Neuropsychological consequences three years post-covid-19 are persistent and have great impact on everyday activities.
Ann Björkdahl, Jerry Larsson
Three years after COVID-19, 10 of 12 cognitive tests still showed below-expected performance in this group of 59 working-age adults, and 77% reported ongoing cognitive impact on daily life.
Fatigue scores were unchanged from 18 months.
Key findings
1At 36 months, 10 of 12 neuropsychological tests still showed significantly below-expected performance. The most affected were verbal learning (RAVLT A, 51% of participants more than 1 SD below expected), visual attention (D2 BZO, 65%), and visual search (D2 KL, 58%).
2Fatigue was high and unchanged: 75% of participants at 18 months and 78% at 36 months scored above the brain-fatigue cut-off, with no significant change detected between time points.
3Activity limitations persisted at 36 months, especially in work and leisure. Only 10.5% of participants felt they had recovered, while 28% perceived no improvement at all. At 36 months, 43% had returned to full-time work and 19% had not been able to return at all.
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What it does not show
No pre-illness neuropsychological data existed; premorbid levels were estimated using the hold method, which is reasonable but indirect, especially for a highly educated sample (69.5% with higher education) whose expected performance was already about 1 SD above the population norm. The sample was limited to those available from the original cohort and could not be expanded; 23 of 82 participants dropped out between 18 and 36 months (12 declined, 3 moved, 5 unreachable, 3 other illness), which may bias the 36-month group toward those still engaged with follow-up. No control group of non-infected individuals was included; all comparisons are within-person against estimated premorbid levels. The sample was working-age, Swedish-speaking, and highly educated, limiting generalisability to older, less-educated, or non-Swedish-speaking populations. WAIS III (not the current WAIS-IV) was used, though the authors note this is unlikely to matter given the within-person design.
Declared interests
The authors declare no conflicts of interest.
The easy way to misread this
Do not read the small improvements in WAIS Matrices and D2 KL, or the modest shifts in activity-area proportions, as evidence of meaningful recovery. The overall picture is that 10 of 12 tests remain significantly below expected at 36 months, 77% still report cognitive impact on daily life, and only 10.5% feel they have recovered. The 'improvements' in activity ratings are small percentage-point changes in a group that still has high proportions of some or great problems, particularly in work and leisure.
Summarised by AI from the full paper, without a clinician reviewing it. Check it against the source before it changes what you do. Read it on PubMed →