Meta-Analysis

. 2025 Jan;32(1):e16181.

doi: 10.1111/ene.16181. Epub 2024 Feb 20.

Cognitive domains affected post-COVID-19; a systematic review and meta-analysis

Jack B Fanshawe^{1

2}, Brendan F Sargent^{1

3}, James B Badenoch^{4

5}, Aman Saini⁶, Cameron J Watson^{7

8}, Aleksandra Pokrovskaya⁹, Daruj Aniwattanapong^{7

10}, Isabella Conti⁷, Charles Nye¹¹, Ella Burchill¹², Zain U Hussain^{13

14}, Khanafi Said¹⁵, Elinda Kuhoga¹⁵, Kukatharmini Tharmaratnam³, Sophie Pendered³, Bernard Mbwele¹⁵, Maxime Taquet^{1

2}, Greta K Wood³, Jonathan P Rogers¹², Adam Hampshire⁹, Alan Carson¹⁶, Anthony S David¹², Benedict D Michael^{3

17

18}, Timothy R Nicholson⁷, Stella-Maria Paddick^{19

20}, Charles E Leek²¹

Affiliations

¹ Department of Psychiatry, University of Oxford, Oxford, UK.
² Oxford Health NHS Foundation Trust, Oxford, UK.
³ Department of Clinical Infection, Microbiology and Immunology, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK.
⁴ Barts Health NHS Trust, London, UK.
⁵ Preventive Neurology Unit, Queen Mary University of London, London, UK.
⁶ School of Life and Medical Sciences, University College London, London, UK.
⁷ Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
⁸ South London and Maudsley NHS Foundation Trust, London, UK.
⁹ Department of Brain Sciences, Imperial College London, London, UK.
¹⁰ Department of Psychiatry, King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
¹¹ Gloucestershire Hospitals NHS Foundation Trust, Gloucester, UK.
¹² Division of Psychiatry, University College London, London, UK.
¹³ NHS Greater Glasgow and Clyde, Glasgow, UK.
¹⁴ Edinburgh Medical School, University of Edinburgh, Edinburgh, UK.
¹⁵ Mbeya College of Health and Allied Sciences, University of Dar es Salaam, Mbeya, Tanzania.
¹⁶ Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK.
¹⁷ NIHR Health Protection Research Unit in Emerging and Zoonotic Infections at University of Liverpool, Liverpool, UK.
¹⁸ Walton Centre NHS Foundation Trust, Liverpool, UK.
¹⁹ Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK.
²⁰ Gateshead Health NHS Foundation Trust, Gateshead, UK.
²¹ Department of Psychology, University of Liverpool, Liverpool, UK.

PMID: 38375608
PMCID: PMC11618111
DOI: 10.1111/ene.16181

Meta-Analysis

Cognitive domains affected post-COVID-19; a systematic review and meta-analysis

Jack B Fanshawe et al. Eur J Neurol. 2025 Jan.

. 2025 Jan;32(1):e16181.

doi: 10.1111/ene.16181. Epub 2024 Feb 20.

Authors

Affiliations

¹ Department of Psychiatry, University of Oxford, Oxford, UK.
² Oxford Health NHS Foundation Trust, Oxford, UK.
³ Department of Clinical Infection, Microbiology and Immunology, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK.
⁴ Barts Health NHS Trust, London, UK.
⁵ Preventive Neurology Unit, Queen Mary University of London, London, UK.
⁶ School of Life and Medical Sciences, University College London, London, UK.
⁷ Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
⁸ South London and Maudsley NHS Foundation Trust, London, UK.
⁹ Department of Brain Sciences, Imperial College London, London, UK.
¹⁰ Department of Psychiatry, King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
¹¹ Gloucestershire Hospitals NHS Foundation Trust, Gloucester, UK.
¹² Division of Psychiatry, University College London, London, UK.
¹³ NHS Greater Glasgow and Clyde, Glasgow, UK.
¹⁴ Edinburgh Medical School, University of Edinburgh, Edinburgh, UK.
¹⁵ Mbeya College of Health and Allied Sciences, University of Dar es Salaam, Mbeya, Tanzania.
¹⁶ Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK.
¹⁷ NIHR Health Protection Research Unit in Emerging and Zoonotic Infections at University of Liverpool, Liverpool, UK.
¹⁸ Walton Centre NHS Foundation Trust, Liverpool, UK.
¹⁹ Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK.
²⁰ Gateshead Health NHS Foundation Trust, Gateshead, UK.
²¹ Department of Psychology, University of Liverpool, Liverpool, UK.

PMID: 38375608
PMCID: PMC11618111
DOI: 10.1111/ene.16181

Erratum in

Correction to "Cognitive Domains Affected Post-COVID-19; a Systematic Review and Meta-Analysis".
[No authors listed] [No authors listed] Eur J Neurol. 2025 Jun;32(6):e70253. doi: 10.1111/ene.70253. Eur J Neurol. 2025. PMID: 40539250 Free PMC article. No abstract available.

Abstract

Background and purpose: This review aims to characterize the pattern of post-COVID-19 cognitive impairment, allowing better prediction of impact on daily function to inform clinical management and rehabilitation.

Methods: A systematic review and meta-analysis of neurocognitive sequelae following COVID-19 was conducted, following PRISMA-S guidelines. Studies were included if they reported domain-specific cognitive assessment in patients with COVID-19 at >4 weeks post-infection. Studies were deemed high-quality if they had >40 participants, utilized healthy controls, had low attrition rates and mitigated for confounders.

Results: Five of the seven primary Diagnostic and Statistical Manual of Mental Disorders (DSM-5) cognitive domains were assessed by enough high-quality studies to facilitate meta-analysis. Medium effect sizes indicating impairment in patients post-COVID-19 versus controls were seen across executive function (standardised mean difference (SMD) -0.45), learning and memory (SMD -0.55), complex attention (SMD -0.54) and language (SMD -0.54), with perceptual motor function appearing to be impacted to a greater degree (SMD -0.70). A narrative synthesis of the 56 low-quality studies also suggested no obvious pattern of impairment.

Conclusions: This review found moderate impairments across multiple domains of cognition in patients post-COVID-19, with no specific pattern. The reported literature was significantly heterogeneous, with a wide variety of cognitive tasks, small sample sizes and disparate initial disease severities limiting interpretability. The finding of consistent impairment across a range of cognitive tasks suggests broad, as opposed to domain-specific, brain dysfunction. Future studies should utilize a harmonized test battery to facilitate inter-study comparisons, whilst also accounting for the interactions between COVID-19, neurological sequelae and mental health, the interplay between which might explain cognitive impairment.

Keywords: COVID‐19; attention; cognition; cognitive impairment; executive function; language; learning; memory.

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Conflict of interest statement

BDM declares payments for the UMASS lecture 2023 and for medicolegal work unrelated to the topic of this manuscript or the manuscript itself. BDM is also the Encephalitis Society Vice Chair for which he receives no remuneration. AC has received a CSO Scotland grant for cognitive phenotyping of post‐covid symptoms for work unrelated to this manuscript. AC has been a Virginia University Grand Rounds speaker honorarium on functional cognitive disorders and has received payment for expert testimony on a range of neuropsychiatric topics unrelated to this manuscript. AC is also a paid editor for the Journal of Neurology, Neurosurgery and Psychiatry and a president of FND society for which he receives no remuneration. S‐MP reports receiving travel reimbursement for acting as an invited speaker at two conferences; (1) International Brain Research Organisation—Regional African Neurology Training (2023) and (2) Alzheimer's Association—Dementia in LMICs (2022). S‐MP also sits on the executive committee of the RCPsych VIPSIG, an unpaid role. KS has received support from the Tanzanian Medical Students Association for support to attend academic conferences unrelated to this work. ASD is supported by the NIHR Biomedical Research Centre, University College Hospital London and is the president of the International Neuropsychiatric Association. JPR acknowledges a grant from the Wellcome trust paid to his institution to cover salary and research expenses for work unrelated to this manuscript. MT acknowledges grants from the MQ Mental Health Research and Wolfson Foundation to investigate mechanisms of post‐COVID cognitive deficits. AH is co‐founder and director of H2CD Inc, a software company that provides online assessment technology for research and healthcare purposes unrelated to this manuscript. GKW, KT, BFS, CN, JBF, DA, BM, SP, AP, ZUH, EB, AS, ECL, EK, TRN, JBB, IC have no COI to declare.

Figures

**FIGURE 1**
Forest plot of meta‐analysed SMDs for executive function test scores of patients post‐COVID‐19 disease and healthy controls.

**FIGURE 2**
Forest plot of meta‐analysed SMDs for learning and memory test scores of patients post‐COVID‐19 disease and healthy controls.

**FIGURE 3**
Forest plot of meta‐analysed SMDs for perceptual motor function test scores of patients post‐COVID‐19 disease and healthy controls.

**FIGURE 4**
Forest plot of meta‐analysed SMDs for language test scores of patients post‐COVID‐19 disease and healthy controls.

**FIGURE 5**
Forest plot of meta‐analysed SMDs for complex attention test scores of patients post‐COVID‐19 disease and healthy controls.

See this image and copyright information in PMC

References

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REFERENCES FOR SYSTEMATIC REVIEW'S INCLUDED STUDIES

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Cognitive domains affected post-COVID-19; a systematic review and meta-analysis

Affiliations

Cognitive domains affected post-COVID-19; a systematic review and meta-analysis

Authors

Affiliations

Erratum in

Abstract

Conflict of interest statement

Figures

References

REFERENCES FOR SYSTEMATIC REVIEW'S INCLUDED STUDIES

Publication types

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Medical