Cognitive dysfunction in post‐COVID‐19 condition: Mechanisms, management, and rehabilitation

Abstract

The long‐term effects of COVID‐19 on cognitive function have become an area of increasing concern. This paper provides an overview of characteristics, risk factors, possible mechanisms, and management strategies for cognitive dysfunction in post‐COVID‐19 condition (PCC).Prolonged cognitive dysfunction is one of the most common impairments in PCC, affecting between 17% and 28% of the individuals more than 12 weeks after the infection and persisting in some cases for several years. Cognitive dysfunctions can be manifested as a wide range of symptoms including memory impairment, attention deficit, executive dysfunction, and reduced processing speed. Risk factors for developing PCC, with or without cognitive impairments, include advanced age, preexisting medical conditions, and the severity of acute illness. The underlying mechanisms remain unclear, but proposed contributors include neuroinflammation, hypoxia, vascular damage, and latent virus reactivation not excluding the possibility of direct viral invasion of the central nervous system, illustrating complex viral pathology.As the individual variation of the cognitive impairments is large, a neuropsychological examination and a person‐centered multidimensional approach are required. According to the World Health Organization, limited evidence on COVID‐19‐related cognitive impairments necessitates implementing rehabilitation interventions from established practices of similar conditions. Psychoeducation and compensatory skills training are recommended. Assistive products and environmental modifications adapted to individual needs might be helpful. In specific attention‐ and working memory dysfunctions, cognitive training—carefully monitored for intensity—might be effective for people who do not suffer from post‐exertional malaise. Further research is crucial for evidence‐based interventions specific to COVID‐19‐related cognitive impairments.

Cognitive Impairment in the Post-Acute Phases of COVID-19 and Mechanisms: An Introduction and Narrative Review

“…Long-term cognitive dysfunction is one of the most common impairments of Long COVID, affecting 17% to 28% of people [ 13 ]. A previous meta-analysis reported that 38.3% of individuals who recovered from COVID-19 self-reported cognitive deficits [ 11 ].…”

Possible Role of Cannabis in the Management of Neuroinflammation in Patients with Post-COVID Condition

“…Among the PCC symptoms, prolonged cognitive dysfunction is one of the most common impairments affecting between 17 and 28% of the individuals, and in some cases, persisting for several years. Cognitive dysfunction, commonly observed in these patients, often includes memory impairment, attention deficit, and executive dysfunction where research has revealed a significant reduction in gray matter volume, impaired hippocampal neurogenesis, a decrease in oligodendrocytes and myelin loss causing a reduction in global brain size [39][40][41]. Chronic fatigue syndrome also recurs in patients with PCC and is characterized by immunological, neurological, and gastrointestinal alterations similar to Epstein-Barr virus (EBV)-acquired immunodeficiency in myalgic encephalomyelitis, suggesting the possibility that this virus is related to PCC [42][43][44][45].…”

Assessment and Characterization of Covid-19 Related Cognitive Decline: Results From a Natural Experiment

“…[21] Viral infections can indirectly impact episodic memory by reducing the attention and processing speed necessary for encoding. [23] Cognitive exams were done during annual monitoring visits; therefore, the timing of the test administration differed for each participant. Participants included in this analysis had ≥2 assessments during the study period, with ≥1 before and ≥1 after the onset of COVID-19 symptoms.…”