A 10-week video-based cognitive rehabilitation program improved patient-set goals in adults with long COVID cognitive symptoms.
A 10-week, individualized cognitive rehabilitation program delivered by video visit was associated with sustained functional gains among adults with long COVID–related cognitive symptoms in a randomized clinical trial conducted in England, according to findings published today in JAMA Network Open.1
“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,” lead author Martina Vanova, PhD, who completed the work at University College London (UCL) before moving to Kingston University, said in a press release.2
Vanova and colleagues enrolled 78 participants who had experienced cognitive symptoms attributed to long COVID for at least 3 months. Participants were randomly assigned to receive either the cognitive rehabilitation intervention or standard National Health Service care, which varied by region. Before treatment, all participants completed an online goal-setting interview to identify 3 functional goals, many of which were related to work performance, sustained attention, reading, hobbies, or other daily activities.1
Key Facts
The intervention consisted of hour-long, one-on-one video sessions with a therapist over 10 weeks. Rather than targeting performance on a single cognitive test, the program focused on individualized strategies to support patient-defined rehabilitation goals. According to the investigators, therapists helped participants develop compensatory approaches tailored to specific functional problems, such as difficulty concentrating, planning, multitasking, or completing cognitively demanding activities.1,2
At 3 months after treatment completion, 84% of participants assigned to cognitive rehabilitation reported significant improvement in goal attainment on a 10-point scale, compared with 53% of participants receiving usual care. At 6 months, 53% of those in the intervention group reported substantial improvement, defined as a gain of at least 4 points on the 10-point goal-attainment scale, compared with 15% in the control group.1
Investigators also reported improvements in executive function measures, including cognitive flexibility and processing speed, among participants receiving cognitive rehabilitation. Safety outcomes and adverse events were not detailed in the release.2
Long COVID, or post–COVID-19 condition, is generally characterized by symptoms that occur after SARS-CoV-2 infection, persist beyond the acute illness, and are not explained by an alternative diagnosis. The World Health Organization clinical case definition describes symptoms occurring usually 3 months from onset of COVID-19, lasting at least 2 months, and affecting daily functioning.3 Cognitive symptoms—including impaired concentration, memory difficulties, and reduced executive function—are among the manifestations recognized in clinical guidance for assessment and management of long-term effects of COVID-19.4
Current management remains largely supportive and symptom directed. NICE guidance recommends holistic assessment, individualized care planning, rehabilitation support when appropriate, and attention to fluctuating or relapsing symptoms, including fatigue, cognitive impairment, and functional limitations.4 No pharmacologic therapy has an established indication specifically for long COVID–associated cognitive impairment, making nonpharmacologic interventions an area of active clinical interest.
The UCL program is best understood as a structured behavioral rehabilitation strategy rather than a disease-modifying treatment. Its clinical relevance lies in its focus on patient-selected functional outcomes—returning to work tasks, reading, concentrating on leisure activities, or managing cognitive load—rather than solely on psychometric test changes. That approach may be meaningful for clinicians seeing patients whose primary concern is impaired daily function despite normal or nonspecific findings on routine evaluation.
However, interpretation should remain cautious. The study was small, with 78 participants, and was conducted within a single national health system. The comparator was standard care, which varied by region, and the nature of the intervention made blinding unlikely. The primary functional outcome relied on self-reported goal attainment, although reported gains were supported by some objective executive function measures. Durability beyond 6 months, generalizability to broader long COVID populations, optimal therapist training requirements, and implementation feasibility in routine services remain open questions.
UCL investigators stated that early results from a related analysis suggest the program may be cost-effective, although those findings were not fully detailed in the release. Dennis Chan, professor at the UCL Institute of Cognitive Neuroscience and joint senior author, said the study suggests individualized cognitive rehabilitation “can help those affected return to normal function.”2 Further larger, multisite studies will be needed to determine how the program compares with other rehabilitation models and whether benefit is consistent across symptom severity, time since infection, and comorbid fatigue or mood symptoms.
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