Cognitive impairment: a late neurological complication among COVID-19 survivors

To the Editor,
Investigations on COVID-19 have generally concentrated on clinical symptoms and signs associated with severe or fatal illness. However, according to recent analyses, an increasing number of patients with initially mild COVID-19 will undergo prolonged symptoms (Davis et al. 2021).
According to the Centers for Disease Control and Prevention (CDC), ‘long COVID’ is characterized as a disease with a group of symptoms engaging diverse organs that develops throughout or following a confirmed or suspected case of COVID-19 so that it persists for more than 28 days (Davis et al. 2021; Hampshire et al. 2021; Taquet et al. 2021). ‘Long COVID’ results in diverse consequences that commonly involve multiple organ systems, significantly impacting morbidity, mortality, and quality of life (Davis et al. 2021). Major features of ‘long COVID’ consist of breathlessness, headache, chest pain, abdominal symptoms, myalgia, fatigue, cognitive difficulties, anxiety, and depression (Davis et al. 2021; Taquet et al. 2021).
Therefore, there is escalating warning regarding potential long-term consequences of COVID-19, with reports of ‘long COVID’ symptoms continuing into the chronic stage, including cognitive impairment (Hampshire et al. 2021).
Several studies have reported abnormal measurement of cognitive functioning in survivors of COVID-19 (Davis et al. 2021; Hampshire et al. 2021; Taquet et al. 2021; Becker et al. 2021). Although hospitalization was found to be a key determining factor in a large-scale investigation in the United Kingdom, individuals with milder cases and no record of hospitalization have also been shown to experience measurable cognitive challenges (Hampshire et al. 2021). As a result, they were unable to return to their former jobs and continued to suffer from a substantial symptom burden (Davis et al. 2021). Even those who managed to return to their job experienced relapses induced by the mental effort and stress of work, commonly forcing them to leave their job (Davis et al. 2021).
This calls attention to the importance of allowing all patients to have adequate time off to achieve recovery, being able to meet the criteria for disability benefits if long-term support is required, and obtaining suitable facilities at work including telecommuting, flexible work hours, and step-by-step returns. Therefore, policymakers should employ educational and preventive measures addressed at patients with COVID-19, physicians, and the general public in order to handle functional, cognitive, and mood impairments among COVID-19 survivors. This is due to the fact that in ‘long COVID’, cognition impairment should be observed as a widespread indicator and treated holistically with medical, psychological, and rehabilitative interventions and help based on individual needs.
In summary, it is imperative to recognize that cognition impairment is an important concern after COVID-19 infection, which necessitates assessment, follow-up, and rehabilitative caring. In the context of rehabilitation, cognitive rehabilitation has been proved in many other neurological disorders, such as traumatic brain injuries, stroke, and concussion (Nouraeinejad 2018). The author has broadly worked in the area of cognitive rehabilitation, and he has proposed the application of cognitive rehabilitation for patients affected by cognitive impairment during the course of COVID-19 (Nouraeinejad 2022). In the meantime, clinical services should be prepared and occupied to manage ‘long COVID’ characteristics in keeping with the best available evidence as it emerges.

Disclosures

This research received no external funding.
Institutional review board statement: Not applicable.
The author declares no conflict of interest.

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