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. 2025 Sep 15.
doi: 10.1007/s13365-025-01276-5. Online ahead of print.

Cognitive and vascular (dys)function after COVID-19

Aleksandra Đ Ilić  1   2 , Vladimir Galić  3   4 , Vojislava Bugarski Ignjatović  3   4 , Željka Nikolašević  3 , Dmitar Vlahović  3   4 , Goran Knezović  3   4 , Jasmina Boban  3   5 , Duško Kozić  3   5 , Željko Živanović  3   4
Affiliations

Cognitive and vascular (dys)function after COVID-19

Aleksandra Đ Ilić et al. J Neurovirol. .

Abstract

COVID-19 is a systemic infection that causes endothelial dysfunction, contributing to severe cases. While vascular complications are well-documented, their impact on vascular structure, function, and cognition remains unclear. This cross-sectional study explored vascular and cognitive differences across patients with mild, moderate, and severe COVID-19, examining correlations between global cognitive performance and vascular parameters. This study included 83 working-age patients (30-65 years, both sexes) who recovered from COVID-19 within 6-12 months. They were grouped by severity: mild (outpatients, no oxygen support), moderate (hospitalized, conventional oxygen therapy), and severe (hospitalized, advanced oxygen therapy). Exclusions included pre-existing cognitive or neurological conditions, significant atherosclerosis, malignancies, and prior COVID-19 vaccination. Global cognitive function was assessed using the Montreal Cognitive Assessment (MoCA) test, while vascular parameters - carotid intima-media thickness (IMT), beta stiffness index (β index), mean flow velocity (MVs), maximum velocity after breath-holding (MV-BH), and breath-holding index (BHI) - were evaluated using duplex ultrasound and transcranial Doppler. Patients with severe COVID-19 had the highest carotid stiffness and poorest cerebrovascular reactivity. While MoCA scores showed no significant group differences, 23-40% had mild cognitive impairment. MoCA scores negatively correlated with β index in mild group (ρ=--0.453; p = 0.034), while MVs positively correlated with MoCA in severe cases (ρ = 0.414; p = 0.028). The association between arterial stiffness and cognitive impairment in mild cases, suggests lasting effects of SARS-CoV-2 rather than pre-existing conditions. These findings highlight carotid stiffness as a key factor in post-COVID-19 cognitive impairment, emphasizing early risk identification for timely intervention.

Keywords: Breath holding index; Carotid stiffness; Cerebrovascular reactivity; Cognition; SARS-CoV-2; Β index.

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Conflict of interest statement

Declarations. Ethical approval: The study was approved by the Ethics Committee of the University Clinical Center of Vojvodina (approval number 00-421/2020). All procedures performed were in accordance with the ethical standards of the institutional and/or national research committee and with 1964. Helsinki Declaration and its later amendments or comparable ethical standards. Consent to participate: Informed written consent was obtained from all participants included in the study. Competing interests: The authors declare no competing interests. Data sharing statement: The data supporting the findings of this study are available from the corresponding author upon reasonable request. Clinical trial number: Not applicable.

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