Long COVID Self-Management - Cognition

Managing Problems with Attention, Memory and Thinking Clearly

Some people who have had COVID-19 have trouble with their attention, memory, and being able to think clearly.

Many things can affect our mental abilities. It is common for people who have been severely ill, especially those who had a breathing tube in the hospital, to have new difficulties with their thinking. People who had mild cases of COVID-19 can have difficulties with their ability to think clearly, as well as those who were severely ill.

It is not yet clear how COVID-19 affects the brain. It could be linked to inflammation or changes in availability of oxygen to parts of the brain. For some people, these go away within weeks or months. For others, symptoms can last longer.

Difficulties with attention, memory, and how quickly you are able to make sense of information can have an impact on your day-to-day life. For example, you may experience one of more of the following:

• Trouble with giving attention to more than one thing at a time.
• You are more easily distracted by your own thoughts and sensations (e.g., worries, pain) or external causes (e.g., noise, movement).
• Losing your train of thought during conversation.
• Difficulties keeping your attention on one thing for a long period of time (e.g., reading, work).
• An increase in errors at work, school, or home.
• Trouble remembering details from conversations or remembering where you put your keys.
• Forgetting to follow through on plans.

These changes can have a big impact on your life. While some changes may be due to the effect of COVID-19, issues like poor sleep, fatigue, pain, stress, anxiety, and depression, can also impact your thinking abilities. There are many things that you can do to try to improve your cognition and learn to cope with areas of difficulty.

General Ways to Optimize Brain Health (and Mood!)

Physical Exercise

Being active can help your brain recover. It increases heart rate, which pumps more oxygen to the brain. It releases endorphins, which boost mood, and can also improve your sleep. Slowly add exercise to your daily routine (see module on exercise).

Mental Fitness

Even though it can be fatiguing, challenging your mind daily is good for your brain and can improve your mood. Choose activities that are challenging but achievable. Take up a new hobby, learn about a new topic, or learn a new language or skill. You could also read, try out a new recipe, play cards or games, or engage in stimulating conversations.

Manage Stress

When we are stressed, we tend to focus on what is making us stressed, which means it is harder to concentrate on other things. Mindfulness, meditation, and relaxation strategies can help with managing stress. When stress levels go down, people may experience improved coordination, attention, memory, and mood. Visit Managing Stress, Anxiety, and/or Low Mood.

Social Engagement

Social interactions help to reduce stress. They can lead to the release of neurotransmitters (chemical messengers in the brain) that make you feel more positive.

Connect with Nature

Nature can be calming and reduce stress. It can focus our attention outward and help us to focus on the present moment, instead of thoughts of the past or future.

Improve Sleep

When we sleep, toxins are cleared from our brain. Sleep also helps to solidify memories. When you sleep well, your thinking abilities are better during the day. See Sleep module. Visit the Sleep page.

Eat Well

Your brain needs a constant supply of fuel. Eating nutritious foods gives you energy and helps your brain function. Speak with your doctor about improving your diet before making any major changes.

Strategies to Manage Cognitive Fatigue and Improve Attention and Concentration

What is Cognitive Fatigue?

It feels like your brain has run out of energy and is no longer keeping up. It is hard to think when your brain is tired. Cognitive fatigue can be caused by anything that makes your brain work (e.g., listening, reading, talking, etc.).

To Help with Cognitive Fatigue

Minimize Distractions

Turn off the TV and radio. Move to a quieter room.

Focus on One Thing at a Time

You will get more done if you focus on one thing at a time instead of multitasking.

Break down complicated tasks into smaller steps. Give yourself time to plan.

Set Yourself a Goal and Use Rewards

For example, you could finish a task, then have a cup of tea.

Pace Activities

Pace your activities by:

• Monitoring your level of fatigue.
• Taking advantage of your “peak” time. It can be harder to focus when you are cognitively fatigued. Plan to do important or detailed tasks early in your day.
• Scheduling rest periods and breaks. Set an alarm to remind yourself to take a break. Breaks could be a nap, going for a walk, sitting quietly, or changing activities.
• Switching between cognitive and physical tasks.
• Switching between easy and hard tasks.
• Giving yourself plenty of time to complete tasks.

Establish a System for Handling Interruptions

For example, use sticky notes as place holders- note where you stopped and what needs to be done next. Decide if you would like phone calls to go to voicemail.

Double-Check Your Work

Cognitive fatigue and difficulties with attention can make it easy to miss details. Set aside time to double-check your work to avoid mistakes. It may also be helpful to ask someone else to check it too.

Modify Your Environment to Reduce How Much Energy You Use

To reduce clutter, assign a place for everything and always put everything back in its place. If you put things that you use a lot close at hand, you will save mental energy.

Strategies to Improve Memory

Many people do not realize that attention is the foundation for memory. If we don’t pay attention, we won’t remember! Therefore, it can be helpful to use some of the strategies listed above (e.g., minimizing distractions, focusing on one thing at a time) in addition to the strategies below:

Suggestions on How to Remember New Information or Skills

Make Eye-Contact

Make eye-contact with the person giving you the information.

Pay Close Attention to What You Want to Remember

One way to do this is to use the “see it and say it” strategy. This is especially helpful for remembering common everyday tasks, such as locking the door. If you focus on seeing yourself lock the door and say to yourself, “I am locking the door”, it will be easier to remember that it was done.

• Ask for information to be provided to you a little bit at a time. It is okay to say to people that you need help remembering things.
• Ask for information to be provided to you in multiple ways. For example, if learning a new skill, you could ask for someone to tell you the steps, give a demonstration, monitor your attempts, and provide written instructions.

Allow Yourself Multiple Exposures

Allow yourself multiple exposures to new information.

Ask Questions

Ask questions if you are not sure what people told you or to clarify what they mean.

Repeat Back the Information

Consider repeating back the information to the deliverer to ensure accuracy and help get the material into your memory.

Ask for Extra Time

Ask for extra time if you feel you are slower to process information or respond to others. You may want to review information and write down questions to ask later.

Make Associations

Make associations. It is easier to remember information if you tie the new information to information that you already know. For example, if you want to recall the name of someone new, you could make a personal association (e.g.: I had a neighbour named Bob) or create a memorable mental image (e.g., imagine Bob driving a Bobcat construction vehicle).

Keep a Notebook or Planner

Keep a notebook or planner handy to jot down instructions or other reminders.

• Ask a Person You Trust to Attend Important Appointments
• Ask a person you trust to attend important appointments and take notes so you can be sure you have all the information.

Suggestions that Can Help with Remembering to do Tasks

Establish a Daily Routine and Follow it

Have a written schedule placed where you can view it easily every day. Practice checking your schedule for the day in the morning and your schedule for the next day in the early evening.

Tie New Tasks to Established Tasks

For example, you reduce cognitive demands if you tie medication to breakfast and dinner (if instructed to take them morning and evening).

Make Checklists

Make checklists with multiple steps.

Create a list of items that you need to take with you when you leave the house and keep it by the door. It can be fun to put this list to song, so it serves as a quick and funny reminder. For example, you could sing “Keys, Glasses, Wallet, Phone” to your favourite tune.

Use External Memory Aids

For example, use sticky notes, highlight information, and set alarms to remind you. Using cues helps you to remember.

Ask for Phone Reminders

Ask for phone reminders for appointments, if possible..

Try the 'See it and Say it" Strategy

Try the “see it and say it” strategy for tasks you need to do in the future. For example, if you want to remember to pick up apples from the grocery store, you may visualize walking towards the grocery store, getting into the store, and going to the produce section where the apples are kept. You might “say it” by stating out loud (or mentally), “I will stop at the grocery store on my way home to buy apples.”

Ideas You Can Use to Help You Remember Where You Put Things

Select a “Home” for Items

Decide on one place where you keep your medication and always put it back in the same place. Do the same thing for other items (e.g., keys, wallet, glasses etc.) “A place for everything, and everything in its place.”

Use Organizational Systems

Use organizational systems (e.g., baskets, tray organizers, key holders).