Is Covid Rewriting the Rules of Aging?

#1

https://www.wsj.com/health/wellness/is-covid-rewriting-the-rules-of-aging-brain-decline-alarms-doctors-6ed3dfaa

I haven’t had Covid vaccine since the 2 initial Moderna shots for Delta in 2020/21. The high prevalence of Long Covid and myself probably having a mild case along with several studies pointing to links to dementia make me look in to getting the vaccine in 2025, especially now that Novavax traditional antigen (non-mRNA) is available.

YOUR HEALTH
Is Covid Rewriting the Rules of Aging? Brain Decline Alarms Doctors
Millions of long-Covid patients continue to struggle with cognitive difficulties
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Five years after the pandemic’s start, millions of Americans are still struggling with long-lasting symptoms of Covid-19. Cognitive difficulties are among the most troubling and common symptoms in people both old and young.
These ailments can be severe enough to leave former professionals like Ken Todd unable to work and even diagnosed with a form of mild cognitive impairment.
I first spoke with Todd, a 56-year-old former Showtime executive in New York City, in 2022 for a column on long-Covid patients grappling with crippling fatigue.
Todd says he stopped working in 2023. When he tried to apply for jobs he realized he just didn’t have the physical or mental stamina. “It just exacerbated my symptoms,” he says.
Todd was diagnosed with a form of mild cognitive impairment in February. Now, he is pursuing cognitive rehabilitation to learn strategies to compensate for his cognitive deficiencies, along with other therapies. “We have not talked about regression,” says Todd. “But we need to keep monitoring it.”
Our exchange raises a troubling question: Are long-Covid patients’ cognitive symptoms getting better or regressing? And are those patients being diagnosed with mild cognitive impairment, or MCI, more at risk for developing dementia or Alzheimer’s disease later?
I posed these questions to the doctors and scientists who see and study these patients. Most agree that long-Covid patients experience cognitive issues and other neurological symptoms likely fueled by brain inflammation.
Cognitive difficulty
It remains unclear if these changes will persist or worsen over time. But there are some disturbing signals that they could, at least in a certain subset of patients. And there is some evidence that the age when you got Covid-19 may be an important factor.
Studies have found that older people who have Covid-19 are at increased risk of developing Alzheimer’s sooner than if they haven’t had it. Covid may be accelerating the process in people already at risk of dementia, or contributing to it.
In younger people such as Todd, complaints of brain fog and cognitive difficulties may be intertwined with, or stem from, other common long-Covid symptoms, such as fatigue and pain, doctors say.
Dr. Gabriel de Erausquin, a neurologist at University of Texas Health San Antonio, recently published a study that found the risk of moderate to severe cognitive impairment in older adults with long Covid was double that of younger ones.
For those long-Covid patients over 57, the symptoms associated with cognitive difficulties look much like early dementia, he says.
“It doesn’t look in older adults that this is a reversible process,” says de Erausquin.
“If you look at the tests they have the profile of a person with very early Alzheimer’s disease. Do they have Alzheimer’s disease? We don’t know.”
A rising rate
Beyond age, his research has found that long-Covid patients more susceptible to cognitive impairments share a certain number of genes, have a reduced size of some brain structures, and typically lose their sense of smell soon after a Covid-19 infection.
De Erausquin is conducting a study following about 4,000 people in five locations around the world who contracted Covid-19 when they were over 60 years old. Preliminary data shows that up to one-third of long-Covid people over 65 meet criteria for an MCI diagnosis.
“That’s huge,” he says. “That’s a four- or fivefold increase in the prevalence.”
MCI can be caused by a variety of factors, explains Ronald Petersen, a neurology professor at the Mayo Clinic College of Medicine and Science in Rochester, Minn.
Symptoms typically include short-term memory problems—such as forgetting important information—to the point it becomes noticeable.
In people in their 70s or 80s, a common cause of MCI is underlying Alzheimer’s disease, says Petersen. About 10% to 15% of people with MCI who see a doctor will develop dementia a year, he says.
Some causes of MCI—such as sleep apnea—are treatable, making the condition reversible. This could be the case for long-Covid patients, or at least some of them.
Some long-Covid patients do show improving cognitive symptoms though recovery isn’t linear, says Dr. Igor Koralnik, chief of neuro-infectious diseases and global neurology at Northwestern Medicine in Chicago.
Bumpy road
A February study his group published in the Archives of Physical Medicine and Rehabilitation found that after cognitive rehabilitation about half of patients reported an improvement. But about one-third of the 70 patients didn’t have a significant difference in objective measures of memory.
“There are bumps on the way especially if they develop another episode of Covid,” says Koralnik.
For some long-Covid patients, neurological symptoms seem to get worse with time.
Juan Lewis, a former deputy commander of an air base squadron in Germany, was hospitalized with Covid-19 in April of 2020. His initial symptoms were pulmonary but soon he noticed cognitive difficulties.
“I thought Covid was just in the lungs,” the now 59-year-old says from his home in San Antonio.
Lewis was a multitasking master with an impeccable memory before retiring from the Air Force and getting a job with the Department of Defense. In 2021, he was diagnosed with mild cognitive impairment.
“I very seldom go places by myself,” he says. “My wife is often with me. I’m easily distracted. I constantly leave credit cards in restaurants.”
“I’m extremely worried,” he says. “I don’t want dementia.”
Write to Sumathi Reddy at Sumathi.Reddy@wsj.com
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#2

This is of course concerning. But there are many reasons why you many simply not want to get Covid-19, that go beyond these neurological issues. There’s long been evidence that the virus does damage and persists in multiple tissues, the lungs, the heart and so forth. The problems this can cause are not just in those with Long Covid. This can occur even in those who have had asymptomatic covid. It’s the virus that’s the problem.

The takeaway here is that it’s best not to get covid at all. That, of course may not be practical - it is so widespread, that unless you’re a hermit, odds are you are going to get it. As the saying goes, everyone can be divided into two groups - those who have had covid and those who haven’t had covid yet but will have it in the future. The fact that apparently the US administration has halted all work on updating the vaccine against newer variants is also a negative.

The vaccine issue is somewhat confusing. It’s clear that there’s a (small?) group of people who have experienced some kind of injury from the vaccine. And it’s clear that the vaccine lowers the odds of death and hospitalization from covid. What is not so clear is whether the covid vaccine helps against Long Covid, or prevents or ameliorates all the other actions of this virus in the brain as well as other tissues. But ultimately, while death is the worst outcome, I think we’re all concerned about those neurological and other issues - and it would be nice if we had some clarity as to whether the vaccine is helpful in this context.

My approach has been to get vaccinated and boosted once a year. But mostly trying to avoid super risky situations where the odds of catching the virus are high - basically, I’m trying to delay the time when I’ll likely get the virus for as long as possible. I’m not going to extreme measures like masking everywhere, I’m trying to live a somewhat normal life, masking in high risk settings like doctor offices etc., but perhaps I should be even more proactive. Alltogether quite worrisome.

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#3

If you have Kaiser, SOL on Novavax.

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#4

I know these guys are hyenas, but I find their presentation to be for the masses which may not include you. What I take away is that vaccines have significant effects which nobody has tested for like 4-6 months out:

I’m sure you saw the study, it’s been in the news.

As to avoiding long covid, Nattokinase, bromelain, and curcumin taken in close proximity is a killer combination to get rid of the spike protein. No toxicity, no risk and low cost. Give it a long try. I have a pineapple, which I never did before and discovered it’s quite a treat. Sugary, but still loaded with the good stuff.

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#5

I’ll be brief to avoid politics. My understanding of the current evidence, shows that there is no evidence of net benefit to annual COVID vaccination if you’re less than 60.

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#6

That was my take thus far HOWEVER, given the new studies on dementia prevention and availability of non-mRNA vaccine changes the benefit to risk ratio, possibly for those that between ages 40-60. I certainly would not consider my 20 year old son.

It’s the mRNA vaccines cause CD8 T-cell mediated cytoxicity which may explain some of the auto-immunity phenomenon we have been seeing, however they are more effective (it’s a trade-off) and thus make more sense for older people with less responsive immune systems.

I am considering Novax - non-mRNA to lessen the chance of the infection or reduce the severity of the infection as preventive measure against COVID new omicron variants and it’s contribution to dementia risk. I am on the front lines with high exposure to infectious agents, as are you.

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#7

Hi Dr Bart,

I’ve taken a different approach, and you are the expert as an immunologist. I purposely get exposed 15-20 times per week to influenza, covid, RSV. It’s now been 3+ years since I’ve had anything more than a couple of days of the sniffles, but no systemic unwell state. This is along with taking rapamycin regularly, and not stopping for viral illnesses.

My last vaccine now has to be 3 years+ ago. I consider it a luxury to be in the ER getting exposed as it seems to have given me small bumps in immunity and with trends in changing genome of the virus … I stay mostly immune.

With the exposures you get - do you see it as being worthwhile to be immunized? I personally don’t.

This is from someone who was over the top at the beginning, and for cause with maximal PPE and got myself a Honeywell PAPR and wore it for anyone with a respiratory symptom of any kind.

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#8

CD8 T-cell responses are a normal and essential part of how vaccines — especially mRNA ones — build lasting immunity. Pointing to that as a cause of autoimmunity without clear evidence risks confusing normal immune function with pathology. Are there any peer-reviewed studies showing this mechanism causing clinically significant autoimmunity beyond rare case reports?

#9

I think that is a good approach for milder cold virus, the constant exposure allows the immune system to constantly adapt to the continuous antigenic drift. However at times where there is a major antigenic shift this may backfire.

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#10

mRNA vaccines work thru a novel mechanism for stimulating powerful CD8 and CD4 mediated immunity via de novo generation of antigen that will be present on the cell surface. I can only theorize that may be a reason why we see increased autoimmune and autoinflammatory with these types of vaccines. So until we can fully elucidate the mechanism, personally I would chose traditional inactivated viral or antigen based vaccine (with adjuvant) to reduce the risk. Now mRNA based may a good choice for someone less immunocompetent - obese, diabetic, older. It’s all RISK vs BENEFIT.

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#11

Has there been a study showing COVID vaccines decrease dementia?

#12

Probably not, the vaccine was only available about 4 years ago, not enough time to follow the post-vaccination period to look for dementia development EVEN if they started the study in 2020.

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#13

I discussed it with the new o3 model for
ChatGPT, seems that the current evidence leads in the direction that Covid vaccination helps, and perhaps a lot:

Below is the best‑quality evidence that SARS‑CoV‑2 vaccination might lower a person’s long‑term risk of dementia. I group the data from strongest to most speculative, then flag caveats.

1 Population‑scale cohort evidence

Study Design & population Dementia‑related outcome Effect size (vaccinated vs unvaccinated)
UK Biobank (Int J Infect Dis 2024) 393 k adults, median 54‑day follow‑up after ≥1 mRNA or adenoviral dose First hospital admission for dementia HR 0.11 (95 % CI 0.06–0.22) – an 89 % relative risk reduction
Israel Maccabi HMO registry (Front Public Health 2023) 25 733 older adults with pre‑existing cognitive disorders + 65 k controls 14‑mo mortality & neuro‑psychiatric deterioration Mortality 7 % (vaccinated) vs 52 % (unvaccinated); lower new antipsychotic use, suggesting slower clinical decline

Strengths: electronic‑health‑record data, adjustment for comorbidities, consistent across sensitivity analyses.
Limitations: follow‑up is short, healthy‑vaccinee bias possible, dementia incidence was secondary in the Israeli study.

2 Long‑COVID cognitive sequelae (an intermediate endpoint)

•	Swedish national cohort (BMJ 2023) — 300 k vaccinated vs 290 k unvaccinated adults who later caught COVID‑19. Prior vaccination cut the risk of a post‑COVID condition (PCC) diagnosis that included cognitive impairment by 58 % (aHR 0.42, 95 % CI 0.38–0.46); each extra dose lowered risk further.  
•	UK community sample (NEJM 2024, >100 k participants) — average IQ‑equivalent loss after infection was smaller, and sometimes absent, in people who had multiple vaccine doses.

Because persistent cognitive deficits and vascular events are known precursors of vascular and Alzheimer‑type dementias, lowering long‑COVID burden is a plausible dementia‑prevention pathway.

3 Mechanistic & animal data

•	Mouse “long‑COVID” model (Nat Immunol 2024) — a single low‑dose adenoviral‑vector vaccine given before infection blocked hippocampal IL‑1β surges, preserved adult neurogenesis, and prevented memory‑loss on the Y‑maze.

Interpretation: vaccination blunts neuro‑inflammation that can seed later neurodegeneration.

4 Indirect evidence: vaccination prevents the exposure that raises dementia risk

Large EHR studies show that SARS‑CoV‑2 infection itself raises the 1‑year hazard of a new Alzheimer’s diagnosis by ~70 % (HR 1.69 among 6.2 million U.S. seniors).
By sharply reducing infections, severe disease, strokes, and ICU stays, vaccination plausibly lowers downstream neurodegenerative risk even if the vaccine has no direct CNS effect.

5 Conflicting findings

One small database analysis (QJM 2024) reported higher short‑term Alzheimer/MCI incidence after vaccination. The authors relied on spontaneous diagnosis codes with limited covariate adjustment and could not separate detection bias from causation. No signal of excess dementia emerged in the far larger UK Biobank or Israeli cohorts above, so this remains an outlier that needs replication.

How strong is the case today?

1.	Suggestive but not definitive. The only study that measured incident dementia after vaccination (UK Biobank) points to a large protective association, but follow‑up was <2 months and residual confounding can’t be ruled out.
2.	Mechanistic plausibility is growing. Multiple pathways—lower viral neuro‑invasion, reduced micro‑vascular injury, damped systemic inflammation—converge on mechanisms already linked to dementia.
3.	Research gaps. We still lack long‑term (>3 y) incidence data, randomized evidence, and biomarker studies in older adults.

Practical takeaway

Staying up‑to‑date on COVID‑19 boosters is already warranted to avoid acute illness; the possibility of lowering future dementia risk is an extra, still‑emerging dividend. For patients at high baseline risk (age ≥65, ApoE ε4 carriers, vascular comorbidities), that potential benefit reinforces the risk‑benefit tilt in favor of vaccination while we await longer‑term follow‑up studies.

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#14

Did o3 use the search tool for you query? Do you have the sources?

#15


https://pmc.ncbi.nlm.nih.gov/articles/PMC10361652/

https://www.bmj.com/content/383/bmj-2023-076990?utm_source=chatgpt.com

https://www.nature.com/articles/s41590-024-01868-z?utm_source=chatgpt.com

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#16

These might also be of interest:

Eric Topol’s Ground Truths articles discussing the relationship between COVID-19 and dementia risks:

1. The Brain and Long Covid

Discusses UK Biobank findings showing brain atrophy and cognitive decline in individuals post-COVID-19 infection.

Read the article

2. Long Covid at 3 Years

Highlights studies indicating a correlation between prior SARS-CoV-2 infection and increased risk of Alzheimer’s disease.

Read the article

3. Long Covid and Cognitive Deficits

Explores the potential for increased risk of Parkinson’s disease and dementia years after COVID-19 infection.

Read the article

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#17

Thanks, @Neo I’m pretty bullish on COVID vaccines (I’ve had 4 or 5 or so).

Does anyone have a good dashboard to track viral infections in local population. It would be helpful to know when we are in middle of an infectious wave. Bad outcomes aside it’s annoying to get sick.

With AI agents maybe it will be possible to create a dashboard easily later on.

I’ve been thinking about nasal sprays to block infections as well.

#18

In the US these might help

And

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#19

So does Covid vaccine help or hurt when in comes to dementia?

Long Covid and Cognitive Deficits

Explores the potential for increased risk of Parkinson’s disease and dementia years after COVID-19 infection

A potential association between COVID-19 vaccination and development of Alzheimer’s disease

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#20

Myself and my wife get a booster every year or when there is a new updated vaccine. To date we have not experienced any side effects from the vaccines. We have been getting the Moderna although the very first one yrs ago was pfizer’s i believe. On that one we got the first shot then a few weeks later had to come back for the 2nd of the shot series.

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