“These findings indicate subtle but persistent BBB disruption in LC individuals over two years post-infection, with a potential link to motor dysfunction.”
Leah H. Rubin et al., Science Direct
Summary from Science Direct
- Blood-brain barrier (BBB) disruption may underlie neuropsychiatric symptoms in Long COVID (LC).
- Non-contrast MRI technique reveals higher BBB permeability in LC vs. recovered controls.
- Higher BBB permeability was significantly associated with poorer motor function, but not other cognitive domains.
- Findings indicate persistent BBB disruptions two + years post-infection in LC.
- BBB integrity may be a biomarker of motor dysfunction in LC.
On July 28th 2025, Science Direct published the following paper, “Blood-Brain barrier disruption in long COVID and cognitive correlates: A cross-sectional MRI study.” Dr Charles Shepherd, MEA Hon. Medical Adviser provides comment below.
Extracts
Using a non-contrast magnetic resonance imaging (MRI) technique, we investigated BBB permeability in individuals with LC and its relationship to cognitive function. We hypothesized that LC individuals would show greater BBB permeability than recovered individuals, and that higher permeability would correlate with poorer cognition.
Ninety-seven participants meeting the 2024 NASEM definition of LC with at least one neuropsychiatric symptom and 31 recovered controls completed an MRI scan and cognitive testing. BBB permeability was assessed using water-extraction-with-phase-contrast-arterial-spin-tagging (WEPCAST) MRI, which estimates the permeability-surface-area product (PS) of arterially labeled water entering the brain.
PS was significantly elevated in the LC group after adjusting for age and sex (B = 18.59, SE = 6.11, β = 0.28, P = 0.003). No significant group differences were found in cerebral blood flow, extraction fraction (E), or brain volume. Within the LC group, higher PS was associated with poorer motor function, but not with other cognitive domains.
These findings indicate subtle but persistent BBB disruption in LC individuals over two years post-infection, with a potential link to motor dysfunction. This supports prior evidence of BBB changes following severe COVID-19 and suggests that BBB integrity may be a long-term biomarker of neuropsychiatric complications in LC.
MEA Comment
Some interesting research findings here relating the the blood brain barrier (BBB) – which in very simple terms is the cellular barrier that prevents infections and other harmful things in the blood entering the brain and nervous system
Disruption of the blood brain barrier following a viral infection may also be relevant to ME/CFS and many years ago the MEA funded Professor Mina Behan in Glasgow to carry out some BBB research.
Dr Charles Shepherd,
Trustee and Hon. Medical Adviser to the ME Association,
Member of the 2018-2021 NICE guideline on ME/CFS committee,
Member of the 2002 Chief Medical Officer's Working Group on ME/CFS
