Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2025 Jun 14;25(1):250.
doi: 10.1186/s12883-025-04174-9.

Long-term neurological and cognitive impact of COVID-19: a systematic review and meta-analysis in over 4 million patients

Toka Elboraay #  1   2 , Mahmoud A Ebada #  3   4   5 , Maged Elsayed  1   2 , Heba Ahmed Aboeldahab  6   2 , Hazem Mohamed Salamah  1   2 , Omar Rageh  7   2 , Mohamed Elmallahy  7   2 , Hadeer Elsaeed AboElfarh  8   2 , Lena Said Mansour  9   2 , Yehia Nabil  1   2 , Ahmed Khaled Abd Eltawab  10   2 , Hany Atwan  11   2 , Souad Alkanj  1   2
Affiliations
Meta-Analysis

Long-term neurological and cognitive impact of COVID-19: a systematic review and meta-analysis in over 4 million patients

Toka Elboraay et al. BMC Neurol. .

Abstract

Background: Neuropsychiatric symptoms emerged early in the COVID-19 pandemic as a key feature of the virus, with research confirming a range of neuropsychiatric manifestations linked to acute SARS-CoV-2 infection. However, the persistence of neurological symptoms in the post-acute and chronic phases remains unclear. This meta-analysis assesses the long-term neurological effects of COVID-19 in recovered patients, providing insights for mental health service planning.

Methods: A comprehensive literature search was conducted across five electronic databases: PubMed, Scopus, Web of Science, EBSCO, and CENTRAL, up to March 22, 2024. Studies evaluating the prevalence of long-term neurological symptoms in COVID-19 survivors with at least six months of follow-up were included. Pooled prevalence estimates, subgroup analyses, and meta-regression were performed, and publication bias was assessed.

Results: The prevalence rates for the different symptoms were as follows: fatigue 43.3% (95% CI [36.1-50.9%]), memory disorders 27.8% (95% CI [20.1-37.1%]), cognitive impairment 27.1% (95% CI [20.4-34.9%]), sleep disorders 24.4% (95% CI [18.1-32.1%]), concentration impairment 23.8% (95% CI [17.2-31.9%]), headache 20.3% (95% CI [15-26.9%]), dizziness 16% (95% CI [9.5-25.7%]), stress 15.9% (95% CI [10.2-24%]), depression 14.0% (95% CI [10.1-19.2%]), anxiety 13.2% (95% CI [9.6-17.9%]), and migraine 13% (95% CI [2.2-49.8%]). Significant heterogeneity was observed across all symptoms. Meta-regression analysis showed higher stress, fatigue, and headache in females, and increased stress and concentration impairment with higher BMI.

Conclusions: Neurological symptoms are common and persistent in COVID-19 survivors. This meta-analysis highlights the significant burden these symptoms place on individuals, emphasizing the need for well-resourced multidisciplinary healthcare services to support post-COVID recovery.

Registration and protocol: This meta-analysis was registered in PROSPERO with registration number CRD42024576237.

Keywords: COVID-19 recovery; Long COVID; Multidisciplinary care; Neurological manifestations; Post-COVID syndrome.

PubMed Disclaimer

Conflict of interest statement

Declarations. Ethics approval and consent to participate: This study did not involve human participants or animals; therefore, ethical approval was not applicable. We conducted this systematic review and meta-analysis in accordance with the Meta-analysis of Observational Studies in Epidemiology (MOOSE) guidelines and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Consent for publication: Not Applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
The flow diagram of the articles’ selection process [208]
Fig. 2
Fig. 2
Pooled Prevalence of COVID-19-Related Neurological Sequelae Across Studies
See this image and copyright information in PMC

Similar articles

See all similar articles

References

    1. Ebada MA, Wadaa-Allah A, Bahbah E, Negida A. An updated review on COVID-19. Infect Disord Drug Targets. 2021;21. - PubMed
    1. Abdelgawad HAH, Sayed A, Munir M, Elberry MH, Sayed IM, Kamal MA, et al. Clinical review of COVID-19; pathogenesis, diagnosis, and management. Curr Pharm Des. 2020;27:4232–44. - PubMed
    1. Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020;395:1054–62. - PMC - PubMed
    1. Abdelsattar N, Alrawi A, Abdelraoof M, Zaazouee M, Elsayed S, Farhat A, et al. Prevalence of negative mental health status during COVID-19 pandemic among general population of seven Arab countries: A cross-sectional study of 28843 participants. Indian J Psychiatry. 2023;65:90. - PMC - PubMed
    1. Stefano GB, Büttiker P, Weissenberger S, Ptacek R, Wang F, Esch T, et al. Biomedical perspectives of acute and chronic neurological and neuropsychiatric sequelae of COVID-19. Curr Neuropharmacol. 2021;20:1229–40. - PMC - PubMed

LinkOut - more resources