You Have “Covid ADD”
Neurologists see patients with a wide variety of symptoms including weakness, numbness, tingling, dizziness, headache, trouble walking, memory loss, vision loss, double vision, and body pain. All are distressing, but I have learned over the course of my almost 25-year career that the symptom patients fear most of all is memory loss, which often includes trouble thinking of words and names. Historically, patients who come to see me for their memory or mention memory loss are older patients or patients who have other neurological diagnoses such as MS or stroke.
In the Covid era I have become aware of a much higher frequency of patients of all ages reporting trouble with their memory. Most patients now routinely ask, “By the way, is it normal if I forget things or can’t think of the right word or say the wrong word?” Many visits include an account of a memory lapse that is very disturbing to the patient. Sometimes a patient will report to me the distressing event of forgetting the name of someone dear to them. A patient last week was understandably distraught that she could not remember her granddaughter’s name. Another told me that he could not remember his zip code at the gas pump when he put in his credit card.
Everyone knows the phenomenon of going into a room and forgetting why they are there. Many of my patients in the Covid era are frightened because this normal human experience is occurring so frequently. I can relate! I really enjoy cooking dinner because it relaxes me physically and mentally after a busy day at work. During Covid, I repeatedly find that I have no idea why I have opened the pantry door, the refrigerator, or the spice drawer, or what the word is for that thing I measure with or stir with or cut with! I look at the cookbook on the island and it says, “1 teaspoon of mustard seeds.” I immediately turn to the stove with the spice bottle and measuring spoons in my hands, and I think, “Did it say 1 teaspoon or 1 tablespoon? Arghhh. Thank goodness I am a neurologist, or I would be sure I have dementia.” I like to say that I now have the attention span of a gnat. I have found that I need to talk out loud to myself at home and at work to keep focused. Interestingly, I remember talking out loud to myself for months after my mother passed away several years ago to stay on task.
What I have found by examining many of my patients with even the most astonishing lapses is that their difficulties with thinking are not true deficiencies in memory but rather trouble with focus and concentration. These patients encode new information but have trouble accessing it. Their processing and connections are disrupted and slowed. Familiar words and names are harder to generate. These patients respond well to what neurologists call cues, which are hints and reminders. In real life these cues are things that jog your memory, like lists. I always tell my patients, never hesitate to rely on a list! Many of them report what I call “Aha” moments --- the times when your lost word or memory suddenly comes to you. Moments like this signify that memory is intact and should bring reassurance.
These thinking problems are unlike those that I find on neurological examination in someone with Alzheimer’s disease. Rather they are akin to the cognitive problems experienced by people with ADD, so I have come to say, “You have ‘Covid ADD.’” This diagnosis does not require someone to have had Covid. It merely requires someone to be living in the Covid era. Neurologists know that stress is a strong trigger for memory loss. We recognize a diagnosis called pseudodementia which is when a patient seems to have dementia but in fact their thinking deficits are caused by depression, anxiety, extreme stress, or pain, rather than a neurodegenerative process. I would argue that “Covid ADD” and pseudodementia have the same underpinnings and are two points along a spectrum.
When I tell my patients that the underlying stress of the pandemic combined with their own personal stressors is causing their “Covid ADD,” I like to emphasize that I am not saying that they are “all stressed out,” but rather “under stress” during this difficult time. Many of my patients are coping well in the pandemic and holding together a household and a job, perhaps combined with looking after young children who are going to school online or elderly parents with health problems or both. They feel competent, so they may find it hard to believe that the stress of the pandemic is causing their thinking problems. I remind them that the stress we are all living with comes at a price.
I look forward to the time when we can all say, “Remember back in the pandemic when ___?” The shared experience of Covid will bring us together for years to come. During the pandemic, many of us are experiencing “Covid ADD.” In the future, I believe that our brains can and will heal from this condition. Sharing memories of the pandemic down the road will be part of this healing process.