OpenHealth Q&A

39-Year-Old Woman Experiencing Dramatic Cognitive Decline and New Autonomic Issues Following COVID-19 and Mononucleosis - Seeking Guidance

**Demographic Information:** - **Age:** 39 - **Gender:** Female (Assigned at Birth) - **Ethnicity:** Caucasian - **Height:** 5'2" (157 cm) - **Weight:** 225 lbs (102 kg) - **Location:** United States (as of 2025) **Medical Background:** - History of multiple pregnancies with several miscarriages - Diagnosed with Post-Traumatic Stress Disorder (PTSD) - Suffering from Obsessive Compulsive Disorder (OCD) - Living with Major Depressive Disorder (MDD) - Diagnosed with Generalized Anxiety Disorder (GAD) - Experiencing Panic Disorder - Migraines with aura (since 2000) - IQ of 140 before current issues arose - Asperger's syndrome (now classified as Autism Spectrum Disorder Level 1) - Sleep Apnea (managed with CPAP) **Current Medications:** - Tylenol (as needed) - Ibuprofen (as needed) - Prozac - Propranolol - Vitamin D - Cannabis to assist with sleep and OCD symptoms - Remeron - Prazosin - CPAP device for sleep apnea management **Main Concern & Onset of Symptoms:** In September 2022, shortly after being diagnosed with both COVID-19 and Mononucleosis, I began to experience an alarming decline in my working memory and cognitive abilities. This deterioration has had a significant effect on my daily life, hindering my capability to work, drive, and manage everyday tasks safely. **Symptoms Overview:** **Cognitive Issues:** - **Working Memory Decline:** Previously capable of mental math involving polynomial equations, I now struggle with basic addition. - **Executive Functioning Challenges:** - **Driving:** My ability to drive has diminished as I can't accurately assess the positions of other vehicles. - **Cooking:** Preparing food with heat poses a danger because I forget whether or not the heat is on. - **Daily Life Impact:** These cognitive challenges have led to job loss, and I am unsure of what employment options remain viable for me. - **Emotional Difficulties:** My previously managed mental health issues have become increasingly unmanageable, with emotional control much harder to achieve. I find myself reacting more intensely to stimuli and experiencing spontaneous bouts of crying. I often relied on my cognitive skills to cope with these matters effectively, which has now changed. **New Physical Symptoms:** - Severe tingling and numbness - Heart palpitations - Swelling in limbs - Daily near-fainting spells that frequently lead to actual fainting if I don’t maintain hydration and proper electrolytes **Timeline of Events:** - **September 2022:** Testing positive for both Mononucleosis and COVID-19 marked the beginning of my cognitive struggles. - **Post-September 2022:** Ongoing issues with Mono/EBV since the initial diagnosis. **Medical Consultations & Findings Thus Far:** - My Primary Care Physician is quite worried and has ordered necessary evaluations. **Cardiac Assessment:** - ECG: Results normal - Holter Monitor: Results normal - Tilt Table Test: Scheduled - Echocardiogram: Scheduled **Brain Assessments:** - MRI of the brain: No abnormalities found - CT Scan of head and neck: No abnormalities found **Cognitive Evaluations:** - Neuropsychological assessments revealed notable deficiencies in working memory and broadly low cognitive performance. - The evaluation indicated that while I am capable of memory encoding, I struggle significantly with memory retrieval. - Stressful events in 2022 and 2024 may have intensified my condition, including episodes of "autistic burnout," where I found it difficult to communicate for several days. - The focus from the neuropsychologist was largely on "long COVID," suggesting that I pursue therapy for my PTSD and OCD as a means to regain functionality. - I am concerned as I have coped with my mental health challenges throughout my life, and this new cognitive impairment hinders that ability. **Additional Testing Scheduled:** - Assessments for Autism and ADHD are planned to better understand my baseline and current state. **Seeking Advice from r/AskDocs:** Given the intense nature of my cognitive decline, particularly affecting my working memory, along with recent changes in autonomic functionality, I would appreciate guidance on potential next steps or alternative diagnoses to consider. Are there specific specialists I should consult (such as neurologists or immunologists) or additional tests that should be conducted to gain insight into the cause of this drastic change in my cognitive abilities and emerging physical symptoms? I am struggling to cope and am eager to find a way to regain my ability to work productively again.

Answers (1)

6/22/2025, 10:20:49 PM

OpenHealth AI

I'm truly sorry to hear about the challenging symptoms you're experiencing following your diagnoses of COVID-19 and mononucleosis. Your cognitive decline and autonomic issues are understandably distressing, and it’s great that you’re actively seeking clarity and support.

Main Points:

• You’re experiencing significant cognitive decline and physical symptoms after COVID-19 and mononucleosis.
• Ongoing evaluations are necessary to understand your condition better.
• There are specific steps and potential specialists that may help you.

Explanation:

The combination of cognitive issues, emotional distress, and physical symptoms you describe could be related to several factors, including long COVID, the effects of mononucleosis (often caused by the Epstein-Barr virus), or the exacerbation of your existing mental health conditions. Given your history and symptoms, it's crucial to approach this comprehensively.

While the evaluations you've undergone so far are important, there are additional avenues you could explore to gain deeper insights into your condition.

Next Steps:

1. Continue Evaluations:

   • Tilt Table Test and Echocardiogram: Stay updated and share all symptoms with your doctors before these tests.
   • Keep a Symptom Diary: Document daily fluctuations in cognitive function, emotional state, and physical symptoms (e.g., heart palpitations, near-fainting spells). This could help identify patterns or triggers.

2. Consult Specialists:

   • Neurologist: Given the severe cognitive decline, a neurologist can provide additional testing for neurological causes and might offer treatments to support cognitive function.
   • Immunologist: It may help to evaluate for autoimmune responses or persistent viral load, especially given Epstein-Barr virus's potential link to diverse symptoms.
   • Psychiatrist: Given your complex mental health history, a psychiatrist experienced in trauma and PTSD can help develop a management plan that also considers your cognitive struggles.

3. Therapeutic Support:

   • Cognitive Behavioral Therapy (CBT): This can specifically address coping mechanisms for cognitive and emotional symptoms.
   • Occupational Therapy: A professional can help you adapt daily activities and assist with cognitive rehabilitation strategies.

4. Self-Care Practices:

   • Hydrate and Eat Well: Focus on a balanced diet rich in whole foods, vitamins, and minerals to support your overall health. Maintaining hydration is crucial given your near-fainting spells.
   • Mindfulness and Stress Management: Techniques such as mindfulness meditation or gentle yoga can help improve anxiety and emotional regulation.

5. Lifestyle Adjustments:

   • Set a routine that breaks tasks into smaller, manageable steps. This can help with executive function challenges; for example, using timers when cooking to help you remember when to check on cooking items.
   • Use reminders, sticky notes, or apps to assist with memory retrieval for daily tasks.

Lastly, please remember that regaining cognitive function can take time, especially after viral infections like COVID-19 or mononucleosis. Progress may be gradual, so it's important to remain patient and persistent in seeking the answers and help you need. If you have questions or need support during this process, reach out. You're not alone in this journey.