‘I Feel Like I Have Dementia’: Brain Fog Plagues Covid Survivors
PAM BELLUCK，The New York Times, Oct 15th, 2020
作者：PAM BELLUCK，紐約時報，2020年10月15日
作者介紹：Pam Belluck是時報健康和科學作者，曾與團隊共同獲得普利策獎，還曾獲得娜麗·布萊最佳頭版新聞獎。她著有《Island Practice》，該書講述了一個不凡的醫生的故事。
邁克爾·里根在紐約的家中。揮之不去的認知和神經系統癥狀迫使他離開了工作崗位。
After contracting the coronavirus in March, Michael Reagan lost all memory of his 12-day vacation in Paris, even though the trip was just a few weeks earlier.
在3月份感染新冠病毒后，邁克爾·里根完全忘記了自己在巴黎的12天假期做了什么，盡管那次旅行只是幾周前的事。
Several weeks after Erica Taylor recovered from her Covid-19 symptoms of nausea and cough, she became confused and forgetful, failing to even recognize her own car, the only Toyota Prius in her apartment complex’s parking lot.
埃麗卡·泰勒的新冠肺炎癥狀包括惡心和咳嗽，她在康復幾周后開始變得糊涂健忘，甚至認不出自己的車——她家公寓停車場里唯一的一輛豐田普銳斯。
Lisa Mizelle, a veteran nurse practitioner at an urgent care clinic who fell ill with the virus in July, finds herself forgetting routine treatments and lab tests, and has to ask colleagues about terminology she used to know automatically.
麗莎·米澤爾是一家急診診所的資深執業護士，她在7月感染這種病毒，發現自己記不住常規治療方法和各種化驗，不得不向同事詢問她以前爛熟于心的術語。
“I leave the room and I can’t remember what the patient just said,” she said, adding that if she hadn’t exhausted her medical leave she’d take more time off.
她說，“我離開病房就忘了病人剛剛說了什么”，還說若不是用完了病假，她會休息更久。
“It scares me to think I’m working,” Ms. Mizelle, 53, said. “I feel like I have dementia.”
“一想到自己在工作，我就感到害怕，”53歲的米澤爾說。“我覺得自己好像得了癡呆癥。”
It’s becoming known as Covid brain fog: troubling cognitive symptoms that can include memory loss, confusion, difficulty focusing, dizziness and grasping for everyday words. Increasingly, Covid survivors say brain fog is impairing their ability to work and function normally.
這些情況現被稱為新冠腦霧(Covid brain fog)：包括失憶、思維混亂、注意力難集中、頭暈和遺忘日常詞匯等令人困擾的認知癥狀。越來越多的新冠幸存者說，腦霧正在損害他們的工作能力和正常機能。
“There are thousands of people who have that,” said Dr. Igor Koralnik, chief of neuro-infectious disease at Northwestern Medicine in Chicago, who has already seen hundreds of survivors at a post-Covid clinic he leads. “The impact on the work force that’s affected is going to be significant.
“成千上萬的人出現這樣的問題，”芝加哥西北醫學院(Northwestern Medicine in Chicago)的神經感染疾病主任伊戈爾·科拉尼克博士說，他在自己負責的一家新冠康復診所診斷過數百名幸存者。“這對勞動力造成的影響是不容忽視的。”
Scientists aren’t sure what causes brain fog, which varies widely and affects even people who became only mildly physically ill from Covid-19 and had no previous medical conditions. Leading theories are that it arises when the body’s immune response to the virus doesn’t shut down or from inflammation in blood vessels leading to the brain.
科學家們不確定是什么原因導致了腦霧，這種現象差異很大，甚至影響到那些只有輕微新冠癥狀并且以前沒有任何疾病的人。主流理論認為，當人體對病毒的免疫反應沒有停止，或是通向大腦的血管出現炎癥，腦霧就會出現。
麗莎·米澤爾是一名執業護士，她忘記了各種常規的化驗和工作術語。
Confusion, delirium and other types of altered mental function, called encephalopathy, have occurred during hospitalization for Covid-19 respiratory problems, and a study found such patients needed longer hospitalizations, had higher mortality rates and often couldn’t manage daily activities right after hospitalization.
在患者因新冠呼吸系統疾病住院時，會出現精神恍惚、神志不清和其他類型的心智功能改變，即腦病(encephalopathy)，一項研究發現，這類患者需要住院更久，死亡率更高，且往往在出院后無法立即應付日常活動。
But research on long-lasting brain fog is just beginning. A French report in August on 120 patients who had been hospitalized found that 34 percent had memory loss and 27 percent had concentration problems months later.
但是，對長時間腦霧癥狀的研究才剛剛開始。8月，法國的一份報告對120名住院患者進行了調查，發現其中34%的人在數月后出現失憶，27%的人有注意力不集中問題。
In a soon-to-be-published survey of 3,930 members of Survivor Corps, a group of people who have connected to discuss life after Covid, over half reported difficulty concentrating or focusing, said Natalie Lambert, an associate research professor at Indiana University School of Medicine, who helped lead the study. It was the fourth most common symptom out of the 101 long-term and short-term physical, neurological and psychological conditions that survivors reported. Memory problems, dizziness or confusion were reported by a third or more respondents.
“幸存者軍團(Survivor Corps)”是一群彼此聯絡，討論新冠康復后生活的人，其3930名成員參與了一項即將公布的調查，超過半數的人都表示難以集中或專注精神，幫助領導了這項研究的印第安納大學醫學院(Indiana University School of Medicine)的副教授娜塔莉·蘭伯特表示。在幸存者們報告的101種生理、神經和心理的長短期癥狀中，這是第四大常見癥狀。三分之一或更多的受訪者報告了記憶問題、頭暈或精神恍惚。
“It is debilitating,” said Rick Sullivan, 60, of Brentwood, Calif., who’s had episodes of brain fog since July after overcoming a several-week bout with Covid-19 breathing problems and body aches. “I become almost catatonic. It feels as though I am under anesthesia.”
“這會使你衰弱，”來自加州布倫特伍德、60歲的里克·沙利文說，在克服了為期數周的新冠呼吸問題和身體疼痛后，他自7月以來出現了多次腦霧。“我幾乎患上了緊張癥。感覺好像被麻醉了一樣。”
Wreaking havoc on the job
對工作造成嚴重破壞
埃麗卡·泰勒是一名律師，她的大腦曾出現過感覺像“白噪音”的情況。她認不出公寓停車場里自己的車，不得不請假暫離工作崗位。
When Ms. Taylor, 31, contracted the virus in mid-June, she thought she’d need only a brief break from working as a lawyer for an Atlanta nonprofit helping low-income tenants.
當31歲的泰勒在6月中旬感染病毒時，她認為自己只需暫時離開在亞特蘭大一家幫助低收入租戶的非營利性機構的律師崗位。
But she became so disoriented that she washed her TV remote with her laundry and had to return a foster dog she’d recently taken in because she couldn’t trust herself to care for a pet.
但她頭腦徹底失調，甚至把電視遙控器混進衣服里一起洗，還不得不退回最近才收養的一只狗，因為她已經不相信自己能照顧好寵物。
One morning, “everything in my brain was white static,” she said. “I was sitting on the edge of the bed, crying and feeling ‘something’s wrong, I should be asking for help,’ but I couldn’t remember who or what I should be asking. I forgot who I was and where I was.”
一天早上，“我腦子里全是白色靜電，”她說。“我當時坐在床邊，哭了起來，感覺’出事了，我應該尋求幫助’，但我記不起自己該找誰或者求什么。我忘了我是誰，我在什么地方。”
By July, she thought she’d improved and told her boss she could return. But after another “white static” episode, she messaged him: “I’m scared. I really want to get back to work. But, I keep getting really tired and really confused.” He suggested she rest and heal.
到了7月，她覺得自己有所好轉，告訴老板她可以回去工作。但在又一次“白色靜電”發作之后，她給老板發信息說：“我很害怕。我真的很想回去工作。可是我一直覺得很累，真的很迷糊。”他建議她休息并且進行治療。
She resumed working in early August, but her mind wandered and reading emails was “like reading Greek,” she said. By September, her employer urged a 13-week leave.
她在8月初恢復了工作，但思緒飄忽不定，她說，讀電子郵件“就像讀希臘語”。到了9月，雇主敦促她休假13周。
“They finally landed on ‘You’re going to have to step away,’” said Ms. Taylor, who requested to volunteer for the nonprofit while on leave but was told no. “I’m gutted, to be honest.”
“他們最終決定‘你必須離開’，”泰勒說，她在休假期間尋求為非營利組織擔任志愿者，但遭到拒絕。“說實話，我很傷心。”
里根翻閱一本3月份去巴黎旅行的攝影集。他什么都不記得了。
Mr. Reagan, 50, who spent five days in and out of hospitals, initially resumed work as a vascular specialist for a company that makes stents and catheters.
現年50歲的里根曾在醫院進出五天，起初，他痊愈后回到任職的制造支架和導管的公司，恢復了作為血管專家的工作。
But finger tremors and seizures, neurological symptoms that sometimes accompany brain fog, meant “there is no way I’m going to go into surgery and teach a doctor how to suture an artery,” he said.
但有時伴隨腦霧而來的手指顫抖和癲癇這些神經系統癥狀，意味著“我不可能去做手術，教醫生如何縫合動脈”，他說。
In meetings, “I can’t find words,” said Mr. Reagan, who has now taken a leave. “I feel like I sound like an idiot.”
“我找不到合適的詞，”碰面的時候，現在已經休假的里根說。“我覺得自己聽上去像個白癡。”
Before Ms. Mizelle contracted the virus in July and was hospitalized with pneumonia for five days in August, she’d treat six patients an hour by herself at her clinic in Huntsville, Ala. But recently, she said, “I told our scheduler I can’t work alone because I’m slow in thinking, I’m dizzy, and I just need somebody else there to work with me.”
米澤爾于7月感染病毒，8月因肺炎住院五天，在此之前，她在亞拉巴馬州亨茨維爾的診所每小時獨自治療六名患者。但最近，她說，“我告訴我們的調度人員，我不能獨自工作，因為我思維遲鈍，頭暈，需要有人跟我一起工作。”
Sometimes in exam rooms, she said, “I’m trying to be slick with the patient so they don’t know, because you don’t want your provider to be in a fog, which is very scary.”
她說，有時在診療室，“我試著跟病人巧妙地溝通，這樣他們就不知道我的情況了，因為你不希望給你治病的人陷入迷茫，這是很可怕的。”
Searching for answers to a mysterious cause
尋找神秘原因的答案
Brain fog’s cause is a mystery partly because symptoms are so varied.
腦霧的成因至今仍是個謎，部分是由于其癥狀五花八門。
米澤爾在她家門前。在她工作的急診診所，同事們在她接待病人時一直支持她。
“The simplest answer is people still have persistent immune activation after the initial infection subsided,” said Dr. Avindra Nath, chief of infections of the nervous system at the National Institute of Neurological Disorders and Stroke.
“最簡單的答案是，在最初的感染消退之后，人們仍有持續的免疫激活，”國家神經紊亂與中風研究所(National Institute of Neurological Disorders and Stroke)神經系統感染主任阿維德拉·納特博士說。
Inflammation in blood vessels, or cells lining the vessels, may be involved, said Dr. Serena Spudich, chief of neurological infections and global neurology at Yale School of Medicine. Inflammatory molecules, released in effective immune responses, “can also be sort of toxins, particularly to the brain,” she said.
耶魯大學醫學院(Yale School of Medicine)神經感染和全球神經病學主任瑟琳娜·斯普迪赫博士說，這可能與血管內炎癥或血管內皮細胞有關。她說，在有效的免疫反應中釋放的炎癥分子“也可能是某種毒素，特別是對大腦而言”。
Tiny strokes may cause some symptoms, said Dr. Dona Kim Murphey, a neurologist and neuroscientist, who herself has experienced post-Covid neurological issues, including “alien hand syndrome,” in which she felt a “super-bizarre sense of my left hand, like I didn’t understand why it was positioned the way it was and I was really captivated by it.”
小型中風可能引起一些癥狀，神經科醫生、神經學家堂娜·金·墨菲博士說，她本人也經歷了感染新冠后的神經問題，包括“異手綜合征”，她覺得一個“我的左手有一種超級奇怪的感覺，就好像我不明白它為什么是在這個位置，百思不得其解”。
Other possible causes are autoimmune reactions “when antibodies mistakenly attack nerve cells,” Dr. Spudich said.
其他可能的原因是“當抗體錯誤地攻擊神經細胞時”出現的自身免疫反應，斯普迪赫說。
Symptoms like tingling or numbness can occur when damaged nerves send wrong signals, said Dr. Allison Navis, a neuro-infectious disease specialist at Mount Sinai Health System. Some people with brain fog still experience lung or heart issues, which can exacerbate neurological symptoms.
芒特西奈醫療系統(Mount Sinai Health System)的神經傳染病專家艾莉森·納維斯說，當受損的神經發出錯誤信號時，就會出現刺痛或麻木等癥狀。一些腦霧患者仍然會出現肺或心臟問題，這可能會加劇神經系統癥狀。
So far, MRI scans haven’t indicated damaged brain areas, neurologists say.
神經學家說，到目前為止，核磁共振掃描并未顯示出受損的大腦區域。
