What treatment options are available for patients experiencing post-COVID (Coronavirus disease 2019) cognitive problems?

Medical Advisory BoardAll articles are reviewed for accuracy by our Medical Advisory Board
Educational purpose only • Exercise caution as content is pending human review
Article Review Status
Submitted
Under Review
Approved

Last updated: October 13, 2025 • View editorial policy

Personalize

Help us tailor your experience

Which best describes you? Your choice helps us use language that's most understandable for you.

Treatment Options for Post-COVID Cognitive Problems

Currently, there are no specific FDA-approved treatments for post-COVID cognitive impairment, and management should focus on symptom-based approaches, cognitive rehabilitation, and addressing underlying mechanisms of neuroinflammation.

Understanding Post-COVID Cognitive Impairment

Prevalence and Characteristics

  • Cognitive impairment is found in approximately 22% of COVID-19 patients at 12 weeks post-infection and may increase over time, affecting 26% of patients at 12 months 1

  • The most commonly affected cognitive domains include:

    • Delayed verbal memory (particularly affected) 2
    • Executive functioning 2, 3
    • Attention 2, 3
    • Language processing 4

  • Cognitive deficits can occur regardless of initial COVID-19 severity, affecting both hospitalized and non-hospitalized patients 1

  • These impairments can persist for at least 2 years after infection, unlike anxiety and depression which tend to resolve over time 1

Underlying Mechanisms

  • Neuroinflammation and microglial activation 1
  • Damage to blood vessels through coagulopathy and endothelial dysfunction 1
  • Direct neuronal injury 1
  • Alzheimer's disease-like signaling with amyloid formation 1
  • Activation of the kynurenine pathway (associated with cognitive impairment) 1
  • Brain and brainstem hypometabolism 1
  • Myelin loss and cellular dysregulation similar to "chemo-brain" 1
  • Hypothalamus-pituitary-adrenal axis dysfunction with low cortisol levels 1

Treatment Approaches

Cognitive Assessment and Monitoring

  • Standard cognitive screening tests like Mini-Mental State Examination may miss deficits; more comprehensive testing is recommended 4, 5
  • Montreal Cognitive Assessment (MoCA) appears more sensitive for detecting post-COVID cognitive impairments 4, 5
  • Objective cognitive testing is important as some patients may not recognize or report their impairment 1

Cognitive Rehabilitation

  • Although specific evidence for post-COVID cognitive rehabilitation is limited, this approach should be considered based on its use in other neurological conditions 1
  • Olfactory training may be beneficial for patients with smell/taste disturbances, which can be associated with cognitive issues 1

Pharmacological Approaches

  • No medications have proven efficacy specifically for post-COVID cognitive impairment 1
  • Theoretical candidates under investigation include:
    • Luteolin (a flavonoid that may inhibit proinflammatory cascades of mast cells and microglia) 1
    • Cannabidiol and cannabivarine (potential to downregulate CNS proteins related to symptoms) 1
    • Methylene blue (for potential mitochondrial protective effects) 1
    • Clomipramine (tricyclic antidepressant with anti-inflammatory properties) 1

Brain Imaging

  • Brain imaging is not routinely recommended for investigating post-COVID cognitive complaints except to rule out other causes 1
  • Some studies have shown hypometabolism in specific brain areas associated with cognitive symptoms, but these findings are primarily for research purposes 1

Special Considerations

Risk Factors for More Severe Cognitive Impairment

  • Hospitalization during acute COVID-19 2
  • Presence of fatigue 2
  • Older age 2
  • Higher d-dimer levels during acute illness 6
  • Residual pulmonary dysfunction 6

Impact on Quality of Life

  • Cognitive impairments significantly correlate with:
    • Lower work function 6
    • Poorer quality of life 6
    • Subjective cognitive complaints 2, 6

Common Pitfalls in Management

  • Relying solely on basic cognitive screening tests, which may miss deficits 4
  • Attributing cognitive symptoms solely to anxiety or depression, when cognitive impairment appears to be independent of these conditions 1
  • Failing to recognize that cognitive symptoms may persist or worsen over time, requiring ongoing monitoring 1
  • Not addressing daytime sleepiness, which has been associated with cognitive profiles in post-COVID patients 4

Treatment Algorithm

  1. Comprehensive cognitive assessment using sensitive tools like MoCA
  2. Rule out other causes of cognitive impairment with appropriate testing
  3. Address modifiable factors (sleep disturbances, fatigue)
  4. Consider cognitive rehabilitation focused on most affected domains
  5. Monitor for progression or improvement of symptoms over time
  6. Consider enrollment in clinical trials of investigational therapies

References

1
Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

3
Research

Cognitive dysfunction following COVID-19 infection.

Journal of neurovirology, 2022

6
Research

Cognitive impairments four months after COVID-19 hospital discharge: Pattern, severity and association with illness variables.

European neuropsychopharmacology : the journal of the European College of Neuropsychopharmacology, 2021

Related Questions

What are the management options for cognitive decline following COVID-19 (Coronavirus disease 2019)?
What is the management approach for patients with neurological sequelae of Covid 19 (Coronavirus disease 2019) infection?
What are the post-COVID-19 (Coronavirus Disease 2019) mentation changes?
What is the management approach for complete right bundle branch block (RBBB)?
What is the evaluation and treatment approach for a patient presenting with a malar rash, potentially indicative of systemic lupus erythematosus (SLE)?
What is the starting dose of Strattera (atomoxetine) for adults and children?
Why order Alpha-Fetoprotein (AFP) and human Chorionic Gonadotropin (hCG) lab tests for a patient with a testicular mass?
Is it safe to use Strattera (Atomoxetine) and Sertraline (Selective Serotonin Reuptake Inhibitor) together?
What is the initial workup and treatment for a new onset seizure?

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

Have a follow-up question?

Our Medical A.I. is used by practicing medical doctors at top research institutions around the world. Ask any follow up question and get world-class guideline-backed answers instantly.

Ask Question