Profiles of Individuals With Long COVID Reporting Persistent Cognitive Complaints, 2025, Fernandez et al

[forestglip]

Profiles of Individuals With Long COVID Reporting Persistent Cognitive Complaints

Carmen Cabello Fernandez, Vincent Didone, Hichem Slama, Gilles Dupuis, Patrick Fery, Gaël Delrue, Alexia Lesoinne, Fabienne Collette, Sylvie Willems

[Line breaks added]

Objective
A subset of COVID-19 patients continues to experience cognitive difficulties 24 months post-infection. The factors driving these symptoms are complex, and the underlying pathophysiology is unclear. This study aimed to characterize individuals with Long COVID reporting cognitive issues.

Method
One hundred twenty-three patients underwent a comprehensive neuropsychological evaluation resulting from the baseline of an RCT study (COVCOG), along with questionnaires assessing cognitive complaints, fatigue, sleep difficulties, quality of life, psychological distress, and impact on daily activities. Latent Profile Analyses on cognitive scores were conducted to investigate the presence of different patient profiles. Robust analyses of variance and Pearson’s chi-square examined the profiles’ effects on demographic variables and questionnaire scores.

Results
Patients had had predominantly mild to moderate infections (87.8%) and were assessed an average of 20.9 (±8.6) months post-infection. Neuropsychological assessment showed cognitive impairment in at least one domain in 72% of the patients, mainly in attention and executive functions.

Over 80% reported sleep problems and fatigue, 97% concentration problems, and some 80% memory and word-finding problems. The self-report questionnaires also revealed significant complaints.

Three profiles emerged (all ps < .001). Profiles 1 and 2 both experienced widespread cognitive issues; Profile 1 patients expressed more complaints about cognitive functioning and daily fatigue (all ps < .045). Patients in Profile 3 were more frequently men (all ps < .049) with a specific impairment of verbal long-term memory and fewer complaints.

Conclusions
The study identifies three different profiles of individuals with Long COVID, highlighting the need for comprehensive evaluations including neuropsychological, psychological, somatic, and functional aspects to implement effective, tailored interventions.

Clinicaltrials.gov: NCT05167266.

Link | PDF (Archives of Clinical Neuropsychology) [Open Access]

 

[rvallee]

Yes, patients who report cognitive problems report cognitive problems.

And, yes, we need "effective, tailored interventions". Just like on day one. Just like for decades before that.

Nothing's changed. It's as if it's them who are in a state of perpetual amnesia and executive impairment, because all of this is just going around in circles, with the same useless junk proposed every single time, after years of people saying that symptom self-reports are useless, despite the fact that symptoms can only be self-reported, and the best they can do is still: they self-report exactly what they have been self-reporting from the start, someone, uh, should maybe think about doing something here?

In a sane system, it would actually matter that we just keep being proven right. But it doesn't, and this isn't just correlation, it means that those systems are not especially sane.

 

[bobbler]

I have just searched for this one to see if it was already on here, having come across it due to a twitter/X thread.

I will post those threads next and separately because I'm making a hash of doing that at the moment.

I was attracted to looking at it because there was a nice pic of a table of the symptoms found in one of those posts. I think it is really useful to us for people to understand and break down that it is indeed things like the impact of being able to understand reading/hearing something when there is competing noise in the background . Or another specific. Rather than the awful wish from some to roll it into generic terms that they can distort the meaning of (and indeed that non-specificity doesn't help work out which aspects are which cause, hence some calling it 'mental health' when some of these are actually just more exhaustion-related and are an extreme version of classic cognitive 'slips' known about in cognitive psychology from when normal people become over-ehxuasted or ill) like 'brain fog'.

For someone to look into how when we get exhausted we can't necessarily manage to get the words together to reply properly to a serious question (which should we really be being asked ad hoc and expecting a top of head answer for anyway?) that might affect our future or help provided. But that doesn't mean we 'lack capacity' just need adjustments and understanding, which I'm sure for other conditions would have been well-understood in the past.


But I wanted to put a note that having had a quick squizz through this paper it is a good and important one. Because the conclusions being much more precise is starting to (even though they use that grim term psychoeducation) not be talking about generic therapies but stepping outside the clinical psychology as if it is 'mental health transdiagnostic something a bit of CBT will help' and into the realising that things like reduced ability to deal with divided attention when trying to listen to something need eg adjustments.

I would hope that cognitive psychology as a discipline begins to step into things and starts using the type of approach you'd see eg for air traffic control instead of what should be seen as old hat but unfortunately isn't and is getting worse the uninventive off the shelf increasingly that'll do generic transdiagnostic because they don't really care what the issue is staff getting funded.

A comprehensive assessment of neuropsychological, psychological, and functional aspects in patients with long-standing COVID may help identify key factors of the patient profile that could influence their recovery trajectory and subsequently support the design of targeted interventions. The identification of different patient profiles in our study might suggest that modular psychoeducation tailored to each patient could be the most effective approach with, for example, some patients that may benefit more from the use of memory aids, while others may need help for managing the reduction in attentional resources.

These individual cognitive difficulties—defining distinct patient profiles—require further investigation. The existence of different phenotypes also raises questions about the long-term evolution of cognitive difficulties, particularly regarding the potential increased risk of developing neurodegenerative disorders following SARS-CoV-2 infection, as suggested by recent studies (Duff et al., 2024) and observed in the context of other viral infections (Levine et al., 2023).

I was relatively impressed by seeing a section of self-analysis of the limitations and strengths of the method itself too.

for example in the study limitations section is:

Secondly, 88% of our patients had mild or moderate COVID infections and only 14% had been hospitalized; accordingly, results may differ for patients with more severe acute disease. However, several studies have shown that patients with more severe disease in the acute phase (i.e., hospitalized patients) do not necessarily show greater cognitive deficits after 3–7 months (Krishnan et al., 2022; Miskowiak et al., 2023; Woo et al., 2020). Similarly, our sample had a high level of education (mean = 14 years, SD = 3), which is generally considered a proxy of cognitive reserve. It would be worth exploring whether our findings apply to individuals with a lower level of education.

and there is soemthing to be said for encouraging that this level should be the minimum norm at least somewhere within people's papers to avoid eg the errors of the type @dave30th has had to flag in other publications that failed to differentiate effects found in hospitalised patients not being extrapolatable to those who weren't who developed long covid.

 

[bobbler]