Cognitive rehabilitation improves long COVID function

Individualized cognitive rehabilitation improved personally meaningful daily-function goals in adults with long COVID cognitive impairment.
*Single-blind randomized clinical trial; Level 2 (OCEBM).

Citation

Vanova M, Patel AMR, Scott I, et al. Cognitive Rehabilitation and Functional Outcomes in Long COVID–Related Cognitive Impairment: A Randomized Clinical Trial. JAMA Network Open. 2026;9(7):e2620687.

Background

Cognitive problems are common after long COVID and can disrupt work, independence, and quality of life. Proven treatments are limited, and rehabilitation approaches used in other neurologic conditions may help patients apply practical strategies to daily tasks.

Patients

78 adults aged 30 to 60 years in England with prior COVID-19, cognitive symptoms lasting more than 3 months, and objective impairment in at least 2 cognitive areas. Key exclusions included acute neurologic disease, major psychiatric or medical disorders, high alcohol intake, recreational drug use, and cognition-impairing medicines.

Intervention

Ten weekly 1-hour telehealth sessions of individualized, goal-oriented cognitive rehabilitation focused on 3 patient-selected functional goals.

Control

Usual care, which varied and often included access to specialist memory clinics and fatigue management.

Outcome

Primary outcome: patient-reported goal attainment using the Bangor Goal-Setting Interview (1 to 10; 2-point improvement considered clinically meaningful). Secondary outcomes included goal satisfaction, cognitive testing, fatigue, mood, sleep, and function.

Follow-up Period

3 and 6 months after randomization.

Results

Outcome Time Adjusted benefit vs usual care
Goal attainment (primary) 3 months Mean difference 2.88 points (95% CI, 2.03 to 3.73)
Goal attainment (primary) 6 months Mean difference 1.72 points (95% CI, 0.86 to 2.57)
Goal satisfaction 3 months Mean difference 2.87 points (95% CI, 2.08 to 3.65)
Goal satisfaction 6 months Mean difference 1.53 points (95% CI, 0.56 to 2.50)
Cognitive flexibility test 3 and 6 months Small improvement favoring rehabilitation

Analyses were intention-to-treat. Clinically meaningful goal-attainment response at 3 months occurred in 84.2% with rehabilitation versus 52.5% with usual care; number needed to treat was about 4. No clear benefit was seen for fatigue, mood, sleep, memory, language, attention, or overall cognition.

Limitations

Participants were not blinded, usual care was not an active attention control, and therapist contact differed. The sample was mostly White and highly educated. Six-month cognitive testing had substantial missing data. Cognitive test gains were small and may not be meaningful to patients.

Funding

Public UK research funding; no conflicts reported.

Clinical Application

Consider goal-based cognitive rehabilitation for selected long COVID patients with confirmed cognitive impairment and daily-function goals.