Cognitive Deficits in Long COVID Patients: A Comprehensive Analysis of SARS-CoV-2 Infection and Symptom Duration Effects


The COVID-19 pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has had a profound impact on global health and well-being.

While much research has focused on the acute effects of the virus, a growing body of evidence suggests that some individuals may experience lingering symptoms and cognitive deficits long after their initial infection, a condition often referred to as “long COVID.”

In this article, we delve into a comprehensive study that investigates the cognitive effects of community-based SARS-CoV-2 infection, particularly among individuals with prolonged symptom duration.

Study Design and Methodology

The study in question was conducted using data from the CSSB (Cognition and Severe SARS-CoV-2 in Birmingham) cohort, which comprises individuals with both SARS-CoV-2 negative and positive statuses across various symptom durations.

By including participants with diverse infection and symptom profiles, researchers aimed to disentangle the effects of infection and symptom duration on cognitive performance.

At the initial Round 1 testing, participants with positive SARS-CoV-2 infection status displayed lower cognitive task accuracy scores compared to those with negative status, even when controlling for symptom duration. The most significant cognitive deficits were observed in individuals with symptom durations exceeding 12 weeks.

These participants often self-identified as experiencing “long COVID” and met the criteria for “Post-COVID-19 syndrome” and “Post COVID-19 condition” according to NICE and WHO definitions.

Cognitive Deficits and Impact

The cognitive deficits observed in participants with prolonged symptom duration were comparable in magnitude to those caused by other factors such as hospitalization during illness, an increase in age of approximately 10 years, and mild to moderate psychological distress.

However, the deficits were smaller than those associated with lower educational attainment or experiencing above-threshold fatigue levels. Remarkably, the study found no evidence of an effect of SARS-CoV-2 infection on average reaction time during cognitive tasks.

This absence of impairment in processing speed is a positive finding, as processing speed is crucial for cognition and has extensive implications for health outcomes, including frailty, dementia, and mortality.

Notably, participants who reported feeling recovered and “back to normal” after their COVID-19 illness showed no detectable cognitive impairment, even among those with long-term symptoms lasting for more than 12 weeks. Additionally, the presence of ongoing symptoms of psychological distress, fatigue, and functional impairment partially mediated the observed cognitive deficits, suggesting that these symptoms are intertwined with recovery and associated cognitive performance.

Longitudinal Follow-Up and Recovery Rates

Longitudinal follow-up, conducted after approximately 9 months, revealed that individuals who had SARS-CoV-2 infection and had not reported recovery at Round 1 showed no change in cognitive accuracy, either improvement or decline. These cognitive deficits persisted even at almost two years since the initial infection.

In an opportunistic analysis of individuals who had negative SARS-CoV-2 statuses but experienced first infections between cognitive assessments, the evidence of cognitive sequelae was less convincing.

These later COVID-19 infections occurred predominantly after vaccination against SARS-CoV-2 and were skewed toward shorter durations. The reduced likelihood of long COVID for more recent variants and after vaccination may explain these findings.

Limitations and Implications

The study acknowledged several limitations, including the unavailability of certain data such as prior neurovascular and neurodegenerative comorbidities, pre-infection cognitive assessment data for most cases, and information on treatment or cognitive rehabilitation following SARS-CoV-2 infection. Additionally, the study’s cohort composition had some disparities compared to the broader UK population, limiting the generalizability of the findings.


In conclusion, the study indicates that individuals with prolonged symptoms following SARS-CoV-2 infection during the first year of the pandemic exhibited cognitive deficits. Moreover, those with ongoing symptoms at the initial testing did not show cognitive recovery at follow-up, almost two years post-infection.

Considering the sizable population affected by long COVID, with detrimental impacts on quality of life and daily functioning, the study emphasizes the need for renewed efforts in identifying and supporting those suffering from ongoing symptoms following COVID-19.

The study also underscores the importance of assessing the ongoing aspect of long COVID definitions as a better predictor of cognitive impairment due to COVID-19 than symptom duration.

Future research should focus on understanding recovery trajectories and mechanisms following ongoing symptoms of COVID-19 and investigating the long-term implications of the observed cognitive deficits on both individuals and society at large.

in deep…

The COVID-19 pandemic has wreaked havoc on the global population, leaving in its wake a complex array of symptoms and aftereffects for those infected. One of the most perplexing and debilitating consequences of COVID-19 is the condition known as long COVID, or post-acute sequelae of SARS-CoV-2 infection (PASC). Among the myriad symptoms experienced by long COVID patients, cognitive deficits stand out as a particularly challenging and distressing aspect. In this comprehensive article, we aim to delve into the multifaceted causes of cognitive deficits in long COVID, exploring potential mechanisms and interactions that contribute to this enigmatic phenomenon.

The Landscape of Cognitive Deficits in Long COVID

Long COVID patients often report experiencing cognitive difficulties, encompassing problems with attention, memory, concentration, and processing speed. These cognitive impairments can be severe enough to hinder daily activities, work productivity, and social interactions, leading to significant challenges in regaining a semblance of normalcy post-infection.

Inflammation: The Underlying Culprit

One of the primary suspects in the realm of cognitive deficits in long COVID is inflammation. COVID-19 is notorious for inducing a hyperactive immune response, leading to a state of systemic inflammation. While this inflammation is essential for fighting off the virus, it can also infiltrate the central nervous system and cause brain inflammation, a phenomenon known as neuroinflammation.

The brain is an exquisitely sensitive organ, and when exposed to neuroinflammation, its delicate neural networks can suffer damage and dysfunction. Cognitive impairments may arise as a result of the impact on brain regions responsible for attention, memory consolidation, and executive function. The severity and duration of neuroinflammation may vary among long COVID patients, contributing to the diversity of cognitive deficits observed.

Direct Brain Infection: A Trojan Horse in Cognitive Function

Beyond the systemic inflammatory response, another hypothesis gaining momentum is the possibility of direct brain infection by the SARS-CoV-2 virus. While primarily a respiratory virus, studies have indicated the presence of the virus in the brain tissues of infected individuals, suggesting that it can indeed cross the protective blood-brain barrier. Once inside the brain, the virus can directly infect brain cells, such as neurons and glial cells.

This viral invasion of the brain may trigger a cascade of cellular responses, leading to neural damage and death. The areas most affected could be those associated with cognitive functions, resulting in the observed deficits in attention, memory, and executive control. The interplay between inflammation and direct viral infection may exacerbate cognitive impairment, making it challenging to pinpoint a single causative factor.

Stress: A Neurological Double-Edged Sword

The stress response to a serious illness like COVID-19 can further complicate the cognitive landscape in long COVID patients. Stress activates the hypothalamic-pituitary-adrenal (HPA) axis, leading to the release of stress hormones, including cortisol. Prolonged exposure to elevated cortisol levels can have detrimental effects on the brain, particularly the hippocampus, a region crucial for memory consolidation.

High cortisol levels may impair hippocampal function and disrupt neural pathways involved in attention and executive function, contributing to cognitive deficits. Moreover, the emotional toll of dealing with a prolonged illness and uncertainty about recovery can also impact cognitive performance.

Other Contributing Factors

Several other factors can influence cognitive deficits in long COVID patients:

  • Dehydration: Dehydration, often experienced during illness, can lead to fatigue and hinder cognitive function.
  • Anemia: Anemia, characterized by low red blood cell count, can cause cognitive impairment due to reduced oxygen supply to the brain.
  • Vitamin Deficiencies: Deficiencies in essential vitamins, such as vitamin B12, can adversely affect cognitive function.
  • Sleep Deprivation: Poor sleep quality and deprivation can impair memory consolidation and cognitive processing.
  • Medication Side Effects: Some medications used to treat COVID-19 or its symptoms may have cognitive side effects.

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