Your frontal lobes help make you who you are. As primates, we are blessed with a robust amount of brainpower, and as humans this accomplishment is due primarily to our prefrontal lobes. This structure, located directly behind the forehead and above the eyes, receives no direct input from the outside world but instead coordinates activity from other brain regions to creates a unified whole of comprehension and attention. It’s an exclusively internal affair.
The prefrontal cortex is where we make executive decisions. These functions include:
- Response Inhibition
- Emotional control
- Task initiation
- Organization
- Goal-directed persistence
- Metacognition (thinking about thinking)
- Working Memory
- Sustained attention
- Planning/prioritization
- Time management
- Flexibility (ability to revise)
- Shifting focus
For more detailed information on how disruption of the prefrontal cortex can affect a person, view this in-depth video.
A very famous case in the mid-1800s, that of Phineas Gage, made explicit what may happen to a person whose prefrontal cortex is damaged. Gage, a railroad foreman, was tamping a boulder for destruction with a metal rod when the explosion went awry and sent the rod through Gage’s skull. Amazingly, Gage survived; however, he was forever a changed man. No longer the reliable, punctual, responsible foreman that his coworkers had come to know, instead Gage grew vulgar, intemperate, impulsive, and brusque. He could not work for the railroad any longer due to his lack of ability to follow plans. Eventually, Gage became a transient, making his way onto the circus route.
Gage’s case has attained immortality in neuroscience circles, an object lesson of deficits in the prefrontal cortex. We now know how crucial this area is for what we consider on an everyday basis who we are, what it means to be us as individuals.
Covid-19 can affect the frontal lobes, resulting in what is clinically known as dysexecutive syndrome. The majority of cases are mild, with symptoms lying along a spectrum. Most people, if they are affected by Covid-19 dysexecutive syndrome, experience mental lethargy (also known as mental fatigue), confusion (which may include mild amnesia), and headache. Also common are loss of or alteration in sense of smell (anosmia/dysnosmia) and sense of taste (ageusia/dysgeusia).
A recent review (December 2021) of Covid-19 research found that, “Among nearly 38,000 patients hospitalized with COVID-19 in the United States and Europe, symptoms led doctors to suspect brain complications in about 11%. Magnetic resonance imaging (MRI) and computed tomography (CT) exams confirmed central nervous system abnormalities that were most likely associated with the virus in 10% of those patients, for an overall incidence of 1.2%.” Previous research had noted that up to 34% of those diagnosed with Long Covid qualified as having dysexecutive syndrome. These numbers do not include those who may have subclinical levels of cognitive disturbance.
When Covid-19 enters the body, it might reach the brain in several ways. It is hypothesized that the virus might gain entry via neuroinvasion through the nostrils, directly into the brain; also, it might travel into the central nervous system via the vagus nerve (in fact, data recently bolstered this view); or it might cause cytokine storm, bypassing a thereby weakened blood-brain barrier.
Other ways Covid-19 might affect the brain include thrombosis or coagulopathy (pathological blood clotting), which could lead to stroke; or hypoxia due to respiratory issues. But I wish to focus on the first three methods, because they do not necessarily lead to dire outcomes—as, say, a stroke might—but may involve neuroinflammation, which could cause dysexecutive syndrome and its attendant behavioral changes.
Neuroinflammation in Covid-19 would be generated in most cases by the immune system being overactivated. That is, the body recognizes that the body has foreign material and attempts to flush the invasion, but in the process of doing so the body generates excess cytokines, which can in turn activate microglia in the brain. Microglia remove dead neurons and other material left behind by the process of apoptosis (that is, cell death). In nearly all instances, once apoptosis has been signaled in a cell the process is irreversible. As excess cytokines increase in the cerebral spinal fluid, neuroinflammation occurs, as well as demyelinization of neurons (the erosion of the neuronal lipid envelope) and neurodegeneration.
The prefrontal lobes are comprised of several structures, including the orbitofrontal cortex, the ventromedial prefrontal cortex (vmPFC), dorsolateral prefrontal cortex (dlPFC), and rostal prefrontal cortex. I wish to narrow the focus here to the vmPFC, which is an important waystation as it provides many interconnections between other areas of the brain, notably the amygdalae and other portions of the limbic system.
The vmPFC is crucially involved in a person’s understanding of reward and risk, but above and beyond that it helps us process emotions via the interpretation of bodily (somatic) states. This last ability is one that we use when we observe other people and attempt to understand their behaviors and facial expressions: that is, we use our own body states to predict and interpret the actions and emotions of other people. This ability is known as Theory of Mind.
An academic paper, published in 2012, investigated the vmPFC among a population with lesions in this area. Compared to healthy controls, as well as to a similarly situated population with lesions in the dlPFC, the patients with ventromedial prefrontal damage had deficits that, when taken as a whole, were reminiscent of traits otherwise observed in a very different population: authoritarians.
What makes an authoritarian? Robert Altemeyer, a preeminent scholar in the field of authoritarianism, happens to write both academically and commercially, and what I mean by that is that he can craft highly technical prose for one audience and then translate those findings for a lay audience. Altemeyer lists these traits as comprising authoritarianism: “the desire to submit to some authority, aggression that is directed against whomever the authority says should be targeted and a desire to have everybody follow the norms and social conventions that the authority says should be followed.” He details this in The Authoritarians (2006), which can be read for free.
Altemeyer goes on to say that, for all intents and purposes, especially in the United States, the overlap between authoritarians and religious fundamentalists is nearly complete. In almost all circumstances, if you reference data about authoritarians, it can be transferred as being relevant for fundamentalists as well. The correspondence is not exactly 100% but the degree of correlation—above 70%—is quite high, especially when the discipline is social science (notably squishy, as science goes).
An increase in dysexecutive syndrome in the general population would thus indicate an increase in the susceptibility of those affected to experience behavioral changes analogous to those observed in authoritarians and fundamentalists. Damage to the vmPFC disrupts how the brain perceives Theory of Mind; this disruption creates rigidity (black/white thinking) that is a hallmark of both authoritarianism and fundamentalism. In addition, such damage can cause the brain to circumvent intentional thought processes altogether, as the information never reaches the prefrontal cortex; instead, the information is diverted to autonomic processes. Covid-19, in this view, can be seen as an environmental hazard that can so increase this susceptibility to authoritarianism in the normal population.
However, note also that we already have people who may lean authoritarian, just naturally (due to genetics, upbringing, environment, or combination of any or all of these). Dysexecutive syndrome caused by Covid-19, in these people, would probably tip them over firmly into the authoritarian camp. Ideology would not necessarily be adopted due to virus, but damage to the vmPFC has been shown to increase credulity, which could lead to accepting beliefs that one previously may have been inclined to reject. Also, behavioral deficits would be seen by others and experienced by them, which could lead to interpersonal disruptions, which could have its own downstream effects. Damage to the vmPFC has been known to cause strife between the sufferers of the damage and their loved ones. Loss of friendships and other community ties could cascade to isolation, interaction with extremists and their literature, and further involvement along the cycle of radicalization.
What is to be done? Several studies are underway to discover if there are direct ways of arresting or reversing some of the damage that Covid-19 might cause. For example, antihistimines might significantly attenuate symptoms of Long Covid. This is very promising. Of course, that type of intervention may not be for everyone (for example, some antihistimines can disproportionately negatively affect African-Americans in terms of encoding memories). Neuroplasticity might be the best hope many of us have, and one way we may influence our own neuroplasticity on a lay basis could be implementing the practices of mindfulness.
Mindfulness may evoke images of people sitting zazen and meditating, and indeed it could involve that, but in general mindfulness can occur in any setting. The easiest way to access a feeling of mindfulness is to concentrate on one’s immediate senses (sight, sound, smell, taste, touch; also balance/one’s location in space). Instead of letting one’s mind wander along an undirected stream of consciousness, mindfulness is a method of concentrating one’s attention to receiving and interpreting sense data. This strengthens intracortical connections, which can rejuvenate the brain and assist in wiring new connections between established mental networks.
Mindfulness exercises have been shown clinically to increase brain matter, specifically in the hippocampus. The hippocampus is the seat of memory consolidation. Daily mindfulness techniques can effectively grow grey matter. Would this specifically counter the damage caused by Covid-19 dysexecutive syndrome? That still needs to be studied, but the practice itself might be useful, as it would be a process initiated intentionally, which could itself disrupt the otherwise automatic mentation that develops as a result of such damage.