, or even hold a stimulating conversation with someone as they prepare for the next meeting.
Other than individuals working remotely, every other person who was not an essential worker had to settle for a more sedentary lifestyle because there was nowhere to go since most places had closed down. This affected the overall cognitive functioning of individuals because most people were fixated on what will happen next, what if normalcy is never regained, and generally, what the future would hold for them.
The global pandemic took a toll on every individual. The rate of mental health problems was high, with most people being affected by depression and anxiety. A lot of people struggled during this period because there was a lot of uncertainty about everything. But one of the positives is that there were also many mental health conversations, and most employers included mental well-being programs as part of the work benefits for their employees.
Assessing Cognitive Impairments
To address the cognition crisis, with devastating personal, societal, and economic implications, the expanding elderly population requires better cognitive care. We have already understood the importance of early childhood interventions in terms of cognition, we should be able to do the same for older adults.
Our current assessments of cognition are inadequate. It is only initiated when there is a complaint from a patient or caregiver. There is not a routine assessment during annual visits to a physician. Practitioners who assess cognition, such as neuropsychologists or cognitive neurologists, are few in number relative to the assessments needing to be done, resulting in lengthy waiting lists to be seen. There is little consistency in the testing.
Depression is a major contributor to cognitive impairment and needs to be recognized early in the disease process. Cancer-related impairments in cognition are also common. Other conditions commonly associated with cognitive impairments are ADHD, diabetes, anxiety, COPD, Parkinson's disease, multiple sclerosis.
Better metrics are needed to detect and track cognitive impairments over the course of time. We need better surveillance to screen for depression and cognition. Virtual methods are more accessible than ever before. There are innovative tools in facial biometrics, voice metrics, as well as text mining from social media which offer new insights into changes in cognition. Eye movement tracking has also shown promising results in assessing cognition. Virtual assessments done at routine intervals need to ramp up to be able to adequately capture deficits in cognitive processes. The modern healthcare system has the bandwidth to be able to incorporate these methods and there is no better time to get started.
As the global pandemic-related cognitive crisis is a complex issue, it will require a multi-disciplinary team effort from many stakeholders to be able to address and overcome the systemic root causes.
Community-based rehabilitation (CBR) is the most optimistic medium for delivering treatments for cognitive issues related to the pandemic. Community-based rehabilitation takes place in an open public place in the form of a series of treatments with some kind of investment from the participants or the community as a whole. Thus, the emphasis is on the participation of an individual and their ability to work with others in their geographic location.
Virtual mobility could enhance participation in CBR through the engagement of all persons irrespective of physical or geographic barriers, at times, even those with communicative barriers. Professionals from multiple areas need to come together - IT professionals, psychologists or neuropsychologists, allied health therapists, nursing professionals, and medical professionals, to be able to plan events that could positively impact communities.
Firstly, diet is very important. We have to make sure we are maintaining nutritional status that is adequate to maintain a high level of functioning of the brain. If you've ever talked to me about this, I must have mentioned blueberries, cacao, and green tea at some point in the conversation. Skipping meals or overeating can induce brain fog. Routine timing and quantity of meals are very important for brain functioning.
Next, limit screen time and hyper-stimulation of the visual and auditory cortices. Use a glare-resistant screen cover if it is not possible to limit the screen time. Take scheduled breaks from screen and zoom. Use earplugs to reduce noises.
Most importantly, regular exercise is the biggest brain boost that there is. Twenty (20) minutes a day in your neighborhood (outside your home) is all it takes. Exercise has been shown to significantly improve cognitive metrics in Mild Cognitive Impairment. Scientists believe it does so by increasing circulation to the brain. The extra benefit is that improves breathing capacity which also helps to get more oxygen to the brain. Speaking of breathing, deep breathing techniques also help to improve cognitive functioning. Doing so in a socially distant community setting will improve exercise quality and participation. Make plans with a friend to exercise maintaining safe distances. Community-based exercise helps to improve adherence to exercise plans and also has mental health benefits which ultimately benefit cognitive function as well.
There you have it.
- Eat Well.
- Less Screen/Sounds.
- Exercise with a Companion.