Lumosity for long COVID
BRAIN TRAINING PROGRAMS: Lumosity
What are brain training programs like Lumosity?
Lumosity provides research-based brain training games to improve memory, processing speed, and problem-solving for people of all ages and skill levels.1 Users can choose from more than 50 games in the following categories: speed, memory, attention, flexibility, problem-solving, word, and math. The games are intended to be adaptive and have personalized difficulty. Each game is also derived from a clinically-based assessment that could be done in a research lab.
How can brain training programs like Lumosity help alleviate certain long COVID symptoms?
Cognitive symptoms of long COVID include brain fog (trouble thinking clearly or remembering) and difficulty focusing on tasks. The SARS-CoV-2 virus can directly infect the central nervous system and damage brain tissue, which is hypothesized to lead to cognitive impairment. In addition, the virus possesses a spike protein that studies have associated with memory loss after COVID.2 This spike protein can activate neuroinflammation and ultimately lead to memory impairment.
Programs like Lumosity may help with cognitive symptoms of long COVID by training the brain over multiple sessions to improve memory and processing time. As users improve their ability to complete the cognitive tasks for each game, these tasks boost memory and attention in daily activities.
What evidence supports using brain training programs like Lumosity for long COVID?
The founder of Lumosity conducted a randomized study of 4,715 participants who either completed the brain training program for 15 minutes a day for five days per week or online crossword puzzles. After ten weeks, they found that those who used Lumosity improved more on assessments of working memory, short-term memory, processing speed, problem-solving, fluid reasoning, and overall cognitive function.3
Another study conducted in Saudi Arabia had 51 healthy participants randomized to use either Lumosity for 15 minutes a day, at least seven days per week, for three weeks or no brain training as a control. The study found a statistically significant difference in attention-switching tasks and motor speed between the Lumosity and control groups.4
However, some argue that brain training programs such as Lumosity only improve a user’s ability to complete specific tasks assessed in the games with little transferability to overall cognitive performance. One study found no evidence of improvement in decision-making behavior, brain response, or cognitive task performance using Lumosity versus playing online video games.5
Thus, the evidence for Lumosity is controversial and may not be as effective in improving overall cognitive function. Lumosity has also been used anecdotally by long-term COVID patients, but it has not yet been formally studied in this patient population.
References:
1) Discover what your mind can do. Lumosity. 2023. Accessed November 9, 2023. https://www.lumosity.com/en/
Active Clinical Trials: Long COVID, brain training | Card Results | ClinicalTrials.gov
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Lovastatin for long COVID
LOVASTATIN
What is lovastatin (Mevacor, Altoprev)?
Lovastatin is part of a class of drugs commonly referred to as statins. Its role is to reduce the amount of cholesterol the liver makes. Cholesterol comprises HDL, the “good” cholesterol, and LDL, the “bad” cholesterol. The body uses cholesterol to make various hormones and other substances. However, if a person has too much LDL, it can cause a buildup in the arteries, leading to stroke, heart attack, or other health problems.
How does lovastatin relate to long-COVID?
Lovastatin possesses anti-inflammatory and modifying effects on the immune system (1). A recent study conducted in vitro (in test tubes) showed that simvastatin reduced levels of pro-inflammatory proteins and inhibited human cells from being infected with COVID-19 (2). However, statins can also upregulate or increase an enzyme called ACE2. ACE2 is how COVID-19 makes its way into the cells, leading to an influx of disease ( 3).
For those who suffer from long-COVID, the effects of statins may prolong illness even further. Highlights of long-COVID include chronic fatigue, exercise intolerance, and muscle weakness. Muscle weakness or muscle pain (myalgia) is also a primary side effect associated with the use of statins. Therefore, many believe that statins are exaggerating long-COVID in patients. Additionally, statins can decrease the amount of CoQ10 available for use by the body. CoQ10 is an antioxidant that has a role in the cells’ energy production (4). For those suffering from long-COVID and already with a decreased energy reserve, statin use could only exacerbate this problem further.
Although currently, there is no definitive answer regarding the role of lovastatin use in patients with long-COVID, the consensus is to aid on the side of caution. A benefit versus risk scenario for every patient should be warranted for providers to assess whether the cardio-protective use of statins outweighs the prolonged effects of long-COVID in patients.
References:
1https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9520195/
2https://journals.plos.org/ploscompbiol/article?id=10.1371/journal.pcbi.1011050
3https://jamanetwork.com/journals/jama/fullarticle/2780872
4 https://www.mdpi.com/2077-0383/12/14/4659
Pregabalin for long COVID
PREGABALIN
What is pregabalin?
Pregabalin is a medication that mimics gamma-aminobutyric acid (GABA) in the body. GABA is responsible for inhibiting neurons that produce an excitatory signal. In pain or seizures, neurons constantly fire, inducing an excitatory response. GABA works to calm these neurons and return them to normalcy. Pregabalin is commonly used for neuropathy (nerve pain) and those affected with partial seizures [1]. It is a controlled substance (C-V) and does have the potential for abuse if taken differently than prescribed.
Can pregabalin help with long-COVID?
Patients with long-COVID can display a variety of symptoms such as tremors or neuropathy in the fingers or toes. Although the mechanism behind this is still unclear, some theories point to damage of the nerve cells by COVID-19, causing an imbalance in excitatory versus inhibitory neurons [2]. Several providers have turned to therapies, such as pregabalin, to control these symptoms. In a guide created for primary care physicians regarding long-COVID, the use of pregabalin is warranted for neuropathic pain [2]. Additionally, a review study published in 2022 found that in patients with neuropathy from long-COVID, 61% were prescribed agents such as pregabalin for symptom management [3].
Pregabalin may be a helpful therapy for those suffering from neurological pain associated with long-COVID. It may offer symptom management and help restore a patient to pre-COVID baseline function.
References:
2https://www.jabfm.org/content/jabfp/34/6/1229.full.pdf
3https://onlinelibrary.wiley.com/doi/10.1002/acn3.51570
Active Clinical Trials: Long COVID, pregabalin | Card Results | ClinicalTrials.gov
EndeavorRx for long COVID
BRAIN TRAINING PROGRAMS: EndeavorRx
What are brain training programs like EndeavorRx?
EndeavorRx is an FDA-authorized video game to improve attention function in children ages 8-12 with ADHD. The program can be considered part of a treatment plan combined with provider-directed therapy, medication, and educational programs. EndeavorRx is prescribed by a provider and is currently priced at $99 for a 30-day prescription and FSA/HSA eligible.1
Like EndeavorRx, EndeavorOTC is a similar video game app clinically designed to improve adult ADHD symptoms. The game tests your ability to see a target and navigate a course to avoid obstacles. It is recommended to be played for six weeks intervals followed by a one-week break.2
How can brain training programs like EndeavorRx help alleviate certain long COVID symptoms?
Cognitive symptoms of long COVID include brain fog (trouble thinking clearly or remembering) and difficulty focusing on tasks. The SARS-CoV-2 virus can directly infect the central nervous system and damage brain tissue, which is hypothesized to lead to cognitive impairment. In addition, the virus possesses a spike protein that studies have associated with memory loss after COVID.3 EndeavorRx and EndeavorOTC can improve attention in long COVID patients.
What evidence supports using brain training programs like EndeavorRx for long COVID?
EndeavorRx is supported by five clinical studies that included more than 600 children with ADHD. The company’s randomized controlled trial found that the program improved objective attention in children when played for about 25 minutes a day, five days per week, for four weeks, with added benefits in a second month of treatment.4
EndeavorOTC was studied in adults with ADHD, with 73% of participants reporting quality of life improvements. This study found that 60% were better able to complete projects on time, and 53% were better able to manage multiple tasks at once.5
EndeavorRx and EndeavorOTC are currently being studied at Cornell New York Presbyterian and Vanderbilt for use in long COVID patients with cognitive impairment.6
What are some things to watch out for with brain training programs like EndeavorRx?
No serious adverse events have been reported. About 9% of participants reported a treatment-related adverse event such as frustration, headache, dizziness, emotional reaction, nausea, and aggression. All adverse events were transient, and only three led to discontinuation of the program.1
References:
1) The only doctor prescribed video game treatment for kids with ADHD. EndeavorRx. April 2022. Accessed November 8, 2023. https://www.endeavorrx.com
2) Improve your focus, game changing results. EndeavorOTC. 2023. Accessed November 8, 2023. https://www.endeavorotc.com
4) The Research. EndeavorRx. June 2022. Accessed November 8, 2023. https://www.endeavorrx.com/the-research/
6) Aguilar M. Akili’s therapeutic video game will be tested as a treatment for Covid ‘brain fog.’ STAT. April 7, 2021. https://www.statnews.com/2021/04/07/akili-endeavorrx-covid19-brain-fog/
Active Clinical Trials: Long COVID, brain training | Card Results | ClinicalTrials.gov
Pepcid2
CompendiRx:
Empowering the long COVID Community
Who We Are
Welcome to CompendiRx, an innovative online platform dedicated to transforming the journey of individuals grappling with the often-overlooked condition known as COVID. Born from a genuine commitment to addressing the unique challenges faced by this community, CompendiRx stands as a beacon of hope, understanding, and invaluable support.
Our mission is simple yet profound: to offer an empowering registry of treatment ratings and reviews, complemented by concise summaries of the latest research findings relevant to long COVID.
We envision a world where individuals impacted by this condition feel informed, supported, and optimistic about their path to recovery.
Our Core Values
At the heart of CompendiRx is a set of guiding principles that inform every aspect of our operations and interactions with the long COVID community:
Integrity and Trust: Upholding the highest standards of honesty and transparency, we are committed to providing reliable, evidence-based information. Your safety and privacy are paramount to us.
Empowerment through Knowledge: We believe in the power of informed decisions. Access to the latest, scientifically-backed treatment insights can significantly impact recovery outcomes.
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Maraviroc for long COVID
MARAVIROC
What is maraviroc (Selzentry)?
Maraviroc is a medication used to treat human immunodeficiency virus (HIV) in both children and adults. It works by binding to a receptor on HIV, prohibiting it from entering the cells [1]. Maraviroc is not a stand-alone treatment and must be used in combination with other HIV medications.
How does the use of maraviroc relate to long-COVID?
For patients with long-COVID, treatment options are limited and undefined. Researchers have turned to existing medication therapies in hopes they prove useful. Maraviroc is one option that may be beneficial. In long-COVID, it is theorized that a person is not actively infected but is still shedding the virus in the body. By using maraviroc, the virus will be inhibited from entering the cells, leading to viral death and remission for the patient.
Few studies have determined whether Maraviroc shows benefits. The few that have been completed did show some promise. One study looked at 18 patients prescribed maraviroc and pravastatin, a medication used to lower cholesterol. These patients displayed clinical improvement in symptoms after 12 weeks of treatment. Unfortunately, before this study, these patients used other potential long-COVID treatments, thus confounding whether these results were due to maraviroc, pravastatin, or other therapies [2].
Maraviroc may be a potential option to treat long-term COVID; however, further research needs to be completed to examine its effects on the virus itself. At this time, two additional clinical studies aiming to examine the use of maraviroc in COVID-19 patients have been completed; however, results from these studies are not yet available [3].
References:
1http://www.antimicrobe.org/drugpopup/Maraviroc.htm
2https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9944830/
3https://clinicaltrials.gov/study/NCT04435522?term=COVID&cond=Maraviroc&city=&rank=1
Active Clinical Trials: Long COVID, maraviroc | Card Results | ClinicalTrials.gov
Propranolol for long COVID
PROPRANOLOL
What is propranolol?
Propranolol, a medication in the class called beta blockers, is used to treat heart conditions in patients. Beta-blockers work by acting on the beta receptors in the heart, blocking its action and resulting in a decrease in blood pressure.
How can propranolol be used for those with long-COVID?
Recent research has shown that this class of medications may be helpful for those suffering with symptoms of long-COVID. Patients diagnosed with long-COVID often experience symptoms such as lightheadedness, postural orthostatic tachycardia syndrome (POTS), chest pain, and a fast heartbeat. Cardiologists at Cedars-Sinai Hospital have found that treatment with beta-blockers, combined with a low salt intake and adequate hydration, can improve long-COVID symptoms [1].
There is also evidence to suggest that beta blockers have some anti-inflammatory effects. In addition to increasing the heartbeat, beta receptors are pro-inflammatory. They release certain signals that aid in activating the immune response. By blocking these signals, the immune system response decreases, leading to a decrease in clinical symptoms in patients [2]. Additional research is needed to fully understand the scope of propranolol and long-COVID; however, the positive evidence recently discovered provides hope that it may be useful for patients.
References:
2https://www.frontiersin.org/articles/10.3389/fimmu.2021.749291/full
IV Hydration for long COVID
IV HYDRATION/VITAMIN THERAPY
What are IV hydration and vitamin therapy?
Many products on the market are labeled IV hydration or vitamin therapy for long COVID and contain various combinations of intravenous vitamins, antioxidants, and amino acids such as vitamin C, vitamin B12, vitamin D, and glutathione. For hydration, they can also contain added electrolytes and fluids. IV infusions are directly absorbed into the bloodstream, whereas oral supplements must be absorbed from the gastrointestinal system before they can reach the bloodstream. Thus, IV infusions can be more effective in supplementation than oral vitamins.
How can IV hydration/vitamin therapy help alleviate certain long COVID symptoms?
An excess release of inflammatory mediators and oxidative stress are believed to be contributing factors in long COVID that lead to a hyperinflammatory state. This oxidative stress and inflammation can lead to the progression of fatigue and neuropsychiatric symptoms, as well as disruptions in blood flow.1 Vitamins such as vitamin C have antioxidant and anti-inflammatory properties that are believed to relieve some of these symptoms. During acute infections, the demand for vitamin C may be high due to an elevated inflammatory response and high metabolic demand; thus, COVID patients can show severe deficiencies in vitamin C. As a result, IV vitamin therapies may help with these deficiencies and reduce inflammation in the body.
What evidence supports the use of IV hydration/vitamin therapy for long COVID?
The use of IV hydration/vitamin therapy for long COVID is controversial. For commercial IV products and IV vitamin clinics marketed online, there have been no studies to demonstrate their effectiveness other than anecdotal patient stories.
The primary intravenous vitamin studied in clinical trials for fatigue is vitamin C. In a systematic review of 9 studies with 720 participants, 3 out of 4 controlled trials showed significantly decreased fatigue after IV vitamin C therapy. All except one of the observational studies also noted a decrease in fatigue scores. Other symptoms that were alleviated include sleep disturbances, difficulty concentrating, depression, and pain. However, these studies mainly focused on fatigue in cancer patients rather than long COVID patients.2
High-dose IV vitamin C has been studied for use in an acute COVID infection with mixed results. One clinical trial of 60 patients randomized to high-dose IV vitamin C or standard COVID antiviral therapy did not find significantly better outcomes in the group treated with IV vitamin C regarding the amount of oxygen saturation at discharge, length of ICU stay, or mortality.3 Another trial of 54 patients with COVID pneumonia randomized to IV vitamin C 2 grams every 6 hours for five days vs. standard treatment found a significant increase in oxygen saturation and a decrease in respiratory rate.4
Overall, there are proposed associations between IV vitamin therapy (specifically vitamin C) and improvement in fatigue. Still, more evidence from clinical trials needs to support its use in long-term COVID patients. In addition, patients with sufficient vitamin levels in their diet should not require additional supplementation.
What should you be aware of when using IV hydration/vitamin therapy?
Given that some IV hydration/vitamin therapies are offered in various settings, such as spas and salons that may not have medical providers administering the infusion, it is important to consult your doctor before considering one. Patients with congestive heart failure or end-stage renal disease must use caution when receiving IV fluids, as it can exacerbate their conditions. These IV therapies are also not regulated by the FDA. They could carry a risk of infection, damage to the injection site, irritation or inflammation of a vein, or air embolism from air entering the IV.5 In addition, these IV therapies can be fairly expensive.
References:
5) Talk with your provider before undergoing IV vitamin therapy. UCLA Health. November 19, 2018. Accessed November 5, 2023. https://www.uclahealth.org/news/talk-with-your-provider-before-undergoing-iv-vitamin-therapy
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