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Review
. 2025 Jun;35(2):354-380.
doi: 10.1007/s11065-024-09642-6. Epub 2024 Jun 12.

Meta-analysis of Cognitive Function Following Non-severe SARS-CoV-2 Infection

Tara A Austin  1   2   3 , Michael L Thomas  4 , Min Lu  5 , Cooper B Hodges  6 , Emily S Darowski  7 , Rachel Bergmans  8 , Sarah Parr  9   10 , Delaney Pickell  11 , Mikayla Catazaro  9   10 , Crystal Lantrip #  9   10 , Elizabeth W Twamley #  11   12   13
Affiliations
Review

Meta-analysis of Cognitive Function Following Non-severe SARS-CoV-2 Infection

Tara A Austin et al. Neuropsychol Rev. 2025 Jun.

Abstract

To effectively diagnose and treat subjective cognitive symptoms in post-acute sequalae of COVID-19 (PASC), it is important to understand objective cognitive impairment across the range of acute COVID-19 severity. Despite the importance of this area of research, to our knowledge, there are no current meta-analyses of objective cognitive functioning following non-severe initial SARS-CoV-2 infection. The aim of this meta-analysis is to describe objective cognitive impairment in individuals with non-severe (mild or moderate) SARS-CoV-2 cases in the post-acute stage of infection. This meta-analysis was pre-registered with Prospero (CRD42021293124) and utilized the PRISMA checklist for reporting guidelines, with screening conducted by at least two independent reviewers for all aspects of the screening and data extraction process. Fifty-nine articles (total participants = 22,060) with three types of study designs met our full criteria. Individuals with non-severe (mild/moderate) initial SARS-CoV-2 infection demonstrated worse objective cognitive performance compared to healthy comparison participants. However, those with mild (nonhospitalized) initial SARS-CoV-2 infections had better objective cognitive performance than those with moderate (hospitalized but not requiring ICU care) or severe (hospitalized with ICU care) initial SARS-CoV-2 infections. For studies that used normative data comparisons instead of healthy comparison participants, there was a small and nearly significant effect when compared to normative data. There were high levels of heterogeneity (88.6 to 97.3%), likely reflecting small sample sizes and variations in primary study methodology. Individuals who have recovered from non-severe cases of SARS-CoV-2 infections may be at risk for cognitive decline or impairment and may benefit from cognitive health interventions.

Keywords: COVID-19; Cognition; Cognitive decline; PASC; Post-acute sequalae of COVID-19; SARS-CoV-2.

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Conflict of interest statement

Declarations. Ethical Approval: N/A. No original data. Competing Interests: The authors declare no competing interests. Disclaimer: The views expressed herein are those of the authors and do not necessarily reflect the official policy or position of the Department of Veterans Affairs or the United States Government.

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