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

Marika Möller; Kristian Borg; Christer Janson; Maria Lerm; Johan Normark; Katarina Niward

doi:10.1111/joim.13720

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

J Intern Med. 2023 Nov;294(5):563-581. doi: 10.1111/joim.13720. Epub 2023 Sep 27.

Authors

Marika Möller¹, Kristian Borg¹, Christer Janson², Maria Lerm³, Johan Normark⁴, Katarina Niward⁵

Affiliations

¹ Department of Clinical Sciences, Division of Rehabilitation Medicine, Karolinska Institutet, Danderyd University Hospital, Stockholm, Sweden.
² Department of Medical Sciences: Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden.
³ Department of Biomedical and Clinical Sciences, Division of Inflammation and Infection, Linköping University, Linköping, Sweden.
⁴ Department of Clinical Microbiology, Umeå University, Umeå, Sweden.
⁵ Department of Infectious Diseases, and Department of Biomedical and Clinical Sciences, Division of Inflammation and Infection, Linköping University, Linköping, Sweden.

PMID: 37766515
DOI: 10.1111/joim.13720

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.

Keywords: SARS-CoV-2; cognition; fatigue; long-haul COVID; post-acute COVID-19 syndrome.

Publication types

Review