Brain fog has been found to be one of the most common symptoms experienced by long COVID patients. Brain fog is an umbrella term that includes a range of symptoms, including memory problems, confusion, reduced concentration, mental fatigue, and other cognitive difficulties. Brain fog is a result of the disruptions in the neural pathways in the prefrontal cortex.
Understanding Brain Fog
The prefrontal cortex is a part of the brain responsible for attention regulation, memory, and executive functions. The highly intricate circular neural circuits process information and maintain focus without the influence of external stimuli. Unfortunately, this area is susceptible to inflammation and stress, which disrupts its molecular requirements and compromises neural connections. Thus, finding drugs that restore these circuits could be key to alleviating brain fog.
The Potential of Guanfacine and N-acetylcysteine
Guanfacine, initially developed to treat ADHD, strengthens prefrontal cortex connections, protects against inflammation and stress, and enhances cognitive function. Although approved by the FDA for ADHD treatment, it is also used off-label to address conditions associated with prefrontal cortex dysfunction, such as traumatic brain injury and PTSD.
Recognizing the similarities between brain fog in long COVID and traumatic brain injury, researchers explored the potential of guanfacine in combination with N-acetylcysteine. N-acetylcysteine is an antioxidant and anti-inflammatory medication approved for acetaminophen overdose.
Positive Results in a Small Study
In December 2020, eight patients suffering from long-COVID cognitive complaints were prescribed guanfacine and N-acetylcysteine. These patients reported significant difficulties with executive functions, including multitasking, focus, and concentration. Impressively, all eight patients experienced benefits, with some reporting the complete disappearance of brain fog symptoms.
One of the patients, a nurse who works on the medical floor, contracted COVID and suffered from brain fog. It significantly affected her cognitive abilities, leading her to reduce her caseload. When administered the drug combination, her brain fog symptoms diminished, and she was able to resume a normal caseload. When she had to discontinue guanfacine due to blood pressure fluctuation, her cognitive difficulties returned. After getting back on her guanfacine regimen, the symptoms once again improved.
It is important to note that the lack of a placebo group in the study necessitates caution when interpreting these results. Nevertheless, anecdotal evidence indicates that the drug combination may have a positive impact.
Availability of Guanfacine and N-acetylcysteine
While a placebo-controlled trial is crucial to validate the efficacy of this treatment, the accessibility of guanfacine and N-acetylcysteine offers hope to long-haulers seeking relief from their debilitating symptoms.
Guanfacine requires a prescription, and N-acetylcysteine is available over the counter. Patients affected by brain fog can discuss the possibility of this drug combination with their physicians.
Broader Applications and Future Prospects
Beyond COVID-19, the researchers behind this study envision the potential of this treatment regimen for patients facing cognitive deficits due to other conditions. These conditions could include Lyme disease, myalgic encephalomyelitis, and multiple sclerosis. Preliminary success has already been observed in these patient groups.
However, it is essential to emphasize the need for further research, including placebo-controlled clinical trials with larger cohorts of patients. This is necessary for establishing the effectiveness and safety of this approach.