Neuropsychological consequences three years post-covid-19 are persistent and have great impact on everyday activities.

Abstract

Objective Post-COVID-19 condition (PCC) is associated with persistent cognitive dysfunction and fatigue, but limited evidence is available regarding long-term outcomes beyond one year. Design Longitudinal follow-up assessment. Patients Patients who had been previously hospitalized or treated in primary care after COVID-19 infection. Methods Cognitive performance (WAIS-III subtests, Rey Complex Figure, RAVLT, and D2 Test of Attention) and fatigue (MFI-20 and MFS) were examined in 82 participants at 18 months post-infection; 59 of these participants were reassessed at 36 months. Activity limitations were evaluated using structured interviews. Results At 18 months, the scores on most cognitive tests were significantly below expected premorbid levels (mean differences: 7-17 T-points). At 36 months, deficits persisted in most domains, with only WAIS Matrices and D2 KL showing modest improvement (Cohen's d: ~0.4). Fatigue remained high across all dimensions of MFI-20, and 75-78% of patients exceeding the mental fatigue cut-off of MFS. Self-reported cognitive impact and activity limitations showed minimal change over time. Conclusions Post-COVID-19 cognitive dysfunction and fatigue remain prevalent for up to three years post-infection, particularly affecting attention, processing speed, and working memory. These deficits pose substantial barriers to daily functioning and return to work, highlighting the need for targeted rehabilitation strategies.