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Cognitive impairments four months after COVID-19 hospital discharge: pattern, severity and association with illness variables.
Open accessAbstract
The ongoing Coronavirus Disease 2019 (COVID-19) pandemic has affected more than 100 million people and clinics are being established for diagnosing and treating lingering symptoms, so called long-COVID. A key concern are neurological and long-term cognitive complications. At the same time, the prevalence and nature of the cognitive sequalae of COVID-19 are unclear. The present study aimed to investigate the frequency, pattern and severity of cognitive impairments 3-4 months after COVID-19 hospital discharge, their relation to subjective cognitive complaints, quality of life and illness variables. We recruited patients at their follow-up visit at the respiratory outpatient clinic, Copenhagen University Hospital, Bispebjerg, approximately four months after hospitalisation with COVID-19. Patients underwent pulmonary, functional and cognitive assessments. Twenty-nine patients were included. The percentage of patients with clinically significant cognitive impairment ranged from 59% to 65% depending on the applied cut-off for clinical relevance of cognitive impairment, with verbal learning and executive functions being most affected. Objective cognitive impairment scaled with subjective cognitive complaints, lower work function and poorer quality of life. Cognitive impairments were associated with d-dimer levels during acute illness and residual pulmonary dysfunction. In conclusion, these findings provide new evidence for frequent cognitive sequelae of COVID-19 and indicate an association with the severity of the lung affection and potentially restricted cerebral oxygen delivery. Further, the associations with quality of life and functioning call for systematic cognitive screening of patients after recovery from severe COVID-19 illness and implementation of targeted treatments for patients with persistent cognitive impairments.
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“The association between IQCODE and TICS-40 scores was analyzed to ensure the consistency of the 2 cognitive assessments verified in previous studies.20,21”
From One-Year Trajectory of Cognitive Changes in Older Survivors of COVID-19 in Wuhan, China: A Longitudinal Cohort Study (2022) · cites this paper as [21]
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“Möglich sind eine anhaltende Schädigung durch Viren oder Viruspartikel durch eine anhaltende postinfektiöse Inflammation [8] oder durch eine unerkannte hypoxische Schädigung des Hippocampus [27].”
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InfluentialCognitive impairment in hospitalized patients with COVID-19
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BackgroundResultCognitive consequences of COVID-19
Kicherova, O. A., Рейхерт, Л. И., Akhmetyanov, M. A., Deeva, M. V., & Makarova, D. V. (2022) · S S Korsakov Journal of Neurology and Psychiatry · doi:10.17116/jnevro20221221117 · Cited by 1
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Arelis, A. A., Yepez, J. E., Barajas, B. V. R., & Conrique, F. E. D. L. M. (2025) · Applied Neuropsychology Adult · doi:10.1080/23279095.2025.2458684 · Cited by 1
“…performance in COVID-19 patients (Krishnan et al., 2022; Vannorsdall et al., 2022) or impairments in TMT-B (Becker et al., 2021; He et al., 2023; Miskowiak et al., 2021), while others report deficits in both TMT versions (Almeria et al., 2020; García-Sánchez et al., 2022; Peskar et al., 2023;…”
Panagea, E., Messinis, L., Patrikelis, P., Malefaki, S., Petri, M. C., Nasios, G., Liontos, A., Biros, D., Kosmidis, M. H., & Milionis, H. J. (2025) · Applied Neuropsychology Adult · doi:10.1080/23279095.2025.2502871 · Cited by 1
Cognitive functioning in young adults after mild COVID-19: A case-control study from Iran
Akbarzadeh, F., Farıdhosseını, F., Eslamzadeh, M., Ghalandarzadeh, M., Khaniki, S. H., & Ebrahimi, A. (2025) · IBRO Neuroscience Reports · doi:10.1016/j.ibneur.2025.06.003 · Cited by 1
Features of cognitive impairments and their pathogenesis in patients with long COVID-19
Shulga, O. D., Korniichuk, Y. V., Fedotova, T. V., & Skrypka, M. P. (2025) · Psychiatry Neurology and Medical Psychology · doi:10.26565/2312-5675-2025-28-10 · Cited by 1
Leitner, M., Paletta, L., Leal-Garcia, M., Fellner, M., & Koini, M. (2025) · Frontiers in Psychology · doi:10.3389/fpsyg.2025.1582742 · Cited by 1
Charfi, N., Neily, C., Smaoui, N., Gassara, I., Feki, R. C., Bouali, M. M., Maalej, M., Omri, S., & Zouari, L. (2026) · Mental Illness · doi:10.1155/mij/1414254 · Cited by 1
A modern approach to the management of patients with post-COVID syndrome
Editorial, A. (2022) · Meditsinskiy sovet = Medical Council · doi:10.21518/2079-701x-2022-16-6-50-58 · Cited by 1
Hellgren, L., Thornberg, U. B., Samuelsson, K., Levi, R., & Anestis (2022) · Archives of Physical Medicine and Rehabilitation · doi:10.1016/j.apmr.2022.08.800 · Cited by 1
Achados Clínicos pós-Covid-19: Um relato de caso
Torres, H. D. S., Caldeira, A. C. D. A., Santos, P. H. L. D. S., Veras, R. P. M., Santos, P. W. D. S., dos Santos, T. C. P., & Hazime, F. A. (2023) · Research Society and Development · doi:10.33448/rsd-v12i5.41635 · Cited by 1
Impactos na cognição de pessoas idosas infectadas pela Covid-19: uma revisão de literatura
Santos, M. F., Fiamoncini, J. D., Cera, M. L., & Satler, C. E. (2023) · Uningá Review · doi:10.46311/2178-2571.38.eurj4463 · Cited by 1
Tarnanas, I., & Tsolaki, M. (2023) · Advances in experimental medicine and biology · doi:10.1007/978-3-031-31982-2_4 · Cited by 1
Masuccio, F. G., Grange, E., Giovanni, R. D., Marengo, D., Prosperini, L., & Solaro, C. M. (2023) · Neurological Sciences · doi:10.1007/s10072-023-07137-5 · Cited by 1
“There is a growing evidence that SARS-COV-2 infection may modify the brain structure and function, so that common brain network resources might be altered [7, 8], even in case of non-hospitalized COVID-19 [16].”
BackgroundJúnior, M. A. C., Malta, A. D. M. M., Feitoza, H. F. F., Pinto, P. R. F., Saldaña, Y. A., Figueira, E. L., Rodrigues, P. C., Merege, M. C., Nobre, S. É. F. R., Nascimento, A., et al. (2023) · Contribuciones a las Ciencias Sociales · doi:10.55905/revconv.16n.12-256 · Cited by 1
Cognitive disorders of patients with cerebrovascular disorders who suffered from COVID-19
Mishchenko, V. М., Dmytriieva, O., Zdesenko, I. V., & Lehka, M. (2023) · Psychiatry Neurology and Medical Psychology · doi:10.26565/2312-5675-2023-22-03 · Cited by 1
Translation and cultural adaptation of the COVID-19 Yorkshire Rehabilitation Scale into German
Sperl, L., Stamm, T., Mosor, E., Ritschl, V., Sivan, M., Hoffmann, K., & Gantschnig, B. E. (2024) · Frontiers in Medicine · doi:10.3389/fmed.2024.1401491 · Cited by 1
Appropriate Screening Tests to Assess Post-COVID-19 Cognitive Dysfunction in Aeromedical Settings
Beka, S. G., Griffiths, R. F., Myers, J. A., & Skirrow, P. M. (2025) · Aerospace Medicine and Human Performance · doi:10.3357/amhp.6500.2025 · Cited by 2
One Year After Mild COVID-19: Emotional Distress but Preserved Cognition in Healthcare Workers
Peláez, I., Martínez‐Íñigo, D., Fernandes-Magalhaes, R., Lahoz, M. E. D., del Pino, A. B., Pérez-Aranda, S., García-Romero, A., Soldic, D., & Mercado, F. (2025) · Journal of Clinical Medicine · doi:10.3390/jcm14176007 · Cited by 1
“These emotional disturbances have been suggested to negatively impact cognitive processes such as attention, comprehension, and decision-making [15,19].”
InfluentialCOVID-19 and the enteric system: rapidly propagating issues
ACTIS, G. C., PELLICANO, R., Fagoonee, S., & RIBALDONE, D. G. (2022) · Minerva Medica · doi:10.23736/s0026-4806.22.08077-6 · Cited by 1
Perissê, R. A. T., Filho, A. E. D. A. R., Santana, A. L. N., de Lavor, B. S. A., Nascimento, E. S., de Almeida, J. R., Siqueira, M. S. B. D., Cavalcante, R. R. A., Faria, S. C., & de Jesus, T. M. (2022) · Brazilian Journal of Health Review · doi:10.34119/bjhrv5n2-346 · Cited by 1
شويخ, ه. أ. م., & الحويلة, أ. ه. (2022) · Mağallaẗ Kulliyyaẗ Al-Adāb, Ǧāmiʿaẗ Al-Iskandariyyaẗ/Mağallaẗ Kulliyyaẗ Al-Adāb, Ǧāmiʿaẗ Al-Iskandariyyaẗ · doi:10.21608/bfalex.2022.243957 · Cited by 1
Post-COVID Syndrome in Children Residing in the Kabardino-Balkarian Republic
Temmoeva, L. A., Alieva, Z. M., Анатольевна, К. З., Temmoev, N. M., Kardanova, D. A., Khozhaeva, D. S., Леонидович, Д. А., Malkarova, D. S., Джабраилова, М. Х., & Sheriev, A. T. (2022) · Antibiot Khimioter = Antibiotics and Chemotherapy · doi:10.37489/0235-2990-2022-67-3-4-42-45 · Cited by 1
Efeitos neurocognitivos relacionados à COVID-19
Pires, M. E. D. P., Sena, D. D. S., Rosa, M. A., Alves, I. C. S., Monteiro, V. V. C., Reis, A. D. S. D. S., Costa, P. B. C., & de Souza, L. O. (2022) · Research Society and Development · doi:10.33448/rsd-v11i11.34182 · Cited by 1
Neurological manifestations associated with SARS-CoV-2 infection: an updated review.
Macías, D. J. C., Vizcaíno, G., & Siteneski, A. (2023) · Investigación Clínica · doi:10.54817/ic.v64n1a08 · Cited by 2
“Various factors may influence the correlation of cognitive disorders in people infected by SARS-CoV-2-For example, the stress caused by isolation, the pandemic restrictions, online teaching, and the return to regular activities 73-75 .”
Kozik, V., Reuken, P. A., Utech, I., Gramlich, J., Stallmach, Z., Demeyere, N., Rakers, F., Schwab, M., Stallmach, A., & Finke, K. (2022) · medRxiv · doi:10.1101/2022.05.23.22275442 · Cited by 1
Editorial: Cognitive and mental health improvement under- and post-COVID-19, volume II
Nibbio, G., Kotozaki, Y., & Chen, C. (2025) · Frontiers in Psychology · doi:10.3389/fpsyg.2025.1574083 · Cited by 1
Jones, B. (2025) · Preprints.org · doi:10.20944/preprints202506.0027.v1 · Cited by 1
Neuropsychiatrische Post-COVID-Symptome
Laub, C. (2021) · CME · doi:10.1007/s11298-021-2196-7
“Bis zu zwei Drittel der hospitalisierten Patienten berichten noch vier Monate nach der Entlassung über relevante kognitive Störungen, die sie im Alltag beeinträchtigen [18].”
BackgroundInfluentialРОЗРОБЛЕННЯ ЗАСОБУ ДЛЯ ПОКРАЩЕННЯ КОГНІТИВНИХ ФУНКЦІЙ ТА ЗНИЖЕННЯ РІВНЯ ГОМОЦИСТЕЇНУ
Романюк, С. И., Tykhonenko, T., Siromolot, A. A., Гузик, М., Луговська, Н., Galkin, A. Y., Kuchmerovska, T. M., Колибо, Д. В., & Комісаренко, С. В. (2022) · Science and innovation · doi:10.15407/scine18.01.066
Post–Intensive Care Syndrome in COVID-19 Patients Discharged From the Intensive Care Unit
(2021) · Journal of Hospice and Palliative Nursing · doi:10.1097/njh.0000000000000813
de Souza, G. A. S. C., Lovo, C. B., Ferreira, A. D. M., Gois, J. I. P., Kurudez, G. R., Barba, A. D., Órfão, N. H., & Kuehn, C. C. (2022) · Brazilian Journal of Health Review · doi:10.34119/bjhrv5n3-204
Polevaya, S. A., Khalak, M., Lipatov, K., Заречнова, Н. В., Cirkova, M., Eremin, E., & Буланов, Н. А. (2022) · Izvestiya VUZ Applied Nonlinear Dynamics · doi:10.18500/0869-6632-2022-30-3-322-330
de Souza, G. A. S. C., Lovo, C. B., Ferreira, A. D. M., Gois, J. I. P., Kurudez, G. R., Barba, A. D., Órfão, N. H., & Kuehn, C. C. (2022) · Brazilian Journal of Health Review · doi:10.34119/bjhrv5n3-186
Fatigue and Cognitive Impairment After COVID-19Preprint
Hartung, T. J., Neumann, C. H., Bahmer, T. J., Chaplinskaya-Sobol, I., Endres, M., Geritz, J., Hæusler, K. G., Heuschmann, P. U., Hildesheim, H., Hinz, A., et al. (2022) · SSRN Electronic Journal · doi:10.2139/ssrn.4145600
Tarnanas, I., & Tsolaki, M. (2022) · Open Research Europe · doi:10.12688/openreseurope.15005.1
Lupan-Mureșan, E.-M., Golea, A. C., Nemeş, B., & Perju‐Dumbravă, L. (2022) · Psihiatru ro · doi:10.26416/psih.68.1.2022.6307
Psychological Impacts of the COVID-19 Pandemic
Powell, S. K., Saali, A., Serafini, R. A., O’Shea, C. P., Frere, J. J., & Katz, C. L. (2022) · Springer eBooks · doi:10.1007/978-3-031-08045-6_10 · Cited by 2
Silva, N. P., de Oliveira, E. M. P., da Silva, A. B. F., Donelate, C., de Figueirêdo, N. M. A., & da Silva, Â. M. B. F. (2022) · RECIMA21 - Revista Científica Multidisciplinar · doi:10.47820/recima21.v3i11.2227
Metadata
- Authors
- Miskowiak, K., Johnsen, S., Sattler, S., Nielsen, S., Kunalan, K., Rungby, J., Lapperre, T., & Porsberg, C.
- Affiliations
- Bispebjerg Hospital (DK)
- University of Copenhagen (DK)
- University of Antwerp (BE)
- Venue
- European Neuropsychopharmacology
- Publisher
- Elsevier BV
- Published
- 2021-05
- Volume
- 46
- Pages
- 39-48
- ISSN
- 0924-977X (ISSN-L)
- PMC
- PMC8006192
- OpenAlex
- W3148312871
- Cited by
- 365
- References
- 45
- Citations by year
- 2026: 12 · 2025: 45 · 2024: 60 · 2023: 97 · 2022: 115 · 2021: 36
- FWCI
- 36.84
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- European Neuropsychopharmacology (publishedVersion, cc-by)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Research at the University of Copenhagen (University of Copenhagen) (publishedVersion, cc-by)
- Funders
- Lundbeck Foundation
- Topics
- Health Sciences › Medicine › Clinical Neurology › Long-Term Effects of COVID-19
- Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Intensive Care Unit Cognitive Disorders
- Health Sciences › Medicine › Infectious Diseases › COVID-19 Clinical Research Studies
- Keywords
- COVID-19 pandemic, long COVID, cognitive impairment, hospital discharge, subjective cognitive complaints, quality of life, executive function, verbal learning, D-dimer, pulmonary dysfunction, cerebral oxygen delivery, cognitive screening
- MeSH terms
- COVID-19, Aged, Denmark, Female, Follow-Up Studies, Humans, Longitudinal Studies, Male, Middle Aged, Patient Discharge, Prospective Studies, Severity of Illness Index, Time Factors, Cognitive Dysfunction
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