Cognitive Rehabilitation and Functional Outcomes in Long COVID–Related Cognitive Impairment – A Randomized Clinical Trial, 2026, Vanova et al.

Chandelier

Chandelier

Senior Member (Voting Rights)

Martina Vanova, PhD1,2; Aysha Mohamed Rafik Patel, MSc3; Iona Scott3
Gina Gilpin, MSc3; Emily N. Manning, PhD3; Charlotte Ash, BSc3; Philippa Wittenberg, MSc3; Jason Lim, PhD4; Zoe Hoare, PhD5; Rachel Evans, MPhil5; Nathan Bray, PhD6; Christopher M. Kipps, MD, PhD7; Ciara Devine, MSc7; Saliha Ahmed8; Ross Dunne, PhD8,9; Anna Koniotes10; Catherine Warren10; Dennis Chan, MD, PhD3,10; Aida Suarez-Gonzalez, PhD1

Key Points​

Question Does cognitive rehabilitation (CR) improve goal attainment, cognitive, and clinical outcomes in people with cognitive impairment as a part of long COVID?

Findings In this randomized clinical trial of 78 adults with prior COVID-19 infection and objective cognitive impairment, CR resulted in significantly greater functional goal attainment scores compared with treatment as usual at 3 months after randomization, and this significant difference remained at 6 months.

Meaning These findings suggest that CR can effectively treat cognitive impairment in long COVID.

Abstract​

​

Importance Cognitive impairment is common in long COVID and severely affects daily life, with no proven treatments to date.

Objective To evaluate the ability of cognitive rehabilitation (CR) to improve goal attainment, cognitive, and clinical outcomes in individuals with cognitive impairment as part of long COVID.

Design, Setting, and Participants This multicenter, single-blind, 2-arm, parallel-group randomized clinical trial was conducted at 3 sites in England between February 2023 and March 2024.
Participants were adults aged 30 to 60 years with prior COVID-19 infection and objective cognitive impairment (≥1 SD below age norm in ≥2 cognitive domains).
A sample size of 88 participants (44:44) was required to detect a conservative effect of 0.7 on the goal attainment score at 3 months.

Interventions Participants were randomized (1:1) to CR or treatment as usual (TAU).
CR consisted of 10 individual 1-hour sessions conducted once per week with a trained researcher, applying evidence-based strategies to 3 individually selected, personally meaningful functional goals. TAU was variable, with most participants having access to specialist memory clinics.

Main Outcome and Measures The primary outcome consisted of participant-reported goal-attainment scores at 3 months after randomization measured by the Bangor Goal-Setting Interview.
Analysis was conducted on an intention-to-treat basis using multilevel mixed-effects models with 2-sided 95% CIs and 5% significance.

Results A total of 78 participants (24 male [30.8%] and 54 female [69.2%]; mean [SD] age, 47.3 [7.2] years) were randomized, including 38 individuals in CR and 40 individuals in TAU groups.
At 3 months after randomization, goal attainment was significantly greater in the CR compared with the TAU group (adjusted mean difference, 2.88 [95% CI, 2.03-3.73]; P < .001; Cohen d = 1.57), with CR providing a large and clinically meaningful treatment effect.
This was sustained at 6 months, with a lower effect size (adjusted mean difference, 1.72 [95% CI, 0.86-2.57]; P < .001; Cohen d = 0.91).

Conclusions and relevance In this study, individualized, goal-oriented CR led to significant and sustained improvements in goal attainment in people with long COVID–related cognitive impairment.
These findings may guide and inform the provision of CR treatments and services for people living with long COVID.

Trial Registration ClinicalTrials.gov Identifier: NCT05731570
 
www.independent.co.uk

‘Long Covid left me with extreme fatigue and struggling to run my business’

Long Covid affects approximately two million people in the UK causing brain fog, fatigue and anxiety
www.independent.co.uk www.independent.co.uk

Long Covid left Adrian Black with extreme fatigue and brain fog which left him struggling to run his business, but a cognitive rehabilitation trial has helped him take control of his life.

The 62-year-old from Brighton wasn’t particularly unwell when he first caught Covid in spring 2020, but after catching the virus a few times he started to notice “weird symptoms” in November 2021.

“On a bad day I would get up and have breakfast before going back to bed,” Mr Black told the Independent. “I was stammering and I was forgetting appointments, which I’ve never done in my life,” he added.

Mr Black recalled becoming so exhausted that he was unable to enjoy a day trip to London with his wife, instead finding himself with his head down on a cafe table unable to move.
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Mr Black explained he went from being "productive", running a property business, being the chair of a local charity and running an Airbnb to being unable work full-time and struggling to keep track of appointments.

However, a ten-week cognitive rehabilitation programme helped him “work within new limits” and “get control of life”.
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Mr Black made very specific goals; one was to remember where he left an activity off after being distracted, another was to talk to groups of people again after struggling with a stammer even when speaking with his family.

Eventually he was able to achieve these tasks by talking at a charity event and planning out tasks.

“I was getting in a mess because I was starting things and forgetting things. I was used to being someone who was quite productive, but by putting a structure and plan in place I was making fewer mistakes,” he explained.

Although now Mr Black is able to control his fatigue, brain fog and anxiety he admits that he is still only 80 per cent of who he used to be.
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CR produced a small improvement in cognitive flexibility at 3 months (Cohen d = 0.48) and processing speed at 6 months (Cohen d = 0.07) of uncertain clinical relevance given near-normal baseline performance. There was no benefit in other cognitive domains (memory, language, attention, or verbal fluency) or symptoms (fatigue, sleep disturbance, anxiety, or depression). Gains in goal attainment likely reflect the acquisition of task-specific strategies and intervention-related psychological factors, suggesting more efficient use of limited cognitive resources rather than increased capacity.
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It turns out that instructing people to focus on a short list of priorities might make them more likely to report that they do those things. But it does not affect their overall ability to do things.

So what’s the use of this intervention?

On limitations:
We acknowledge some limitations typical of rehabilitation trials. First, participants could not be blinded to group allocation, which is common in behavioral interventions and may introduce expectancy effects. However, meaningful improvement in both groups and a large and sustained between-group difference make this expectancy effect unlikely to fully explain the findings.
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Ehm, why is that? How long the «effect» lasts has little to with if it was due to expectancy bias or other kinds of bias. We know it’s very easy to get people to report differently for a long time, regardless of if there’s any actual change. There is a reason unblinded trials with subjective outcomes are (or rather should be) completely disregarded.
Second, outcome raters were intended to remain blinded, but this was sometimes compromised. Notably, raters were not involved in treatment delivery, reducing the risk of bias related to therapist-participant contact (eg, social desirability).
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The outcome raters were the participants. Of course they could not be blinded.

I wonder what they mean by blinding sometimes being compromised. They have not provided any data about it.
Third, the absence of an active control condition meant greater therapist contact in the intervention group, which may have introduced nonspecific effects. However, the structured, strategy-based nature of CR and the magnitude and persistence of effects make this potential bias unlikely to account for reported findings.
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What does the structured, strategy-based nature of CR have to do with the risk of bias? Surely that would increase it, because the participants are told to behave in a very specific way.
Fourth, although we aimed to recruit a diverse sample, participants were predominantly White British and university educated, limiting generalizability.
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They also had 25 % dropout.
 
The PR is through the roof:
www.mirror.co.uk

Long Covid breakthrough as scientists find simple ways to reverse ‘brain fog’

A Long Covid trial by the University College London helped patients to return to work and their hobbies, and is the first to show that cognitive rehabilitation is possible
www.mirror.co.uk www.mirror.co.uk

Long Covid treatment breakthrough as scientists find simple ways to reverse ‘brain fog’​

A Long Covid trial by the University College London helped patients to return to work and their hobbies, and is the first to show that cognitive rehabilitation is possible
Click to expand...

The first effective Long Covid brain rehab programme has been developed by UK scientists.

The team developed techniques which slashed symptoms, such as brain fog, and enabled patients to return to work and hobbies.
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Study participant Emma Sullivan, a mother of two from Surrey, caught Covid-19 in August 2021 and four months later was diagnosed with Long Covid.

Emma, 57, said: “It was terrible, affecting my life in lots of ways, but particularly mentally. I could no longer concentrate or multi-task and struggled with reading problems, exhaustion and speaking in full sentences.

“The sessions in the trial were really helpful, as they taught me to break tasks down into smaller pieces and stop getting so overwhelmed, and to visualise words that I couldn’t find.

“I built up my concentration abilities once again so I can finish a 1,000 piece jigsaw puzzle by myself, after previously struggling with my granddaughter’s 30-piece puzzles. I can now accept that long Covid has changed my life because now I can manage it better, therefore I’m living better.”
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This sounds like a really good parody:
To improve working memory the programme used the following techniques:

  • Visualisation - for example, practice visualising the events in your calendar for the day with the details and places
  • Chunking - for example, when reading, break long text into smaller sections. After each paragraph, stop and summarise the main idea in your own words
  • Categorising - to remember your shopping list, group the items into categories, such as bakery, meat, diary, etc
To help participants maintain attention during tasks, therapists encouraged them to set a timer for 10 minutes of work, followed by a five-minute breathing break. Another major symptom of Long Covid is being easily distracted by things around you such as loud noises and forgetting what you are doing mid-task.

Therapists encouraged participants to do tasks with no distractions, such as turning off phone notifications and asking people not to disturb them for a period of time. They told participants to keep a log of when they forgot something or became distracted - writing down what they forgot, where they were and what was happening around them. This helped participants to spot patterns and make changes.

Another major problem Long Covid patients struggle with is maintaining a sequence of tasks, such as cooking a meal. Coaches advised participants to talk themselves through the activity step-by-step, saying what they were going to do. It also recommended forming habits to help participants improve, such as doing the chosen activity they want to do - such as reading a book - at the same time each day so they link it with a specific time and place.
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It’s funny how the participants didn’t really use visualisation or categorisation.

And requiring people to do things without distractions, with frequent breaks and with clear instructions show that they have not been «rehabilitated», they have learned how to adapt to their new level of functioning.

There might be some natural recovery thrown in as well.

Oh, and they didn’t correct for multiple comparisons, so all of the secondary outcomes (essentially all of them) have limited statistical validity. Yet another thing they forgot to mention in the limitations..
 
  • 'Visualisation - for example, practice visualising the events in your calendar for the day with the details and places'

Oh for goodness sake! What bloody Nonsense! I used to practice visualisation in my years of mind method experimentations (1970s/80s) - though TBH I gave up Visualisation as a bad job/bloody useless as it made no effect whatsoever on my life ....

I concluded it's just an over-hyped scam.

But doing visualisation with cognitive impairment after ME (I don't use the term 'brain fog') - it was just too demanding/exhausting, not even possible, during the years that my ME cognitive impairment was at a level that it totally restricted my life.

My ME cognitive impairments do still restrict my life massively - but I have kinda adapted to it's restrictions .....
I do think that pwME do that. It's not any kind of 'recovery' ...
It's lowering your expectations.

Are there any validated studies at all that show any kind of effectiveness of any improved functions from practicing Visualisation ????

.
 
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Lou B Lou said:
But doing visualisation with cognitive impairment (I don't use the term 'brain fog') - it was just too demanding, not even possible, during the years that my ME cognitive impairment was at a level that it restricted my life.
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Yes exactly what I was thinking, visualization has become bizarrely strenuous since getting sick — attempting it feels like it just adds to the problem.

Some of these suggestions read like they think people have a second, fully functional brain to corral the first one.

Like yea great, I struggle to remember what I’m doing as I do it, but maybe what I need is to add a second, even more cognitive, task to the mix:
They told participants to keep a log of when they forgot something or became distracted - writing down what they forgot, where they were and what was happening around them.
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The conclusions and marketing are complete fiction. They didn't treat anything, they're making fraudulent claims, with massively misleading headlines about a breakthrough. What in the hell? The primary target they used is a complete joke, has nothing to do with the problem, and actually seems like they mostly added burdensome nonsense to replace it.
ScoutB said:
Some of these suggestions read like they think people have a second, fully functional brain to corral the first one.
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Pretty much that, ain't it? Forgot something? Just remember it! Find someone stuck in a well? Just have them decorate the place a bit in their mind, problem solved.

We're never getting help, aren't we?
 
rvallee said:
Forgot something? Just remember it! Find someone stuck in a well? Just have them decorate the place a bit in their mind, problem solved.

We're never getting help, aren't we?
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At one of my first consultations with the Long Covid clinic I was given a list of tips for dealing with brain fog, which included "Be more organised."

It's as if they genuinely think you're going to read it and go "Oh wow, I hadn't thought of that!!"
 
the first bit I thought was that this was basically just 'teaching to the test' and then claiming that somehow cognitive exhaustion had been changed. Rather than someone having seen the questions before and how to do it.

the first bit I wanted to flag following a quick scan is the classic filter funnel of these studies (also known as the recruitment diagram with drop-outs in it): https://cdn.jamanetwork.com/ama/con...guMqrcPB8Q__&Key-Pair-Id=APKAIE5G5CRDK6RD3PGA

I'm a bit puzzled. If you scroll to the bottom of the diagram. Which confirms 38 were allocated to intervention and 40 to control. BUT At the end they claim that 38 and 40 were analysed respectively, despite the arrows before them showing that eg for the 38 then 15 dropped out - 5 at the first stage and then 10 at the second.

And in fact even in the control arm 10 out of 40 didn't complete (and just 1 at the stage before).

So were they analysing them all despite not having completed or followed up?


And it is a heck of a funnel from 252 screened to begin with through various stages to end up with 78.

Firstly 77 weren't contacted (I guess they had some list and couldn't get in touch with them apparently?),

then 24 didn't consent leaving 151.

140 then provided baseline data,

but 40 'didn't meet the cognitive criteria' or were 'ineligible'

so 98 were invited to WS2,

but only 78 consented for it



those were randomised to 40 in control and 38 in intervention.

but only 33 in intervention (and 39 in control) completed 3month follow-up

and only 28 (and 30 in control) completed 6 month follow up

But they say 38 (intervention) and 40 (control) were analysed?
 
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Chandelier said:
The PR is through the roof:
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For the record, there are at least 10 articles about this paper and new ones are keep popping up.
Of course, most are low quality sites but strings like "embargo-july-1" in the URL show that there’s some planning behind it all.

Code: 
https://au.news.yahoo.com/long-covid-left-extreme-fatigue-150202884.html (The Independent)
https://www.mirror.co.uk/news/health/long-covid-symptoms-brain-fog-37370739.amp
https://www.newsmax.com/health/health-news/covid-long-brain-fog/2026/07/02/id/1261552/
https://www.emjreviews.com/neurology/news/cognitive-therapy-helps-long-covid-cognitive-impairment/
https://www.news-medical.net/news/20260701/Ten-weeks-of-cognitive-rehabilitation-reverses-long-Covid-brain-fog.aspx
https://www.earth.com/news/long-covid-cognitive-rehab-helps-people-return-to-work-and-focus-embargo-july-1/
https://www.patientcareonline.com/view/cognitive-rehabilitation-linked-to-functional-gains-in-long-covid-trial
https://www.healthday.com/health-news/infectious-disease/rehab-program-helps-lift-long-covid-brain-fog
https://www.healthandme.com/health-news/long-covid-rehab-program-may-help-improve-brain-fog-study-finds-article-154870121
https://www.doctors.net.uk/news/long-covid-patients-see-lasting-improvements-after-cognitive-rehabilitation-therapy
 
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