Research: Long Covid changes brain structure

Express: Long Covid causes ‘distinct’ changes in brain structure’

An article in the Express by Fiona Callingham covers a study of 50 patients that showed fatigue with long Covid was linked to structural changes in the brain.

MEA comment from Dr Charles Shepherd

This appears to be a well conducted research study that has examined whether structural changes in parts of the brain could be involved in causing persisting fatigue in people with Long Covid. 

It is interesting to note that two key abnormalities being reported involve parts of the brain – the thalamus and basal ganglia – that have been implicated in causing fatigue in ME/CFS.

So it was surprising and disappointing to see that they did not also include a group of people with ME/CFS as well.

The MEA position remains that the cause of fatigue in ME/CFS is complex and almost certainly involves both central (brain) and peripheral (skeletal muscle/mitochondrial) dysfunction – as well as the possibility that it is maintained by low level immune system activation.

Finally, we do not believe that cognitive dysfunction in ME/CFS (or Long Covid) should be described as a neuropsychiatric symptom.

Dr Charles Shepherd,
Trustee and
Hon. Medical Adviser
to the ME Association.
Member of the 2018-2021 NICE Guideline Committee.
Member of the 2002 Independent Working Group on ME/CFS.

Dr Charles Shepherd


The long-term effects of Covid-19 are still yet to be fully understood. While many people recover from the infection within a few weeks, others can be left with debilitating symptoms for months and even years later. And now research has shown the disease could go as far as to alter the structure of your brain.

A new study, published in The Lancet (below), revealed that patients suffering from Long Covid fatigue also showed a reduction in the size of various parts of the brain via MRI scans.

Research: Structural brain changes in patients with post-COVID fatigue: a prospective observational study | 27 February 2023


Characteristic structural imaging changes of the thalamus and basal ganglia underlie the persistent fatigue experienced by patients with post-COVID syndrome. Evidence for pathological changes to these subcortical motor and cognitive hubs provides a key to the understanding of post-COVID fatigue and related neuropsychiatric complications.

“Our novel finding – that post-Covid fatigue is associated with structural brain damage – highlights the importance of consequent therapeutic management of this debilitating postinfectious syndrome.”

“Moreover, we show that post-Covid fatigue needs to be managed in a wider clinical array that also considers sleep quality, mood alterations, and cognitive impairment… 

“Future research will determine whether these fatigue symptoms are transient or persistent… The identification of distinct subcortical brain correlates provides a foundation for further research on the pathomechanisms of post-Covid fatigue.”

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