Cognitive problems are on the rise

Every month, the Census Bureau conducts a Current Population Survey. In the survey, the census asks a sample of Americans whether they are experiencing serious problems with their memory and concentration. Individuals are defined as disabled if they answer yes to that question or one of five others on limitations to their daily activities.

At the start of 2020, there were fewer than 15 million Americans ages 18 to 64 who reported any kind of disability. However, this number has since increased to roughly 16.5 million as of September 2023.

According to Paris, almost two-thirds of this increase was due to people with newly reported cognitive limitations. Since the pandemic, the number of working age adults who reported "serious difficulty" with their thinking has increased by around 1 million people.

Younger adults between the ages of 18 and 44 are largely behind this rise. Before the pandemic, less than 3% of adults in this age group said they had serious difficulty remembering, concentrating, or making decisions, but it has since increased to almost 4%.

"We need to take this [increase] very seriously as a society," said Monika Mitra, director of the Lurie Institute for Disability Policy at Brandeis University. "We need to understand who these people are, how they're being impacted and what we can do about it."

What could be the cause?

One potential explanation for the increase in people reporting more cognitive difficulties is long COVID. During the pandemic, many people who got sick with COVID-19 often reported lingering "brain fog" even if they had recovered from their physical symptoms.

According to Ziyad Al-Aly, chief of research and development at the V.A. St. Louis Health Care System and a clinical epidemiologist at Washington University in St. Louis, cognitive impairment is a "hallmark of long Covid."

Currently, studies estimate that around 20% to 30% of people who get COVID-19 experience some cognitive impairment several months later. These symptoms can range from mild to debilitating. Research has also found clear biological changes from the virus that have affected people's cognition, including lower levels of serotonin in some cases.

"It's not just fog, it's a brain injury, basically," said Monica Verduzco-Gutierrez, chair of rehabilitation medicine at the University of Texas Health Science Center at San Antonio. "There are neurovascular changes. There's inflammation. There are changes on M.R.I.s."

However, health experts say long COVID is likely not the only factor driving the increase in cognitive problems among Americans.

Among younger adults, the reported rate of cognitive disability has slowly increased for years, even before the pandemic, and experts say that growing ADHD and autism diagnoses in children could have led more people to recognize and report their symptoms.

The pandemic also significantly impacted people's mental health, with many spending more time alone than before. There were also higher reported rates of depression and more prescriptions for psychiatric medications. In addition, polling from Gallup found that depression rates among adults under 45 significantly increased during the pandemic, although they remained stable among older adults.

Margaret Sibley, a professor of psychiatry and behavioral sciences at the University of Washington, noted that stressors during the pandemic could have also worsened existing mental health conditions, such as ADHD.

"If that person's under extreme duress or strain, those symptoms might be temporarily exacerbated," Sibley said.

Overall, "[t]he pandemic changed the world," said James Jackson, a neuropsychologist at Vanderbilt Medical Center. "I do think the sum total of the mental health challenges people are having impacts cognitive function." (Paris, New York Times, 11/13)

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