‘Brain fog’ is a colloquial term that signifies significant, persistent cognitive deficits alongside consistent executive functioning and working memory impairment. Symptoms include lack of mental clarity, poor focus and concentration, memory problems, and more. Currently, there are no treatments for the condition.
Long COVID is characterized as medical symptoms that persist for weeks, months, or even years following a COVID diagnosis that can not be explained by any other medical condition. While symptoms vary, a recent study found that 7.2% of over 2,600 patients with a confirmed COVID-19 diagnosis had long COVID-associated brain fog.
In the current case report, researchers investigated the effects of two drugs on patients with brain fog. The first is known as guanfacine and treats conditions including high blood pressure and ADHD. It is known to strengthen prefrontal cortex activity and protect against inflammation and stress. The second drug is known as N-acetylcysteine (NAC), an antioxidant and anti-inflammatory agent that is available as a supplement.
Arman Fesharaki-Zadeh, MD, PhD, assistant professor of psychiatry and of neurology at Yale Medicine, has been using a combination of guanfacine and NAC to treat patients with traumatic brain injury and PTSD for years. After noticing similarities between these conditions and post-COVID brain fog, he chose to investigate the drug combination on brain fog too.
“I had the idea of approaching the treatment from two different perspectives—modifying the pro-inflammatory, pro-oxidation pathway with NAC, and treating the post-COVID neurocognitive sequelae impacting executive functioning with guanfacine,” he said in a press release.
“We wanted to attack this using a multi-model approach that took advantage of the synergistic relationship between NAC and guanfacine,“ he added.
To begin, he treated a patient with long COVID and brain fog with NAC. After noticing partial benefits in energy and memory, he followed up with guanfacine, which led to more improvement. He then went on to treat 12 patients with the same drug combination. The treatment regimen included 1mg of guanfacine at bedtime and, if well-tolerated, a dosage increase to 2mg after a month alongside 600mg of NAC daily.
Of the treated patients, eight reported substantial benefits, including improved memory, organization skills, and the ability to multitask. Some even reported complete resolution of brain fog. Two, however, did not show up for the follow-up for unknown reasons, and two others discontinued the regimen due to side effects, including low blood pressure and dry mouth.
The researchers noted that the number of patients involved in their case report was too small to provide conclusive results. Nevertheless, they hope their findings will pave the way for placebo-controlled clinical trials for the treatment. They also hope that the regimen may be helpful for other conditions such as post-Lyme and myalgic encephalomyelitis/chronic fatigue syndrome.
They noted, however, that patients needn't wait if they require treatment now. Amy Arnsten, Ph.D., Albert E. Kent Professor of Neuroscience and professor of psychology, one of the study's authors said in a press release: "If patients have a physician who can read our paper, we’re hoping that they can access help right now."
As guanfacine is already FDA-approved, and NAC is available as a supplement, patients may be able to ask their physician for a prescription of guanfacine, and purchase NAC over the counter to treat long-COVID related brain fog.
Sources: Neuroscience News, Neuroimmunology Reports
