POST-COVID-19 COGNITIVE IMPAIRMENT AS A NEUROPSYCHIATRIC SYNDROME: A REVIEW OF MECHANISMS, CLINICAL FEATURES, AND IMPACT ON QUALITY OF LIFE

Authors

DOI:

https://doi.org/10.31435/ijitss.4(48).2025.4538

Keywords:

Long COVID, Cognitive Impairment, Brain Fog, Neuropsychiatric Symptoms, Post-Acute Sequelae of SARS-CoV-2, Quality of Life

Abstract

Introduction: Post-COVID-19 Condition (PCC), commonly referred to as long COVID, has become a major post-pandemic health issue, with many individuals experiencing persistent cognitive and neuropsychiatric symptoms. These difficulties, often described as “brain fog”, include problems with memory, executive functioning and processing speed, and can markedly disrupt daily life, emotional well-being and work capacity.

Methods: A narrative review was performed using PubMed and Google Scholar. Keywords included “post-COVID cognitive impairment”, “long COVID”, “neurocognitive dysfunction”, and related terms. Original studies, cohort research, systematic reviews and meta-analyses were screened for relevance. Documents from WHO, NICE were also reviewed to supplement diagnostic definitions.

Results: Current studies consistently indicate that cognitive impairment represents one of the most common manifestations of long COVID, with estimates ranging from 20% to 30%. Difficulties with executive function, memory, sustained attention and information-processing speed form the core pattern of impairment and exert a meaningful impact on daily independence and well-being. Neuroimaging findings support these complaints, showing corresponding metabolic, structural and microvascular changes. Proposed mechanisms most often involve sustained neuroinflammation, immune imbalance, endothelial injury and microvascular dysfunction.

Conclusions: Post-COVID cognitive impairment remains a significant clinical challenge, affecting daily functioning and long-term recovery for many patients. Clearer diagnostic criteria and improved assessment tools integrating neuropsychological testing, imaging and biomarker data are needed to enhance recognition and to identify those at higher risk. Ongoing research into therapeutic strategies remains essential for optimising long-term management and outcomes in affected patients.

References

Aiyegbusi, O. L., Hughes, S. E., Turner, G., Rivera, S. C., McMullan, C., Chandan, J. S., Haroon, S., Price, G., Davies, E. H., Nirantharakumar, K., Sapey, E., Calvert, M. J., & on behalf of the TLC Study Group. (2021). Symptoms, complications and management of long COVID: A review. Journal of the Royal Society of Medicine, 114(9), 428–442. https://doi.org/10.1177/01410768211032850

World Health Organization. (2021, October 6). A clinical case definition of post COVID-19 condition by a Delphi consensus. https://www.who.int/publications/i/item/WHO-2019-nCoV-Post_COVID-19_condition-Clinical_case_definition-2021.1

Ejalonibu, H., Amah, A., Aburub, A., Kumar, P., Frederick, D. E., & Groot, G. (2024). A review of Patient Reported Outcome Measures (PROMs) for characterizing Long COVID (LC)—Merits, gaps, and recommendations. Journal of Patient-Reported Outcomes, 8(1), 101. https://doi.org/10.1186/s41687-024-00773-1

NICE. (2020, December 18). COVID-19 Rapid Guideline: Managing the Long-Term Effects of COVID-19. NICE Guideline: NG188; NICE. https://www.nice.org.uk/guidance/ng188

Thaweethai, T., Jolley, S. E., Karlson, E. W., Levitan, E. B., Levy, B., McComsey, G. A., McCorkell, L., Nadkarni, G. N., Parthasarathy, S., Singh, U., Walker, T. A., Selvaggi, C. A., Shinnick, D. J., Schulte, C. C. M., Atchley-Challenner, R., Horwitz, L. I., Foulkes, A. S., RECOVER Consortium Authors, RECOVER Consortium, … Zisis, S. (2023). Development of a Definition of Postacute Sequelae of SARS-CoV-2 Infection. JAMA, 329(22), 1934. https://doi.org/10.1001/jama.2023.8823

Cáceres, E., Divani, A. A., Viñan-Garces, A. E., Olivella-Gomez, J., Quintero-Altare, A., Pérez, S., Reyes, L. F., Sasso, N., & Biller, J. (2025). Tackling persistent neurological symptoms in patients following acute COVID-19 infection: An update of the literature. Expert Review of Neurotherapeutics, 25(1), 67–83. https://doi.org/10.1080/14737175.2024.2440543

Premraj, L., Kannapadi, N. V., Briggs, J., Seal, S. M., Battaglini, D., Fanning, J., Suen, J., Robba, C., Fraser, J., & Cho, S.-M. (2022). Mid and long-term neurological and neuropsychiatric manifestations of post-COVID-19 syndrome: A meta-analysis. Journal of the Neurological Sciences, 434, 120162. https://doi.org/10.1016/j.jns.2022.120162

Kim, Y., Bitna-Ha, Kim, S.-W., Chang, H.-H., Kwon, K. T., Bae, S., & Hwang, S. (2022). Post-acute COVID-19 syndrome in patients after 12 months from COVID-19 infection in Korea. BMC Infectious Diseases, 22, 93. https://doi.org/10.1186/s12879-022-07062-6

Ceban, F., Ling, S., Lui, L. M. W., Lee, Y., Gill, H., Teopiz, K. M., Rodrigues, N. B., Subramaniapillai, M., Di Vincenzo, J. D., Cao, B., Lin, K., Mansur, R. B., Ho, R. C., Rosenblat, J. D., Miskowiak, K. W., Vinberg, M., Maletic, V., & McIntyre, R. S. (2022). Fatigue and cognitive impairment in Post-COVID-19 Syndrome: A systematic review and meta-analysis. Brain, Behavior, and Immunity, 101, 93–135. https://doi.org/10.1016/j.bbi.2021.12.020

Elboraay, T., Ebada, M. A., Elsayed, M., Aboeldahab, H. A., Salamah, H. M., Rageh, O., Elmallahy, M., AboElfarh, H. E., Mansour, L. S., Nabil, Y., Eltawab, A. K. A., Atwan, H., & Alkanj, S. (2025). Long-term neurological and cognitive impact of COVID-19: A systematic review and meta-analysis in over 4 million patients. BMC Neurology, 25(1), 250. https://doi.org/10.1186/s12883-025-04174-9

Ferrucci, R., Dini, M., Groppo, E., Rosci, C., Reitano, M. R., Bai, F., Poletti, B., Brugnera, A., Silani, V., D’Arminio Monforte, A., & Priori, A. (2021). Long-Lasting Cognitive Abnormalities after COVID-19. Brain Sciences, 11(2), 235. https://doi.org/10.3390/brainsci11020235

Taquet, M., Sillett, R., Zhu, L., Mendel, J., Camplisson, I., Dercon, Q., & Harrison, P. J. (2022). Neurological and psychiatric risk trajectories after SARS-CoV-2 infection: An analysis of 2-year retrospective cohort studies including 1 284 437 patients. The Lancet Psychiatry, 9(10), 815–827. https://doi.org/10.1016/S2215-0366(22)00260-7

Zeng, N., Zhao, Y.-M., Yan, W., Li, C., Lu, Q.-D., Liu, L., Ni, S.-Y., Mei, H., Yuan, K., Shi, L., Li, P., Fan, T.-T., Yuan, J.-L., Vitiello, M. V., Kosten, T., Kondratiuk, A. L., Sun, H.-Q., Tang, X.-D., Liu, M.-Y., … Lu, L. (2023). A systematic review and meta-analysis of long term physical and mental sequelae of COVID-19 pandemic: Call for research priority and action. Molecular Psychiatry, 28(1), 423–433. https://doi.org/10.1038/s41380-022-01614-7

Gorenshtein, A., Leibovitch, L., Liba, T., Stern, S., & Stern, Y. (2024). Gender Disparities in Neurological Symptoms of Long COVID: A Systematic Review and Meta-Analysis. Neuroepidemiology, 59(4), 426–440. https://doi.org/10.1159/000540919

Van Der Knaap, N., Klinkhammer, S., Postma, A. A., Visser-Meily, J. M. A., Horn, J., Van Heugten, C. M., Voorter, P. H. M., Van Der Thiel, M. M., Drenthen, G. S., Backes, W. H., Van Rosmalen, F., Van Santen, S., Van Bussel, B. C. T., Van Der Horst, I. C. C., Linden, D. E. J., Ariës, M. J. H., & Jansen, J. F. A. (2025). Post-COVID microvascular dysfunction in hospitalized COVID-19 survivors is associated with acute disease severity and persistent cognitive complaints. Journal of the Neurological Sciences, 472, 123464. https://doi.org/10.1016/j.jns.2025.123464

Ariza, M., Béjar, J., Barrué, C., Cano, N., Segura, B., Cortés, C. U., Junqué, C., & Garolera, M. (2025). Cognitive reserve, depressive symptoms, obesity, and change in employment status predict mental processing speed and executive function after COVID-19. European Archives of Psychiatry and Clinical Neuroscience, 275(4), 973–989. https://doi.org/10.1007/s00406-023-01748-x

Ahmad, S. J., Feigen, C. M., Vazquez, J. P., Kobets, A. J., & Altschul, D. J. (2022). Neurological Sequelae of COVID-19. Journal of Integrative Neuroscience, 21(3), 77. https://doi.org/10.31083/j.jin2103077

Marjenberg, Z., Leng, S., Tascini, C., Garg, M., Misso, K., El Guerche Seblain, C., & Shaikh, N. (2023). Risk of long COVID main symptoms after SARS-CoV-2 infection: A systematic review and meta-analysis. Scientific Reports, 13(1), 15332. https://doi.org/10.1038/s41598-023-42321-9

Panagea, E., Messinis, L., Petri, M. C., Liampas, I., Anyfantis, E., Nasios, G., Patrikelis, P., & Kosmidis, M. (2025). Neurocognitive Impairment in Long COVID: A Systematic Review. Archives of Clinical Neuropsychology, 40(1), 125–149. https://doi.org/10.1093/arclin/acae042

Graham, E. L., Clark, J. R., Orban, Z. S., Lim, P. H., Szymanski, A. L., Taylor, C., DiBiase, R. M., Jia, D. T., Balabanov, R., Ho, S. U., Batra, A., Liotta, E. M., & Koralnik, I. J. (2021). Persistent neurologic symptoms and cognitive dysfunction in non-hospitalized Covid-19 “long haulers.” Annals of Clinical and Translational Neurology, 8(5), 1073–1085. https://doi.org/10.1002/acn3.51350

Rofail, D., Somersan-Karakaya, S., Choi, J. Y., Przydzial, K., Zhao, Y., Hussein, M., Norton, T. D., Podolanczuk, A. J., Mylonakis, E., & Geba, G. P. (2024). Thematic analysis to explore patients’ experiences with long COVID-19: A conceptual model of symptoms and impacts on daily lives. BMJ Open, 14(1), e076992. https://doi.org/10.1136/bmjopen-2023-076992

Zawilska, J. B., & Kuczyńska, K. (2022). Psychiatric and neurological complications of long COVID. Journal of Psychiatric Research, 156, 349–360. https://doi.org/10.1016/j.jpsychires.2022.10.045

Leng, A., Shah, M., Ahmad, S. A., Premraj, L., Wildi, K., Li Bassi, G., Pardo, C. A., Choi, A., & Cho, S.-M. (2023). Pathogenesis Underlying Neurological Manifestations of Long COVID Syndrome and Potential Therapeutics. Cells, 12(5), 816. https://doi.org/10.3390/cells12050816

Slama Schwok, A., & Henri, J. (2024). Long Neuro-COVID-19: Current Mechanistic Views and Therapeutic Perspectives. Biomolecules, 14(9), 1081. https://doi.org/10.3390/biom14091081

Guedj, E., Campion, J. Y., Dudouet, P., Kaphan, E., Bregeon, F., Tissot-Dupont, H., Guis, S., Barthelemy, F., Habert, P., Ceccaldi, M., Million, M., Raoult, D., Cammilleri, S., & Eldin, C. (2021). 18F-FDG brain PET hypometabolism in patients with long COVID. European Journal of Nuclear Medicine and Molecular Imaging, 48(9), 2823–2833. https://doi.org/10.1007/s00259-021-05215-4

Dadsena, R., Walders, J., Costa, A. S., Wetz, S., Romanzetti, S., Lischewski, S. A., Krockauer, C., Heine, J., Schlenker, L., Klabunn, P., Schwichtenberg, K., Hartung, T. J., Franke, C., Balloff, C., Binkofski, F., Schulz, J. B., Finke, C., & Reetz, K. (2025). Two‐year impact of COVID‐19: Longitudinal MRI brain changes and neuropsychiatric trajectories. Psychiatry and Clinical Neurosciences, 79(4), 176–186. https://doi.org/10.1111/pcn.13789

Cordani, C., Young, V. M., Arienti, C., Lazzarini, S. G., Del Furia, M. J., Negrini, S., & Kiekens, C. (2023). Cognitive impairment, anxiety and depression: A map of Cochrane evidence relevant to rehabilitation for people with post COVID-19 condition. European Journal of Physical and Rehabilitation Medicine, 58(6). https://doi.org/10.23736/S1973-9087.22.07813-3

Nakamura, Z. M., Nash, R. P., Laughon, S. L., & Rosenstein, D. L. (2021). Neuropsychiatric Complications of COVID-19. Current Psychiatry Reports, 23(5), 25. https://doi.org/10.1007/s11920-021-01237-9

Weix, N. M., Shake, H. M., Duran Saavedra, A. F., Clingan, H. E., Hernandez, V. C., Johnson, G. M., Hansen, A. D., Collins, D. M., Pryor, L. E., Kitchens, R., Armstead, A., & Hilton, C. (2025). Cognitive Interventions and Rehabilitation to Address Long-COVID Symptoms: A Systematic Review. Otjr, 46(1), 74–95. https://doi.org/10.1177/15394492251328310

Downloads

Published

2025-12-30

How to Cite

POST-COVID-19 COGNITIVE IMPAIRMENT AS A NEUROPSYCHIATRIC SYNDROME: A REVIEW OF MECHANISMS, CLINICAL FEATURES, AND IMPACT ON QUALITY OF LIFE. (2025). International Journal of Innovative Technologies in Social Science, 4(4(48). https://doi.org/10.31435/ijitss.4(48).2025.4538