Cognition and Long COVID: a Review.

PURPOSE OF REVIEW: Provide an overview of current knowledge regarding cognitive issues in patients with long COVID, also termed brain fog or cognitive COVID. RECENT FINDINGS: Subjective cognitive symptoms in long COVID patients are common but often go undetected by traditional standardised cognitive test batteries. This discrepancy poses a major clinical and societal problem, given the prevalence, protracted course and impact of cognitive COVID on work functioning. New, online assessment methods for cognitive function are feasible and corroborate subjective self-report symptoms, finding executive function impairments in cognitive COVID. As vaccination protects against brain fog and not against anxiety and depression in long COVID, brain fog can be seen as a core symptom of long COVID, concerning executive functioning, and a direct effect of neurotropic viral brain infiltration. Depression and anxiety are comorbid conditions due to indirect factors associated with the pandemic, such as increased social isolation and loss of work. Ongoing vaccination programs should not only target the elderly, but also working-age people. Online cognitive assessment batteries are recommended for assessment and treatment monitoring in long COVID. Integrated care is recommended given the high rate of multimorbidity. Future research might explore the effects of antiviral medication, modulation of the immune response, and GLP-1 agonists in long COVID.