COVID-19 & the Impact on Swallowing & Cognition

By: Cara Kennedy

Known Long-Term Effects of COVID-19

Swallowing

• Lung Disease/Pulmonary Issues/Hypoxia
• Decreased coordination between swallowing & respiration
• Fluid build up in the lungs
• Strokes, encephalitis, & hypoxia
  • Causes brain damage
    • can weaken muscles, cause discoordination
    • Reduced sensation and/or weakness in muscles for swallowing
  • Silent stokes- can lead to large strokes & dementia
    • Impact white matter of the brain
      • “wiring between brain cells that enables different parts of the brain to communicate with each other” (Budson, 2021)
• Masks — higher risk of xerostomia
  • Can impact oral hygiene routine, thus increasing potential for aspiration pneumonia (Pinzan-Vercelino et al., , 2021)
• Mechanical Ventilation & Intubation
  • Depends on moment of intubation in fight against COVID (early intubation), duration, & extubation
    • Laryngeal trauma
  • Damaged VFs due to mechanical ventilation
    • Impacts airway closure
  • Post-extubation dysphagia can cause aspiration pneumonia, transient hypoxemia, & malnutrition
• Tracheostomy
  • “Prolonged cuff inflation may hinder secretion management and negatively affect swallowing physiology” (Vergara, 2021)

Cognition

• Brain fog/ “COVID brain”
• Most common deficits:
  • Processing speed (18 % of participants), executive functioning (16%), phonemic fluency (15%), category fluency (20%), memory encoding (24%), memory recall (23%) (Becker, 2021)
  • Sustained attention
• “More than 40% of patients with COVID showed neurological manifestations (can lead to death) at the outset, & more than 30% of those had impaired cognition” (Budson, 2021)
• Encephalitis, strokes, & lack of oxygen are common & cause brain damage
• Megakaryocytes
  • Cells found in bone marrow that create platelets
  • Researchers from Johns Hopkins University & Harvard Medical School found evidence of these cells in capillaries of the brain in individuals who died from COVID
    • Should not occur; these researchers (neuropathologists) had never seen this before
      • Believe it is due to strokes that occurred in individuals with COVID (Budson, 2021)
• Those who survive the ICU with acute respiratory failure and/or shock (Budson, 2021)
  • ⅓ of people present with profound cog. Deficits
  • Present similarly to individuals with moderate TBI
  • “Commonly observed long-term psychological effects of the ICU stays include anxiety, depression, and post-traumatic stress disorder,” (Budson, 2021)
    • Findings are consistent with ICU stays due to COVID
    • These psychological effects could negatively impact cognition, swallowing, & voice to some extent***

Voice

• Decreased pulmonary strength and prevalence of pulmonary issues may result in hyperfunction
• Intubation & extubation– strained vocal quality
• Excessive coughing & long lasting shortness of breath
• “In some patients, COVID-19 appears to damage the nerve that regulates speech, causing the vocal cords to impede breathing even when they are not talking,” (Thompson, 2020)
  • Damage to the vagus nerve (X) can cause the vocal folds not to abduct “impeding breathing”
• Vocal fold dysfunction

References

• Becker, J. H. (2021, October 22). Assessment of cognitive function in patients after COVID-19 infection. JAMA Network Open. Retrieved February 17, 2022, from https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2785388
• Budson, A. E. (2021, March 4). The hidden long-term cognitive effects of covid-19. Harvard Health Blog. Retrieved February 17, 2022, from https://www.health.harvard.edu/blog/the-hidden-long-term-cognitive-effects-of-covid-2020100821133
• Heneka, M. T., Golenbock, D., Latz, E., Morgan, D., & Brown, R. (2020, June 4). Immediate and long-term consequences of COVID-19 infections for the development of neurological disease – alzheimer’s research & therapy. BioMed Central. Retrieved February 18, 2022, from https://alzres.biomedcentral.com/articles/10.1186/s13195-020-00640-3
• José Vergara, B. S. (2021, January 1). Swallowing and Communication Management of tracheostomy and laryngectomy in the context of covid-19. JAMA Otolaryngology–Head & Neck Surgery. Retrieved February 16, 2022, from https://jamanetwork.com/journals/jamaotolaryngology/article-abstract/2771746
• Mayo Clinic Staff. (2021, October 22). Covid-19 (coronavirus): Long-term effects. Mayo Clinic. Retrieved February 15, 2022, from https://www.mayoclinic.org/diseases-conditions/coronavirus/in-depth/coronavirus-long-term-effects/art-20490351
• Pinzan-Vercelino, C.-R.-M., Freitas, K.-M.-S., Girão, V.-M.-P., da Silva, D.-de O., Peloso, R.-M., & Pinzan, A. (2021, April 1). Does the use of face masks during the COVID-19 pandemic impact on oral hygiene habits, oral conditions, reasons to seek dental care and esthetic concerns? Journal of clinical and experimental dentistry. Retrieved February 18, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8020324/
• Thompson, D. (2020, November 3). Damage to vocal cords could cause long-term covid symptoms. Medical Xpress – medical research advances and health news. Retrieved February 18, 2022, from https://medicalxpress.com/news/2020-11-vocal-cords-long-term-covid-symptoms.html