More Americans say they have serious cognitive problems — remembering, concentrating or making decisions — than at any time in the past 15 years, Census Bureau data show.
The increase began with the pandemic: the number of working-age adults reporting “severe difficulties” with thinking is estimated to have increased by one million people.
About the same number of adults ages 18 to 64 now report severe cognitive problems such as trouble walking or climbing stairs, for the first time since the office began asking questions each month in the 2000s.
And younger adults are driving the trend.
The sharp increase captures the effects of long Covid for a small but significant portion of younger adults, researchers say, likely in addition to other effects of the pandemic, including psychological distress. But they also say it is not yet possible to fully analyze all the reasons behind the increase.
Richard Deitz, economist at the Federal Reserve Bank of New York, analyzed the data and attributed much of the increase to long Covid. “These numbers don’t do that, they don’t suddenly start increasing like this,” he said.
In its monthly Current Population Survey, the census asks a sample of Americans whether they have serious problems with memory and concentration. defines them as disabled if they answer yes to that question or one of five others about limitations in their daily activities. The questions are not related to disability claims, so respondents have no financial incentive to answer one way or another.
At the beginning of 2020, the survey estimated that there were fewer than 15 million Americans between the ages of 18 and 64 with some type of disability. That increased to around 16.5 million in September 2023.
Nearly two-thirds of that increase was made up of people who had recently reported limitations in their thinking. There were also increases in census estimates of the number of adults with visual impairments or severe difficulties running basic errands. For older working-age Americans, the pandemic ended a years-long decline in reported disability rates.
The increase in cognitive problems aligns with a common symptom affecting many long-haul Covid travelers: “brain fog.”
Emmanuel Aguirre, a 30-year-old software engineer from the Bay Area, had Covid at the end of 2020. Within a month, he said, his life was transformed: “I felt like I was permanently hungover, drunk, high and in a brain. frozen at once.”
He stopped dating, playing video games, and reading novels, although he managed to keep his job, working remotely. Some of his physical symptoms eventually subsided, but the mental confusion has persisted, sometimes disappearing only to crush him days later.
Cognitive decline is a “hallmark sign of long Covid,” said Dr. Ziyad Al-Aly, chief of research and development at the St. Louis VA Healthcare System and a clinical epidemiologist at Washington University in St. Louis.
Studies estimate some 20 percent to 30 per cent of people who contract Covid have some cognitive impairment several months later, including people with symptoms ranging from mild to debilitating. Research has also shown clear biological changes of the virus related to cognition, including, in some patients with long Covid, lower serotonin levels.
“It’s not just fog, it’s basically a brain injury,” said Dr. Monica Verduzco-Gutiérrez, professor of rehabilitation medicine at the University of Texas Health Science Center in San Antonio. “There are neurovascular changes. There is inflammation. There are changes in the MRI scans”
It is unclear why changes in reported cognitive decline appear more common in younger adults. But older adults are more likely to have had some age-related cognitive decline before Covid, said Dr. James C. Jackson, a neuropsychologist at Vanderbilt Medical Center. Cognitive changes “stand out much more” in younger groups, he said.
And long Covid often presents differently in younger and older adults, said Dr. Gabriel de Erausquin, professor of neurology at UT Health San Antonio. In his research, he found that older adults with long-term Covid-related cognitive deficits have more memory-related problems. But younger adults are more likely to experience difficulties with attention and concentration and, in some cases, fatigue or pain so severe that it affects their thinking.
Heather Carr, 31, was selling farm machinery parts in Syracuse, New York, but two coronavirus infections left her bedridden and barely able to articulate a basic line of thought. She had trouble staying awake while she was driving and eventually had to leave her job.
“Now I cry when I try to think,” he said. “My brain short-circuits.”
The number of working-age Americans with disabilities who are unemployed or out of the labor force, like Carr, has remained virtually stable during the pandemic.
But the number of working-age Americans with disabilities who are employed has increased by about 1.5 million people, census data show.
The tight job market and the flexibility of remote work during the pandemic have made things easier for people who had disabilities before Covid. to get jobs. It is also likely that more workers suffered new disabilities, as defined by the census, and kept their jobs.
This could help explain what until now has been only a relatively subtle increase in Social Security disability claims.
Experts say long Covid is probably not the only factor driving the rise in disability.
The reported rate of cognitive disability for younger adults in census data had increased slowly over the years before the pandemic. Disability data experts suggest that, among many factors likely responsible for the increase, the increase ADHD and autism Diagnoses in children could have led more people to recognize and report their cognitive difficulties.
“The pandemic changed the world,” Dr. Jackson said. “I think the sum total of the mental health challenges people face affects cognitive function.”
Younger adults seemed to experience significantly more psychological distress than older adults, and poor mental health has been bound to cognitive problems. Gallup Polls found that depression rates for different age groups, which were relatively similar before the pandemic, spiked for adults under 45 during the pandemic, while remaining stable for older adults.
Kristen Carbone, a 34-year-old actress from New York, said her anxiety and depression increased when the pandemic hit and her memory began to fail. Her problems did not reach the “serious difficulty” the census posed, but they were worse than anything she had experienced before the pandemic, and she never tested positive for Covid, so she said it was unlikely that she was to blame. infection. In her second job as a waitress, she had to start writing down each customer’s orders, even the ones she usually filled out from memory.
“If I don’t fix it right away, it doesn’t exist,” he said.
Since then, his mental health has recovered, he says, but his memory and concentration have not.
The stressors of the pandemic could have worsened existing conditions like ADHD, said Dr. Margaret Sibley, a professor of psychiatry and behavioral sciences at the University of Washington.
“If that person is under pressure or extreme pressure, those symptoms could be temporarily exacerbated,” he said.
Because the census is based entirely on self-reporting, experts say the data could also be capturing a change in how people perceive their cognition, even without changes in their health.
People with disabilities could have taken note of increasing acceptance of disability and are more likely to answer census questions honestly, researchers say. Some young people may have been influenced by what disability researchers describe as increased awareness and acceptance of neurodiversity during the pandemic, such as videos about mental illness and developmental disorders. proliferated onlineoften encouraging people to self diagnose. There was also an increase in advertisements for ADHD medications, Dr. Sibley said.
“Everyone was saying, ‘I’m getting this message online,’” he said. “The subjective experience of the people who received them was that they could make anyone believe that they had ADHD”
But those changes in perception are likely to have relatively little influence on the numbers, said Monika Mitra, director of the Lurie Institute for Disability Policy at Brandeis University. Most of the increase probably reflects real changes in people’s health, she said.
“We need to take this very seriously as a society,” he said. “We need to understand who these people are, how they are affected and what we can do about it.”