I can’t think, I can’t remember: More Americans say they’re in cognitive fog

I can’t think, I can’t remember: More Americans say they’re in cognitive fog

More Americans report having serious cognitive problems — with remembering, concentrating or making decisions — than at any time in the past 15 years, according to Census Bureau data.

The increase began with the pandemic: the number of working-age adults reporting “serious difficulty” thinking increased by about a million people.

About as many adults ages 18 to 64 now report serious cognitive problems as difficulty walking or climbing stairs, for the first time since the bureau began asking these questions monthly in the 2000s.

And young adults are driving the trend.

According to the researchers, this sharp increase reflects the effects of long Covid on a small but significant portion of young adults, most likely in addition to other effects of the pandemic, including psychological distress. But they also say that it is not yet possible to fully analyze all the reasons for this increase.

Richard Deitz, economist at the Federal Reserve Bank of New York, analyzed the data and attributed much of the increase to long Covid. “These numbers don’t do that — they don’t just start going up suddenly like that,” he said.

In its monthly Current Population Survey, the Census asks a sample of Americans whether they have serious problems with memory and concentration. He defines them as disabled if they answer yes to this question or to any of the other five questions regarding limitations in their daily activities. The questions are unrelated to disability claims, so respondents are not financially incentivized to respond one way or another.

As of early 2020, the survey estimated that fewer than 15 million Americans aged 18 to 64 had some sort of disability. This figure increased to around 16.5 million in September 2023.

Nearly two-thirds of this increase consisted of people who recently reported limitations in their thinking. There has also been an increase in census estimates of the number of adults with visual impairments or serious difficulty doing basic errands. For older working-age Americans, the pandemic ended a years-long decline in reported disability rates.

The increase in cognitive problems aligns with a common symptom affecting many Covid long-haulers: “brain fog.”

Emmanuel Aguirre, a 30-year-old software engineer from the Bay Area, got Covid in late 2020. In one month, he said, his life was transformed: “I felt like I was dying. of wood all the time, being drunk, high and in a brain freeze all at once.

He stopped dating, playing video games and reading novels, but he managed to keep his job, working remotely. Some of his physical symptoms eventually subsided, but the brain fog persisted, sometimes disappearing only to overwhelm him a few days later.

Cognitive impairments are a “hallmark of long Covid,” said Dr. Ziyad Al-Aly, chief of research and development at the VA St. Louis Health Care System and a clinical epidemiologist at Washington University in St. Louis.

Studies estimate that some 20 percent has 30 percent of people who contract Covid experience cognitive impairment several months later, including people with symptoms ranging from mild to debilitating. Research has also shown clear biological changes due to the virus related to cognition, including, in some long-term Covid patients, lower serotonin levels.

“It’s not just fog, it’s basically a brain injury,” said Dr. Monica Verduzco-Gutierrez, chair of rehabilitation medicine at the University of Texas Health Science Center at San Antonio. “There are neurovascular changes. There is inflammation. There are changes on MRIs »

It is not clear why changes in reported cognitive impairments appear more common in younger adults. But older people are more likely to have experienced age-related cognitive decline before Covid, said Dr. James C. Jackson, a neuropsychologist at Vanderbilt Medical Center. Cognitive changes “stand out a lot more” in younger cohorts, he said.

And long Covid often presents differently in younger and older adults, said Dr. Gabriel de Erausquin, professor of neurology at UT Health San Antonio. In his research, he found that older people with cognitive deficits linked to a long period of Covid have more memory-related problems. But young adults are more likely to experience difficulty paying attention and concentrating and, in some cases, fatigue or pain so severe that their ability to think is affected.

Heather Carr, 31, sold farm machinery parts in Syracuse, N.Y., but two coronavirus infections left her largely bedridden and barely able to string together basic thoughts. She had trouble staying awake while driving and eventually had to give up her job.

“I cry when I try to think now,” she says. “My brain is short-circuiting.”

The number of working-age Americans with disabilities who are unemployed or inactive, like Ms. Carr, has remained roughly stable during the pandemic.

But the number of working-age Americans with disabilities who are employed has increased by about 1.5 million people, according to census data.

The tight job market and the flexibility of remote work during the pandemic have made it easier for people with disabilities before Covid to obtain employment. It is also likely that more workers became newly disabled, according to the census definition, and remained employed.

This could help explain what has so far been just a relatively subtle increase in Social Security disability claims.

Long Covid is probably not the only factor causing the increase in disability, experts believe.

The rate of cognitive impairment reported among young adults in census data had been increasing slowly in the years before the pandemic. Disability data experts suggest that, among the many factors likely responsible for this increase, the increase ADHD And autism diagnoses in children could have led more people to recognize and report their cognitive difficulties.

Then, during the pandemic, Americans spent more time alonereported higher rates of depression and were prescribed more psychiatric medications.

“The pandemic has changed the world,” said Dr. Jackson. “I think the sum total of mental health issues that people face impacts cognitive function.”

Younger adults seemed to feel much more psychological distress than older adults, and poor mental health has been related has cognitive problems. Gallup Poll found that rates of depression for different age groups, which were relatively similar before the pandemic, skyrocketed among adults under 45 during the pandemic, while remaining stable among older adults.

Kristen Carbone, a 34-year-old actress in New York, said her anxiety and depression increased when the pandemic hit and her memory began to slip away. Her problems didn’t measure up to the “serious difficulties” cited by the census, but they were worse than anything she had experienced before the pandemic – and she never tested positive for Covid, so she said it was unlikely an infection was to blame. At her second job as a server, she had to start writing down each customer’s orders, even those she filled out from memory.

“If I don’t take care of it immediately, it doesn’t exist,” she said.

Since then, her mental health has recovered, she says, but not her memory and concentration.

Stressors from the pandemic could have worsened existing conditions such as ADHD, said Dr. Margaret Sibley, a professor of psychiatry and behavioral sciences at the University of Washington.

“If that person is under extreme duress or strain, these symptoms could be temporarily exacerbated,” she said.

Since the census relies entirely on self-reporting, experts say the data could also reflect a change in how people perceive their cognition, even in the absence of changes in their health status.

People with disabilities may have taken note growing acceptance of disability and become more likely to answer census questions honestly, researchers say. Some young people may have been influenced by what disability researchers describe as increased awareness and acceptance of neurodiversity during the pandemic, as videos about mental illness and developmental disabilities have proliferated online, encouraging people often self-diagnose. There has also been an increase in advertisements for ADHD medications, Dr. Sibley said.

“Everyone was like, ‘I’m getting this message online,’” she said. “The subjective experience of the people receiving them was that they could fool anyone into thinking they had ADHD. »

But these changes in perception will likely have a relatively small influence on the numbers, said Monika Mitra, who directs the Lurie Institute for Disability Policy at Brandeis University. Most of that increase likely reflects real changes in people’s health, she said.

“We need to take this very seriously as a society,” she said. “We need to understand who these people are, how they are affected and what we can do about it. »

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Eric D. Eilerman

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