What management strategies are recommended for patients experiencing cognitive dysfunction as part of Long COVID?

Management of cognitive dysfunction in patients with Long COVID should focus on a personalised, multidisciplinary approach that emphasises symptom management, energy conservation, and gradual rehabilitation within the patient's tolerance limits. Cognitive dysfunction, often described as 'brain fog', may be part of a broader post-viral syndrome resembling myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), which includes cognitive fatigue and post-exertional symptom exacerbation. Therefore, strategies should include careful pacing of cognitive and physical activities to avoid triggering or worsening symptoms, known as post-exertional malaise ¹.

Healthcare professionals should develop a shared understanding with the patient about their cognitive difficulties and collaboratively create a self-management plan that includes adapting daily activities, rest periods, and cognitive pacing to improve functioning and quality of life ¹. Cognitive behavioural therapy (CBT) may be considered as part of this plan to help patients develop coping strategies and manage the personal impact of cognitive symptoms, although it is not a cure ¹.

Referral to specialist multidisciplinary Long COVID or ME/CFS teams is recommended when cognitive dysfunction is severe or persistent, to access expertise from clinicians including neurologists, rehabilitation specialists, occupational therapists, and psychologists ¹. These teams can provide tailored rehabilitation programmes that balance cognitive and physical activity increments carefully to avoid relapse or flare-ups ¹.

Additionally, management should include assessment and treatment of coexisting conditions such as anxiety, depression, or orthostatic intolerance, which can exacerbate cognitive symptoms ¹. Maintaining a healthy lifestyle with adequate nutrition, hydration, and sleep hygiene supports cognitive recovery ¹.

Recent literature supports these approaches and highlights the complex mechanisms underlying cognitive impairment in Long COVID, including neuroinflammation and autonomic dysfunction, reinforcing the need for individualized, multidisciplinary care and cautious rehabilitation (Julide et al., 2024; Astin et al., 2023). Emerging evidence also suggests that pacing and symptom-guided activity management remain central to preventing deterioration (Koc et al., 2022).