Long COVID Brain Fog Treatment: Feasibility Metrics from An Early-phase Randomized Controlled Trial of Constraint-Induced Cognitive Therapy
Shruti Agnihotri1, Gitendra Uswatte1, Karlene Ball1, Brandon Mitchell1, Jason Blake1, Staci McKay1, Fedora Biney1, Olesya Iosipchuk1, Piper Hempfling1, Elise Harris1, Anne Dickerson2, kristine lokken1, amy knight1, Victor Mark1, Gary Cutter1
1University of Alabama at Birmingham, 2East Carolina University
Objective:

This study’s objectives were to evaluate the feasibility of a new rehabilitation approach, Constraint-Induced Cognitive Therapy (CICT), for post-COVID-19 cognitive sequelae.

Background:

Brain fog which is a common symptom of Long COVID, can be disabling. It is characterized by impairments in processing speed, executive function, and memory encoding on neuropsychological testing. CICT is a new rehabilitation method that has shown promising results in stroke survivors with mild-to-moderate cognitive impairment. CICT combines two interventions: Speed of Processing Training and a modified version of the Transfer Package of Constraint-Induced Movement Therapy focused on cognition.

Design/Methods:

Community-residents ≥ 3-months post-COVID-19 infection with mild cognitive impairment and dysfunction in instrumental activities of daily living (IADL) were enrolled. Individuals with pre-existing conditions like dementia, traumatic brain injury, stroke, severe depression or frailty were excluded. Sixteen participants were randomized to Immediate-CICT or treatment-as-usual (TAU) with crossover to CICT. CICT was deemed feasible if (a) ≥80% of participants were adherent, (b) the same found treatment highly satisfying and at most moderately difficult, and (c) <2 study-related, serious adverse-events occurred. The primary outcome was IADL performance in daily life (Canadian Occupational Performance Measure). Employment status and brain fog (Mental Clutter Scale) were also assessed.

Results:

Fourteen completed Immediate-CICT (n=7) or TAU (n=7); two withdrew from TAU before their second testing session. Completers were [M (SD)]: 10 (7) months post-COVID; 51 (13) years old; 10 females, 4 males; 1 African American, 13 European American. All the feasibility benchmarks were met. Immediate-CICT, relative to TAU, produced very large improvements in IADL performance (M=3.7 points, p<.001, d=2.6) and brain fog (M=-4 points, p<.001, d=-2.9). Four of five non-retired Immediate-CICT participants returned-to-work post-treatment; no TAU participants did, p=.048.

Conclusions:

CICT recipients adhered to the protocol and were highly satisfied with their outcomes. Further study of CICT in Long COVID is warranted.

10.1212/WNL.0000000000212380
Disclaimer: Abstracts were not reviewed by Neurology® and do not reflect the views of Neurology® editors or staff.