Neurocognitive trajectories in long COVID: Evidence from longitudinal analyses.
Jacqueline H Becker1, Jia Li2, Jenny J Lin1
1Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY, 10029, USA.
Brain, Behavior, & Immunity - Health
|September 11, 2025
Summary
Cognitive function generally improves after COVID-19, but processing speed and executive functions remain impaired long-term. Lower body mass index predicts better cognitive recovery in Long COVID patients.
Area of Science:
- Neurology
- Infectious Diseases
- Public Health
Background:
- COVID-19 (Coronavirus Disease 2019) survivors frequently report persistent cognitive impairment, commonly termed "brain fog."
- The long-term recovery trajectory of these cognitive deficits following SARS-CoV-2 infection remains incompletely understood.
Purpose of the Study:
- To assess cognitive function changes over a 42-month period after acute SARS-CoV-2 infection.
- To identify factors associated with the trajectory of cognitive function recovery post-COVID-19.
Main Methods:
- Analysis of data from 1553 participants in the Mount Sinai Health System Post-COVID-19 Registry.
- Prospective cohort study following adults after SARS-CoV-2 infection of any severity.
- Cognitive function assessed using validated in-person measures; linear mixed models used to analyze changes over time and influencing factors.
Main Results:
- Cognitive scores for attention, working memory, processing speed, executive functions, and verbal learning/memory showed progressive improvement up to 42 months post-COVID-19.
- Despite improvements, processing speed and executive functioning remained, on average, more than one standard deviation below normative means.
- A body mass index (BMI) below 25 kg/m² was a significant predictor of greater cognitive score improvement.
Conclusions:
- Cognitive impairment following COVID-19 demonstrates improvement over time, but deficits in processing speed and executive functioning persist long-term.
- The cognitive health burden associated with Long COVID is substantial and enduring.
- Future research should focus on interventions for cognitive recovery and dynamic risk prediction models for Long COVID patients.
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