Reduced cerebral blood oxygen levels may be tied to sleepiness, cognitive impairment in long COVID

 Ask your competent? doctor what interventions they have that increase thalamic oxygen levels so that maybe post stroke fatigue can be stopped. And since your doctor will know nothing, you can train them on these.

• oxygen delivery (27 posts to January 2020) Many ideas in here, if your doctor isn't already using them to save neurons immediately post stroke; you don't have a functioning stroke doctor!

Reduced cerebral blood oxygen levels may be tied to sleepiness, cognitive impairment in long COVID

A study published in Annals of Clinical and Translational Neurology showed that widespread reductions in cerebral blood oxygen levels in post-COVID-19 syndrome (PCS) were related to symptoms of daytime dysfunction and cognitive impairment.

“Given that [patients with PCS] frequently have neurological sequelae, robust MRI measures are needed to monitor

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persistent symptoms and gain further insight into long-term outcomes,” wrote Claudia Chien, Charité-Universitätsmedizin Berlin, Berlin, Germany, and colleagues. “Based on recent evidence, we evaluated whether cerebral haemodynamic changes contribute to PCS.”

Using resting-state functional MRI, the researchers investigated brain perfusion and oxygen level estimates in 47 patients (mean age, 44.4  years; 81% female) with PCS and 47 matched healthy controls (mean age, 44.3 years; 77% female). During acute COVID-19 infection, 7 (15%) patients were hospitalised and 3 (6.4%) patients were admitted to the ICU. The mean duration since infection was 8.4 months.

Overall, patients presented with high levels of fatigue (79%) and daytime sleepiness (45%).

The median Epworth Sleepiness Scale score for the PCS and control groups was 11 and 5, respectively. Meanwhile, the corresponding median score on the fatigue scale for motor and cognitive (FSMC) functions was 77 and 36, respectively.

The researchers observed widespread decreased brain oxygen levels in patients with PCS compared with controls, most evidently in the white matter (false discovery rate adjusted p value [P-_FDR] = .038) and cortical grey matter (P-_FDR = .015). Brain perfusion did not differ between patients with PCS and healthy participants. 

Furthermore, the study found that delayed patient caudate nucleus perfusion was associated with better executive function (P-_FDR = .008), while delayed perfusion in the cortical grey matter (hazard ratio [HR] = 0.07; 95% confidence interval [CI], 0.005-0.85; P = .037) and hippocampus  (HR = 0.06; 95% CI, 0.005-0.81; P = .034) were associated with a reduced risk of daytime sleepiness. 

On the other hand, decreased putamen oxygen levels were associated with a reduced risk of poor cognitive outcome (HR = 0.22; 95% CI, 0.06-0.78; P = .019), while lower thalamic oxygen levels were associated with a higher risk of cognitive fatigue (HR = 6.29; 95% CI, 1.39-28.52; P = .017).

“Our findings of lower regional brain blood oxygen levels suggest increased cerebral metabolism in PCS, which potentially holds a compensatory function,” the authors noted. “These haemodynamic changes were related to symptom severity, possibly representing metabolic adaptations.”

“Changes in oxygen metabolism and blood perfusion may serve as an adaptive mechanism to mediate brain vascular damage and/or as a mode of maintaining normal daily functioning,” the authors added.

Source: Annals of Clinical and Translational Neurology