Cognitive Rehabilitation Improves Functional Outcomes in Long COVID Brain Fog

Cognitive rehabilitation has been shown to improve goal attainment among individuals with long-COVID-related cognitive impairment, according to a recent study published in JAMA Network Open.¹

Long-COVID is an ongoing epidemic with a growing number of studies and researchers aimed at understanding the lasting effects of COVID-19. Although the fixed definition of long COVID was only recently established, the symptoms associated with the condition vary significantly. Patients often reported feeling more tired than usual, pain or tightness in the chest, diarrhea, a decreased sense of smell or change in smell, and fatigue, tiredness, or exhaustion.² Another underreported symptom, however, is cognitive impairment, associated with feelings of brain fog.³ Researchers aimed to address this specific symptom by assessing if cognitive rehabilitation could serve as a potential therapy for those with long COVID.¹

The multicenter, single-blind, randomized clinical trial allocated patients with long COVID and experiencing cognitive impairment 1:1 to receive cognitive rehabilitation or treatment as usual (TAU). The study was conducted in 3 National Health Service trusts in the UK between February 2023 and March 2024.

Study Supports Goal-Based Rehabilitation for Long COVID Brain Fog

Participants aged 30 to 60 with evidence of a prior COVID-19 infection and self-reported cognitive symptoms persisting more than 3 months after infection. Goal-oriented cognitive rehabilitation was used to assess participant progress, as it helps identify and target meaningful functional goals relevant to the patient’s life.

The primary outcome, goal attainment, was measured using an online goal-setting interview adapting the Bangor Goal Setting Interview (BGSI). Participants set 3 personal goals, and the attainment scale was ranked 1 through 10. An improvement of 2 or more points was considered clinically meaningful.

There were 258 participants: 78 (mean [SD] age, 47.3 [7.2] years; 24 male [30.8%] and 54 female [69.2%]; 67 White [85.9%] and 11 other ethnicities [14.1%]) randomized to the intention-to-treat analysis, 40 to the TAU group, and 30 to the cognitive rehabilitation group.

The cognitive rehabilitation (CR) group received 10 weekly 1-hour telehealth sessions focused on their 3 goals. The TAU group received standard of care from current clinical services for long COVID.

Completion of the BGSI declined over the course of the study period. At 3 months, completion rates were 39 participants (97.5%) in the TAU and 33 participants in the CR (86.8%) group. By 6 months, these rates declined to 30 participants (75.0%) in the TAU group and 28 participants (73.7%) in the CR group.

Cognitive Rehabilitation Improved Goal Attainment in Long COVID

Overall, the adjusted mean goal attainment scores were significantly higher in the CR (7.84 [0.19]) group when compared with the TAU (4.97 [0.53]) group, at 3 months. At 6 months, the TAU (adjusted mean [SE], 5.74 [0.31]) group improved, while the CR (adjusted mean [SE], 7.46 [0.36]) group remained stable. The mean difference between the 2 groups remained statistically significant (1.72; 95% CI, 0.86-2.57; P < .001).

The CR group also reported higher goal satisfaction when compared with the TAU group at 3 months (adjusted mean difference, 2.87; 95% CI, 2.08-3.65; P < .001) and 6 months (adjusted mean difference, 1.53; 95% CI, 0.56-2.50; P < .01).

“These findings suggest that targeting individually selected functional goals ensures clinical relevance,” the study authors wrote.

The study was limited by its inability to blind participants, with occasional outcome raters unblinding. Additionally, the absence of an active control resulted in greater therapist contact in the intervention group.

“CR improved self-reported goal-specific functional outcomes in long COVID,” the study authors concluded. “Together, these findings provide the first class II evidence for a goal-based cognitive rehabilitation intervention for this population and support its use in routine care.”

References

1. Vanova M, Patel AMR, Scott I, et al. Cognitive rehabilitation and functional outcomes in long COVID-related cognitive impairment. JAMA Netw Open. 2026;9;(7):e2620687. doi:10.1001/jamanetworkopen.2026.20687

2. McCrear S. FAQ: how long COVID is defined, diagnosed, and managed in 2026. AJMC^®. February 26, 2026. Accessed July 21, 2026. https://www.ajmc.com/view/faq-how-long-covid-is-defined-diagnosed-and-managed-in-2026

3. McCrear S, Greenspan N. Diagnosing and managing long COVID symptoms in practice: Noah Greenspan, DPT. AJMC. March 9, 2026. Accessed July 21, 2026. https://www.ajmc.com/view/diagnosing-and-managing-long-covid-symptoms-in-practice-noah-greenspan-dpt