Abnormal Cerebrospinal Fluid Levels in Cognitive Post-Acute Sequelae of COVID-19: Joanna Hellmuth, MD, MS


The cognitive neurologist at the University of California, San Francisco discussed a specific analysis that evaluated differences in cerebrospinal fluid in patients who develop cognitive changes following COVID-19 infection. [WATCH TIME: 6 minutes]

WATCH TIME: 6 minutes

"We don’t know if those oligoclonal bands, which represent unique [immunoglobulin] antibodies, are produced in the brain or not. They are likely produced systemically, and then there was some low level of transit into the brain. But what that suggests is that there’s a systemic inflammatory process happening in people with COVID-related cognitive changes. Again, we only see it’s associated. We don’t know if its causative at this point."

Newly published research has highlighted the clinical characterization of patients who develop cognitive post-acute sequelae (PASC) of COVID-19, sometimes referred to as “COVID fog.” In a relatively small sample study, cognitive PASC participants had a higher number of preexisting cognitive risk factors (2.5 vs 0; P = .03), with more reporting a delay in the onset of their cognitive symptoms by at least 1 or more months.

An exploratory analysis examining cerebrospinal fluid (CSF) levels revealed that 77% (10 of 13) of participants with cognitive PASC had a CSF abnormality compared with 0% (0 of 4) of cognitive controls (P = .01). Two participants with cognitive PASC displayed elevated CSF protein without other explainable cause and the only reported cognitive risk factor was a remote history of corrected B12 deficiency in 1 participant.

Senior author Joanna Hellmuth, MD, MS, believes that through rigorously assessing patients, the clinical community will understand more about the pathogenesis of cognitive PASC. Hellmuth, a cognitive neurologist at the University of California, San Francisco, sat down for an interview to discuss the why she specifically analyzed CSF, the cognitive neurology approach needed to assess viral-related infections, and the biggest take-home points the data are showing.

1. Apple AC, Oddi A, Peluso MJ, et al. Risk factors and abnormal cerebrospinal fluid associate with cognitive symptoms after mild COVID-19. Ann Clin Transl Neurol. Published online January 19, 2022. doi:10.1002/can3.51498
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