UNH Today

In the early days of COVID-19, as people were trying to filter the onslaught of information and what it meant to them, Amy Ramage was focused on their brains. Or more specifically, the brains of those who were or might become infected.

“I knew that the primary concern for the medical community was to keep COVID patients alive, but I also knew that individuals sick enough to be dependent on ventilators were also at risk for brain injury associated with low oxygen levels,” Ramage says. “I became concerned about the survivors of severe COVID infection and whether or not they may suffer from cognitive deficits secondary to oxygen deprivation.”

That concern led Ramage, assistant professor and research coordinator in the department of communication sciences and disorders, to begin researching the possible complication. Peer reviewed journal articles published in April and May revealed her thinking was correct: there was a possibility that some COVID-19 survivors would have cognitive impairments.

“I felt that I had some knowledge about what might be seen by my professional peers in intensive care units, acute care and rehabilitation settings and needed to let them know and to prepare,” Ramage says. “I decided to continue researching the potential for cognitive impairment in COVID and other similar disease processes and to write a tutorial for the major clinical journal in my field.”  

“All the data pointed to a fairly strong potential for the development of cognitive impairments associated with a severe illness like COVID."

That paper was published in August. 

When Ramage first began her research, she found just two papers that addressed the possibility of COVID affecting the brain. Those discussed patients from Wuhan, China, where the coronavirus first appeared in December 2019, and revealed that 2 percent of them had disorders of consciousness when admitted to the hospital, suggesting that mental state was affected by COVID infection, she says.

Not long after, Italy began reporting that some COVID patients were suffering strokes and heart attacks. Various other symptoms were also coming to light. Ramage turned to information on other coronaviruses like SARS and MERS to see if there was any reference to neurological or cognitive conditions. She also looked at the consequences of being on a ventilator and low oxygen levels on brain function and cognition as well as that of critically ill patients.

“All the data pointed to a fairly strong potential for the development of cognitive impairments associated with a severe illness like COVID,” Ramage says. “Given the large numbers of people predicted to suffer from COVID, and the lack of involvement in most cases of speech-language pathologists in their care, it was clear that a call for action was needed.”

Now, nearing almost a year from when the first COVID-19 case was reported, new information regarding how the illness impacts brain function is “changing and growing almost daily,” she says, adding that impact seems to be a secondary condition due to decreased oxygen levels in the blood. Strokes and immune system responses attempting to fight the virus also present risks to brain function.

“Symptoms appear to align best with delirium and include confusion, disorientation and difficulty with attention and memory,” Ramage says.

Knowing that can be vital for patients in rehabilitation settings. While the treatment may not differ than that for other mental challenges, the consequences of not receiving proper care won’t be known until there is more information on COVID’s effects on the brain.

“If health care providers are not aware of the potential cognitive impairments, then symptoms  may be easily missed when patients are still in health care settings where they can receive help,” Ramage says.