Long COVID Brain Fog Eases With Cognitive Rehabilitation

Long COVID can be associated with debilitating cognitive impairment, but new research published in JAMA Network Open suggests that patients may be able to gain meaningful improvements in their daily functioning through a telehealth course of cognitive rehabilitation.

Cognitive rehabilitation is well established to help people with conditions such as stroke and multiple sclerosis and is increasingly being adapted for long COVID. Cognitive dysfunction linked to the condition can affect memory, attention, language, and executive function, the mental skills involved in planning, initiating and sequencing tasks, adapting to unexpected situations, and problem solving.

“We need to recognize that we are talking about people in their most productive years, typically aged 30-65, who before COVID had careers, relationships, goals, and aspirations,” said Martina Vanova, PhD, a lecturer in cognitive and biological psychology at Kingston University London in Kingston upon Thames, England, who led the new study. “Afterwards, many lost their jobs or were forced to reduce their working hours; simple everyday tasks became difficult or exhausting, and their relationships with friends and family were often strained by an illness that is largely invisible to those around them.”


In a randomized controlled trial across three clinics in England between 2023 and 2024, Vanova and her colleagues followed 78 adults (24 men and 54 women; mean age, 47 years; 86% White) who received 10 weeks of 1-hour cognitive rehabilitation telehealth sessions focused on helping them achieve three goals related to work, social connection, or hobbies, such as reading a book for 20 minutes three times per week or completing work tasks.
At 3 months, participants in the intervention group were more successful at reaching their goals as rated on a 10-point scale than those receiving usual care (adjusted mean difference, 2.88; P < .001). Benefits remained significant at 6 months (adjusted mean difference, 1.72; P < .001), according to the researchers.

Patients in the intervention group were more satisfied with their progress toward their goals at 3 months (2.87; 95% CI, 2.08-3.65; P < .001) and 6 months (1.53; 95% CI, 0.56-2.50; P < .01). These patients also experienced modest improvements in executive functioning and processing speed. But cognitive rehabilitation did not improve memory, language, attention, or verbal fluency, the researchers found.

One factor behind the intervention’s success may have been its focus on helping participants regain skills that long COVID had taken from them, Vanova said.

“Aligning the treatment with personally meaningful goals likely increases participants’ engagement,” said Kati Pagulayan, PhD, a professor in the Department of Rehabilitation Medicine at the University of Washington in Seattle, who was not involved in the new research. “Most participants identified work‑related goals, which often carry strong motivational value, especially if someone is hoping to return to a pre-illness level of function.”

People with long COVID can struggle with focusing for more than a few minutes, initiating tasks, and recalling information from minutes before, Vanova said. Therapists taught techniques such as breaking complex information into smaller chunks, organizing information into categories, visualizing information, minimizing distractions, building routines, and using calendars, reminders, and other external cues to support planning and memory.

Patients showing signs of cognitive impairment could seek a referral through their primary care clinician for cognitive evaluation and potential rehabilitation with a neuropsychologist, Vanova said.

The strategies used in the trial “can serve as a guide for clinicians when working with people with long COVID, but these strategies also need to be adjusted to a person’s individual needs and abilities,” Vanova said. However, access to dedicated clinics for people with long COVID is not widespread.

The sources cited in this article reported having no relevant financial conflicts of interest.

https://www.medscape.com/viewarticle/long-covid-brain-fog-eases-cognitive-rehabilitation-2026a1000mlm