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Neuropsychological Evaluations
Traumatic Brain Injury (TBI) - Stroke (CVA) - Dementia
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COVID-19
Many people continue to experience health problems after their initial COVID-19 infection resolves. Persisting COVID-19 problems have been called Post Covid Condition (PCC) or Long COVID. The most common Long COVID symptoms are shortness of breath, fatigue, and Brain Fog. It should be noted that a wide range of ongoing symptoms can occur, which include loss of smell, muscle ache, headache, cough, chest pain, and insomnia. Long COVID can last months or even years. In July of 2021, Long COVID was added as a recognized medical condition which qualified for disability under the Americans with Disabilities Act.
Dr. Kutner presenting on COVID-19 at a conference in April of 2022
Diagnosis
At this point, a definitive test for diagnosis of Long COVID does not exist. Many individuals with Long-Term COVID have negative blood tests. The diagnosis of this condition is made by your health history. Specifically, your health care provider considers the following: was diagnosed with COVID-19, had a positive COVID-19 test, showed symptoms of this condition, or have been exposed to an individual who was sick. We are still early in understanding Long COVID with numerous studies ongoing at this time. It appears that individuals who are at an increased risk of Long COVID include those who: 1) had moderate-severe COVID-19, 2) have had a more severe COVID infection requiring hospitalization or visit to the Emergency Room 3) who have had COVID-19 more than one time, and 4) those with underlying health problems. In addition, individuals who have had Multisystem Inflammatory Syndrome (MIS) are at an increased risk.
Brain Fog
Patients with Long COVID frequently report problems with their ability to think and focus. This has come to be known as Brain Fog. While cognitive problems with Brain Fog exist, the term Brain Fog is not currently an actual medical diagnosis listed in the International Classification of Diseases (ICD-10). Patients who have these symptoms are often given a diagnosis of Unspecified Symptoms and Signs Involving Cognitive Functions and Awareness (R41.9). Research to date has not clearly determined what is causing Covid Brain Fog. Initial considerations include actual effects of the infection on the brain and neuroinflammation. Several studies have pointed to COVID-19 causing neuroinflammation through cytokine release with one recent study revealing inflammation related damage through gliosis.
Neuropsychological Testing
Research to date has not clearly determined what is causing Covid Brain Fog. Initial studies have revealed possible causes of the cognitive problems commonly experienced in Long COVID. Whatever the cause ends up being, individuals with Long COVID often suffer from problems with attention/concentration, thinking, and memory which interferes with their ability to function well at work, school, and at times in their daily activities. In some individuals, stress or depression can be found from continued symptoms such as fatigue, headache, pain, makes their cognitive ability worse. Neuropsychological Testing provides the best window into diagnosing these cognitive problems and assisting patients with compensating for them. In some cases of COVID-19, cognitive problems or Brain Fog is so bad that they are unable to continue in their job.
In these cases, Neuropsychological Testing performed by Dr. Kutner is utilized to assist the patient in qualifying for disability. As noted earlier, Long COVID has been a qualifying Disability under the American Disabilities Act since 2021.