Ten weeks of cognitive rehabilitation reverses long Covid brain fog

Ten weeks of cognitive rehabilitation can help people with long Covid symptoms such as brain fog achieve their goals in returning to work and hobbies, finds a new clinical trial led by University College London (UCL) researchers.

This is the first treatment that has had a clinically meaningful and lasting benefit for the cognitive difficulties associated with long Covid.

The treatment, delivered in hour-long one-to-one video calls where a therapist helped people with long Covid devise strategies to achieve rehabilitation goals, yielded benefits that lasted for at least six months for most participants, according to the findings published in JAMA Network Open.

Lead author Dr Martina Vanova, who completed the research at UCL before moving to Kingston University, said: “As many as one in three people with Covid go on to develop long Covid, and cognitive difficulties are among the most common symptoms that can persist for months, disrupting day-to-day functioning and quality of life. People might find it hard to focus or hold on to their thoughts as they struggle with memory, attention and planning, often compounded by fatigue.

“In our study, we used well-established strategies of goal-oriented cognitive rehabilitation to help people develop ways to tackle the challenges that are most meaningful to them.”

The study, funded by the National Institute for Health and Care Research (NIHR), involved 78 participants in England who had been experiencing cognitive long Covid symptoms for at least three months. Half of them received the rehabilitation treatment while half continued with standard NHS treatments (which varied by region) to act as a comparison group.

Before beginning the treatment, all participants completed an online goal-setting interview to identify three key goals they wanted to attain; most of these were work-related as participants sought to regain their proficiencies, but many participants also set out hobby-related goals such as to remain focused on watching an entire film or to stay focused on a book. Therapists could then help participants to implement strategies tailored to their specific goals.

The researchers found that the large majority (84%) of participants who underwent cognitive rehabilitation therapy reported a significant improvement in goal attainment (which they reported using a 10-point scale) three months after completing the treatment, compared to just over half (53%) of the control (comparison) group who received standard care.

Notably, after six months, just over half (53%) of those who had cognitive rehabilitation reported a substantial improvement in goal attainment, defined as an improvement of four or more points on the 10-point scale, compared to just 15% of those in the control group.

These benefits were underscored by measured improvements in executive function, as participants improved their scores on tests measuring cognitive flexibility and processing speed.

Emma Sullivan, one of the study participants who benefited from cognitive rehabilitation, commented: “I first got Covid in August 2021, and by December was diagnosed with long Covid. It was terrible, affecting my life in lots of ways, but particularly mentally; I could no longer concentrate or multi-task and struggled with reading problems, exhaustion and speaking in full sentences.

“The sessions in the trial were really helpful, as they taught me to break tasks down into smaller pieces and stop getting so overwhelmed, and to visualise words that I couldn’t find. I built up my concentration abilities once again so I can finish a 1,000 piece jigsaw puzzle by myself, after previously struggling with my granddaughter’s 30-piece puzzles.

“I can now accept that long Covid has changed my life, because now I can manage it better, therefore I’m living better.”

The researchers say that early findings of an accompanying analysis suggest the programme is cost-effective.

Since the Covid-19 pandemic, we have been trying to understand better long Covid-related brain fog and have been exploring ways to address it. With this study we have found that an individualised treatment programme of cognitive rehabilitation can help those affected return to normal function.”

Professor Dennis Chan, joint senior author and chief investigator, UCL Institute of Cognitive Neuroscience

Joint senior author Dr Aida Suarez-Gonzalez (UCL Queen Square Institute of Neurology) said: “We have found a treatment that provides clinically meaningful and sustained benefit for people with cognitive long Covid symptoms. As this programme is based on established cognitive rehabilitation techniques that have been used for other conditions, we hope that it can be easily rolled out as a treatment option for people currently living with long Covid.“