Preprint Long COVID Brain Fog Treatment: Findings from a Pilot Randomized Controlled Trial of Constraint-Induced Cognitive Therapy, 2024, Uswatte et al

Abstract

Purpose: Long COVID brain fog is often disabling. Yet, no empirically-supported treatments exist. This study′s objectives were to evaluate feasibility and efficacy, provisionally, of a new rehabilitation approach, Constraint-Induced Cognitive Therapy (CICT), for post-COVID-19 cognitive sequelae.

Design: Sixteen community-residents ≥ 3-months post-COVID-19 infection with mild cognitive impairment and dysfunction in instrumental activities of daily living (IADL) were enrolled. Participants were randomized to Immediate-CICT or treatment-as-usual (TAU) with crossover to CICT. CICT combined behavior change techniques modified from Constraint-Induced Movement Therapy with Speed of Processing Training, a computerized cognitive-training program. CICT was deemed feasible if (a)≥80% of participants completed treatment, (b) the same found treatment highly satisfying and at most moderately difficult, and (c) <2 study-related, serious adverse-events occurred. The primary outcome was IADL performance in daily life (Canadian Occupational Performance Measure). Employment status and brain fog (Mental Clutter Scale) were also assessed.

Results: Fourteen completed Immediate-CICT (n=7) or TAU (n=7); two withdrew from TAU before their second testing session. Completers were [M (SD)]: 10 (7) months post-COVID; 51 (13) years old; 10 females, 4 males; 1 African American, 13 European American. All the feasibility benchmarks were met. Immediate-CICT, relative to TAU, produced very large improvements in IADL performance (M=3.7 points, p<.001, d=2.6) and brain fog (M=-4 points, p <.001, d=-2.9). Four of five non-retired Immediate-CICT participants returned-to-work post-treatment; no TAU participants did, p=.048.

Conclusions: CICT has promise for reducing brain fog, improving IADL, and promoting returning-to-work in adults with Long COVID. Findings warrant a large-scale RCT with an active-comparison group.

https://www.medrxiv.org/content/10.1101/2024.07.04.24309908v1

 

They don't have a clue what any of this is. Just pad on some adjectives and empty buzzwords to old BS and call it novel.

But they'll get their money. That I don't doubt it. And they'll report that it's promising with a trend of "may be"s. Or whatever. Parasitic industry.

Of all the things, if treatment for brain fog came around, it would basically solve the rest, as we'd be able to take the reins and do most of the work. But they're wasting attention on worthless BS.

My health and function have slightly improved compared to 5 years ago, not enough to make a difference but enough to be slightly more aware, but I feel even more hopeless about it. Everything about us, in secret, behind closed doors. What a freaking scam.

 

Tiny numbers (7 in the treatment group, of whom one didn't adhere to the treatment; 9 in the control group, of whom 5 dropped out at various stages), not well matched (treatment group were on average a decade younger than the controls, and had been ill on average 7 months - so still at the stage where many would be expected to recover soon with no treatment - whereas the control group had been ill on average 12 months). Two of the controls had been hospitalised with their acute infection, none of the treatment group had.

 

They're working on the assumption that there's a 'virtuous circle' in which brain fog goes away as long as you just work harder on your 'skills', just as the physical exercise proponents think that physical fatigue goes away if you just train your muscles harder. No awareness at all of the reality of a fluctuating illness in which brain fog can improve as your general health improves and then worsen again when you crash from too much exertion - including cognitive exertion.

 

It completely ignores the fact that it often fluctuates so wildly that some experience periods of crippling cognitive dysfunction, then periods of relatively OK function, then back and on and off. This alone completely debunks all the models that depend on some form or 're-training', especially for such basic things.

Just like the deconditioning hypothesis is easy to reject on the basis that it cannot fluctuate, and that PEM is wildly and frustratingly so. In following the 'pragmatic' evidence-based approach, they completely ignore falsifying their hypotheses, or making sense of real world data. Everything they do is artificial and happens in closed settings, aims to confirm a model by following it as if it's a set of instructions and coat it in sciencey language. Which is exactly what pseudoscience is.

There is zero attempt at making sense of real world data in this paradigm. It's all about creating closed loops prototypes, finding that they don't really work, but arguing that, hey, whatever, looks good enough to them, the people who want it to work, they'll take money to prove that it doesn't really work, but they'll feel that it does anyway.

MythBusters were more careful in their experiments, and it was a freaking borderline comedy TV show.