Long COVID Brain Fog Treatment: An Early-Phase Randomized Controlled Trial of Constraint-Induced Cognitive Therapy Signals Go

Abstract

Purpose: Long COVID brain fog is often disabling. Yet, no empirically supported treatments exist. This study’s objectives were to evaluate the 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 were adherent, (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, four males; one African American, and 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 nonretired Immediate-CICT participants returned to work posttreatment; no TAU participants did, p =.048. Conclusion: Those who received CICT adhered to the protocol and were highly satisfied with their outcomes. The findings warrant a large-scale randomized controlled trial with an active-comparison group.