An international study led by Northwestern Medicine found that patients with long COVID-19 in countries such as the U.S. and Colombia were more likely to report neurological symptoms, including brain fog and fatigue, than patients in countries such as Nigeria and India.
Feinberg Prof. Dr. Igor Koralnik, a study author and founder of the NM Neuro COVID-19 Clinic, said differing social and cultural norms may have been responsible for the differences in reports between countries.
“Here in the U.S., everybody is talking about their mental health, their brain fog and their symptoms the way they are,” Koralnik said. “In Colombia, it seems to be the case as well. This is based on the fact that most of the time, we know what’s going to be for dinner, and we have a roof over our head, and we’re not at war, so we can worry about those issues.”
The study, published Jan. 27 in Frontiers in Human Neuroscience, compared data from more than 3,100 adults with long COVID across medical centers in Chicago; Medellín, Colombia; Lagos, Nigeria; and Jaipur, India.
“We did not expect to see this kind of a drastic difference in the symptom burden,” Koralnik said.
Koralnik said it was important for researchers at each site to share the same understanding of the definition of brain fog.
Brain fog is an informal term that people with long COVID use to describe their symptoms, Koralnik said. He explained that it is a broad, non-scientific phrase people use to indicate that something feels off in how they think or process information.
Koralnik said countries used different questionnaires and tests to assess quality-of-life ratings and cognitive function.
“It was interesting to discuss with the people from Colombia, India and Nigeria — every country is different,” Koralnik said. “It shows you that it’s not one-size-fits-all. You need to have culturally appropriate methods to even test those people.”
He said another limitation was that researchers in some countries analyzed existing patient records, while researchers in others had to recruit patients specifically for the study.
Carolina Hurtado Montoya, a researcher at Universidad CES in Medellín, ran the study on the Colombian side. She said Colombian patients reported symptoms similar to those in the U.S. and were generally willing to report their symptoms related to mental health, such as depression and anxiety.
She said one possible reason is a broader decline in stigma surrounding mental health, especially for younger people.
“For our grandparents, or even our parents, perhaps it was a bit of taboo talking about mental health,” Hurtado Montoya said. “We had very young patients in our study, and there’s a cultural shift in the newer generations to openly discuss mental health.”
Anurag Singh, a collaborator on the study and researcher at NIMS University in Jaipur, said many people in India do not view these symptoms as a medical condition. He explained that issues such as depression, sadness, brain fog or forgetfulness are often not recognized as part of a disease, but rather seen as minor or everyday problems.
Singh said one challenge was getting patients to come for follow-ups.
“The main problem that occurred was the follow-up,” Singh said. “We get patients for the first time, but for the second, third or fourth time — because we need to reanalyze their symptoms every time — most of them don’t come.”
Koralnik said future research is already underway. His team has received funding to conduct a small pilot trial in Colombia, testing cognitive rehabilitation for long COVID brain fog, and has already treated some patients using the same approach as at NU’s Shirley Ryan AbilityLab. He described it as an intensive weeks-long program, “like physical therapy for the brain,” and that patients are improving.
He added that a new two-year project in Nigeria will expand cognitive rehabilitation to both long COVID and post-concussion patients.
“The data can vary across geographic areas,” Koralnik said. “That’s not driven by race, ethnicity or viral strain. It’s driven by socio-economic factors and perceptions, so you need to have culturally-adapted screening and post-COVID care in these areas as well.”
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