Impact of COVID-19 Confinement on the Brain

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There is an increasing amount of research appearing on the psychological and social impact of COVID-19 confinement. One recent report by the National Institutes of Health (NIH), Psychosocial impact of COVID-19 delves into some detail of these issues. There are many others like it. What may be of interest is how all this new research on confinement may suggest similarities with the experiences that new home-based businesses owners have been experiencing when they left an out-of-home job to work entirely in their own homes.

This is a very broad topic and there is a considerable amount of research available already, so it may be of some interest to consider one specific aspect of this: how COVID-19 confinement impacts not just a person’s psychology, but how it may actually be impacting the physiology of the brain.

The psychosomatic relationship

Last month’s article that I wrote, Posture & Pain looked at the physical impact on the body of sitting in front of a screen for prolonged periods of time, especially for children being made to home-school. The conclusion was that small business owners working from home on a computer can experience many of the same physical ailments.

The reason that physical ailments are of interest is that they require different treatments than psychological ones and that they could become physically debilitating. The question we are asking this month is whether there are physically apparent ailments resulting from the psychological impact of confinement.

As it turns out, there are.

Research on Solitary Confinement

Considerable research has been done on inmates, particularly those who have been placed in solitary confinement, sometimes for years. In the very moving article, Understanding the Effects of Solitary Confinement on the Brain Robert King, one of the well-known cases of the “Angola 3” describes how this confinement impacted him:

“My conversation skills are very limited,” he said. “I have some problems with my memory. And my navigational skills have suffered. Places that I know, even where I grew up, I have trouble getting around in, especially at night.”

It is really a heart-wrenching story, but the reality is that over 80,000 people are placed in solitary confinement at any given time. Depending on how long the confinement lasts, their mental capacity is similarly impacted. As such, there is ample evidence that their brains are physically impacted by this experience.

Further down in the article, they describe the effect on laboratory mice who are placed in solitary confinement. In looking at the brains of these mice, they discovered that after just one month of confinement, the neurons in their brains shrunk in size by 20%. After three months, they observed “shrinkage of the cell’s dendrites and axons,” which impacts how brain cells communicate.

There is also a psychosomatic link to stresses of the conditions of the confinement. In one study with rats, they discovered that when they are “under chronic stress as a result of social isolation, [they] possess a smaller hippocampus. This part of the brain is important for memory formation, spatial orientation, and mood regulation.”

There is also evidence that it adversely impacts their circadian rhythms, the body’s internal clock. This in turn “dramatically alters the activity of many genes in the brain… it thinks it’s night when it’s daytime — and those genes are out of sync with one another, affecting the function of eating, feeling, thinking, and interacting.”

The conclusion is quite clear: “the physical and molecular findings in animals are backed up in human behavioral studies,” according to Stephanie Cacioppo, behavioral neuroscientist at the University of Chicago. “In human beings, as social creatures, the stress of seclusion can lead to mood swings and depression, then to cognitive decline in spatial orientation, memory, and attention abilities, and finally, in some cases, to psychosis.”

What is also troubling about the research is that scientists do not know if the effects are reversible. According to the scientists in this article, there is yet not enough data to show that returning a former inmate to a non-confined environment will reverse the cognitive decline. This would prove to be especially disturbing if this is also the case with less severe forms of confinement, such as with COVID-19.

What the neural networks in the brain look like.
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What about milder forms of confinement?

The study of solitary confinement (as well as the impact on the brains of laboratory animals) present extreme cases of confinement. What is the current research about COVID-19 confinement? Will this confinement present milder changes, but equally identifiable ones? Perhaps more pertinently, what is the collective impact of confinement on a very large portion of the entire world’s population?

In the May 2020 NIH study cited above, they determined that “lockdowns can produce acute panic, anxiety, obsessive behaviors, hoarding, paranoia, and depression, and post-traumatic stress disorder (PTSD) in the long run.” Those can be broadly described as socio-psychological effects.

PTSD, in particular, is a recognized long-term effect of one or more traumatic events. It is also recognized as a condition that can physically alter the brain. The Psychology Today article, How PTSD and Trauma Affect Your Brain Functioning, describes that PTSD creates changes in the amygdala and the prefrontal cortex so that they remain in a higher state of tension. This causes lower control over anger and impulsive behaviors. It then also interferes “with the ability to regulate negative emotions and assign more positive meaning to events.” The article concludes that PTSD does alter the brain.

Returning to the NIH article, the authors point out that PTSD is of particular interest and that its symptoms “have been positively associated with the duration of quarantine.” While not everyone will have PTSD, it is definitely a risk.

The mental-physical link

There are also several studies that point out the relationship to illnesses from a sedentary lifestyle. As millions of people are confined to their homes these illnesses are growing exponentially as well. In the article How Social Isolation Affects the Brain, in the journal, The Scientist, epidemiologist Daisy Fancourt points out that: “We are seeing a really growing body of evidence… that is showing how isolation and loneliness are linked in with incidence of different types of disease [and] with premature mortality.” She goes on to say that in addition to obesity and cardiovascular problems, social isolation is linked to cognitive decline and dementia.

While the article also discusses the effects of severe isolation such as with prisoners, it also points out that there are less severe forms of isolation that are less well understood but that have a cumulative effect over time that may be severe.

For example, the elderly and the disabled are subjected to sometimes partial social isolation, but it is the fact that the isolation is long term, sometimes even decades long that leads to cognitive decline, measured by reduced verbal fluency and memory recall.

They also point out from a study of 11,000 subjects that there may be a reciprocal effect as well. The deteriorating brain function also leads to less desire to socialize. This in effect exacerbates the cognitive decline.

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Other environmental factors

It is also true that the external environment is likely to play a role. One study focused on an arctic exploration team that was also subjected to temperatures below -50 degrees Celsius as well as drastic changes in light exposure. This also affected their circadian rhythms, which can also influence outcomes as we saw above.

The subjects “showed anatomical changes to the dentate gyrus, a region of the brain that feeds information into the hippocampus and is associated with learning and memory; the crew members’ dentate gyruses had shrunk by an average of around 7 percent.

The crew members also had reduced blood levels of brain-derived neurotrophic factor (BDNF), a protein involved in stress regulation and memory, and they performed worse on tests of spatial awareness and attention than they had before they left.”

While this is another extreme case, there are some similarities with work-at-home environments that should be pointed out. For example, working in an office outside the home ensures regulated temperatures and schedules, but working from home those environmental factors could be quite different. Likewise, lighting is also less uniformly regulated in a home.

Obviously, those are much less severe environmental factors, but as has been pointed out, it is not just the severity of the factors that impacts the brain, it is also how long those factors were in effect. For business owners making a permanent change in the middle of life to a work-at-home career, there could be many years maybe even decades of impact.

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In a separate study of MRI scans done at UCLA, it was also found that these subjects tended to have smaller gray matter volumes in the hippocampus and amygdala sections of the brain. While the scientists point out that this is not conclusive evidence that isolation causes shrinkage of these portions of the brain, it does suggest some correlation that should be studied further.

The article also mentioned several mice and rat studies not unlike the ones mentioned above. Those experiments corelate the effects with naturally occurring signaling proteins in the brain such as Rac1 and Tac2, which are also linked to memory problems such as Alzheimer’s and other degenerative cognitive conditions. They do point out, however that more research will be needed to arrive at more concrete conclusions.

Also interesting is that there does appear to be a concrete relationship between isolation and inflammation signaling molecules known as interleukin-6. They concluded that “Both isolation and loneliness were linked to inflammation” which can have negative effects on cognitive function as well as other processes throughout the body.

The research is also looking for remedies to these instances for cognitive decline. While the article mentions several pharmacological treatments, there is also an effort to physically boost engagement with inflicted individuals from frequent visits to social outings and online interaction.

It is important to point out however, that those are remedies against further decline. There is yet not enough conclusive evidence that cognitive decline from isolation or confinement is reversible. This is a critical point that the researchers in these articles are quite clear about.

Conclusion

The bottom line is that there is still considerably more research needed to discover the long-term effects of COVID-19 confinement and work-from-home isolation. That said, there is value in looking at extreme confinement such as seen in prisons, research done on lab animals, and the more comprehensive and longitudinal studies of selected groups. The current research in those cases shows that there is measurable cognitive decline that results from confinement, especially when combined with additional external environmental factors such as temperature and light.

The bigger question we cannot yet answer is whether the observed cognitive decline from those studies will also be measurable when confinement it is imposed on a large percentage of the population because of a world-wide pandemic. Yet even in that case, we do know from the research that cognitive decline is directly related to the length of the confinement. More importantly, the cognitive decline then further exacerbates the isolation.

To put it simply, the longer we are confined, the more dramatic the cognitive decline may be. What impact this will have when we also consider the large number of people impacted today, that is still a mystery.

Of course, this pandemic cannot last indefinitely – it will eventually subside. For those who are confined to work from home, there is ample research being done as well as treatments being developed to address those issues. This article is not meant as a source of actionable medical information, but I do hope it is a starting point for a broader discussion about the impact of prolonged isolation on the brain.