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Cognitive impairment after long COVID-19

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

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COVID-19 is caused by the SARS-CoV-2 virus (a respiratory infectious disease)

Cognitive impariment after COVID-19

  • most patients recover following COVID-19 with no sequelae - however there is growing evidence that COVID-19 may result in cognitive impairment (1)
    • individuals with cognitive impairment following COVID-19 experience cognitive deficits, such as:
      • diminished memory and attention
      • sleep disturbances
    • a review notes that (2)
      • cognitive problems are common after acute SARS-CoV-2 infection
        • study evidence suggests up to one third of patients with long COVID have cognitive impairment - however the review notes that estimates vary widely and are complicated by methodological heterogeneity—eg, study size, assessment approach, follow-up duration
      • most frequent symptoms seem to affect memory, attention, and concentration
      • discrete impairments are also seen in attentional and executive processing different types of memory, visuospatial processing, and language
      • linked systemic symptoms such as fatigue, insomnia, and a general befuddled state frequently termed “brain fog” are commonly reported
      • symptoms tend to improve, but this may take up to a year
        • individuals with chronically persistent symptoms lasting more than 12 months have a lower chance of improving
      • symptoms usually fluctuate
    • evidence indicates that COVID-19 may contribute to cognitive decline by damaging crucial brain regions, including the hippocampus and anterior cingulate cortex (1)
    • study evidence has identified active neuroinflammation, mitochondrial dysfunction, and microglial activation in COVID-19 patients, implying that these factors may be potential mechanisms leading to cognitive impairment (1)

Note that before considering cognitive impairment as secondary solely (or partly) due to COVID-19 that the clinician must (2):

  • seek to exclude non-specific cognitive blunting from other underlying causes
    • exclude specific metabolic, toxic, or (patho)physiological causes
    • consider that poor sleep, diet, smoking, alcohol, and recreational drug use, reduced activity levels, and low exposure to natural light may also contribute


  1. Li Z, Zhang Z, Zhang Z, Wang Z, Li H. Cognitive impairment after long COVID-19: current evidence and perspectives. Front Neurol. 2023 Jul 31;14:1239182
  2. Ladds E, Darbyshire J L, Bakerly N D, Falope Z, Tucker-Bell I. Cognitive dysfunction after covid-19 BMJ 2024; 384 :e075387 doi:10.1136/bmj-2023-075387

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