Long Covid and Cognitive Symptoms: Understanding the Challenge and Finding Support
March 2025 marked five years since the World Health Organisation declared Covid 19 a global pandemic. While the acute phase of the virus is now well understood, millions of people worldwide continue to live with its lingering effects. Long Covid brain fog, memory difficulties and problems with concentration are among the most debilitating and least visible of these effects, fundamentally altering a person’s ability to work, study and manage daily life.
At Recallify, our Research Assistant Charlie Roberts has recently completed a PhD focusing on longitudinal memory research with the Long Covid community. Her three years of working directly with people living with Long Covid (pwLC) have informed not only our understanding of these challenges, but also the development of a usability and feasibility pilot study for Recallify with pwLC. This post draws on Charlie’s research, alongside the wider published literature, to outline what we know about Long Covid cognitive symptoms and what can be done to support people experiencing them.
The Cognitive Toll of Long Covid
Covid 19 is caused by the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS CoV 2), which was initially understood as a respiratory illness due to the high death rates in the early months of the pandemic (Miners et al., 2020). However, research has since established that the impact of acute Covid 19 infection can be long lasting and can significantly affect cognitive functioning (Aretouli et al., 2025; Jaywant et al., 2024). There is also evidence that it could lead to a sustained neurological risk trajectory (Taquet et al., 2022) and a potentially higher risk of neurodegenerative conditions such as Alzheimer’s disease and Parkinson’s disease (Baazaoui & Iqbal, 2022). Importantly, Long Covid is not limited to those who had severe acute infections. It is also evident in people who had mild cases (Davis et al., 2023; Greenhalgh et al., 2024).
Long Covid, a term initially coined by patients themselves during the early months of the pandemic (Callard & Perego, 2021), is also referred to as Post Acute Sequelae of SARS CoV 2 (PASC) or Post Covid 19 Condition (PCC). It describes a constellation of symptoms that persist for more than 12 weeks after the initial infection. There are over 200 documented symptoms, affecting multiple organ systems. For many people, symptoms from different systems coexist (Long Covid Support, 2025), making diagnosis and treatment particularly complex.
The scale of the problem is substantial. In England, the 2025 GP Patient Survey found that 4.2% of respondents reported experiencing Long Covid, with a further 9.5% unsure whether they had it. The Long Covid Support status report published in February 2025 estimated approximately 2.5 million people aged 16 and over in England are affected. Although much attention has rightly been given to the physical symptoms, cognitive dysfunction remains one of the most debilitating and persistent symptoms reported by pwLC (Hampshire et al., 2024).
Common Cognitive Symptoms of Long Covid
Long Covid Brain fog
One of the most widely reported symptoms in Long Covid is ‘brain fog’, a non medical term used to describe general cognitive dysfunction including word finding difficulties, memory impairments and attention difficulties, among others. A large scale study published in the New England Journal of Medicine found that participants with unresolved persistent symptoms experienced cognitive losses equivalent to a 6 point reduction in IQ, with those who had been admitted to intensive care showing a 9 point loss (Hampshire et al., 2024). Brain fog has been linked to increased difficulties in daily functioning, with numerous studies confirming its negative impact on quality of life (di Filippo et al., 2023; Jennings et al., 2022; Premraj et al., 2022).
Memory and learning difficulties
Memory and learning are among the primary cognitive concerns for pwLC. People report difficulties with both short term and long term memory, as well as problems involving working memory, attention, concentration and reduced processing speed. Executive function deficits, which affect planning, decision making and problem solving, are also commonly observed (Guo et al., 2022). A longitudinal study following patients for 42 months found that while cognition improved across multiple domains over time, processing speed and executive functioning remained below normal ranges even three and a half years after infection (Jaywant et al., 2024). This suggests that for some people, these are not temporary inconveniences but enduring changes that require sustained support.
Extreme fatigue
Among the most commonly reported and debilitating symptoms is fatigue, affecting a significant proportion of those with Long Covid (Calabria et al., 2022). Fatigue in pwLC is often described as profound, and is frequently exacerbated by even minor physical or mental exertion, a phenomenon known as post exertional malaise. This creates a particularly challenging cycle: the cognitive effort required to compensate for memory and concentration difficulties can itself trigger further fatigue, which in turn worsens cognitive performance.
The Daily Impact: What People Actually Experience
The lived experience of pwLC demonstrates how far reaching cognitive symptoms can be. Through Charlie’s doctoral research working directly with the Long Covid community (Roberts et al., in preparation), a consistent pattern of daily challenges has emerged. People describe missing appointments and medications, not because they do not care, but because the information simply does not stick. There is a pervasive anxiety around memory: a reduced confidence in one’s own ability to remember, which can be as disabling as the memory difficulties themselves.
Many people report difficulties retaining information at work, struggling to maintain employment or continue in education. Household task management becomes effortful. Long Covid brain fog can make even routine tasks feel overwhelming. Social withdrawal is common, often driven by a sense of shame about cognitive symptoms and a fear of forgetting conversations mid flow. The cumulative effect is a significant reduction in independence and confidence, which compounds the emotional burden of living with a chronic condition.
These experiences closely mirror those seen in other neurological conditions such as acquired brain injury and multiple sclerosis, where cognitive rehabilitation and external support strategies have a well established evidence base. This overlap is precisely what drew our team to explore how Recallify, originally designed for conditions like brain injury, could also serve the Long Covid community.
Practical Strategies for Managing Cognitive Symptoms
While there is currently no cure for Long Covid, the NHS and clinical researchers recognise a range of strategies that can help manage cognitive symptoms. Many of these draw on principles that have long been used in neurorehabilitation:
Pacing and energy management. Cognitive overload is a major trigger for brain fog. Breaking tasks into smaller segments and building in regular rest periods can help preserve mental energy throughout the day. The NHS recommends cognitive rehabilitation activities as part of Long Covid treatment, including structured approaches to managing daily tasks.
External memory aids. Relying less on internal memory and more on external supports is a well established compensatory strategy. This might include note taking, voice recordings, calendar reminders and keeping important information in a single, accessible location rather than scattered across notebooks, sticky notes and various apps.
Routine and structure. Establishing consistent daily routines reduces the number of decisions that need to be made, lowering the cognitive demand on an already fatigued system. Routine also helps information become more automatic over time, reducing the burden on working memory.
Active recall and spaced repetition. For those needing to retain information for work or study, techniques grounded in cognitive science can be particularly helpful. Active recall and spaced repetition involve testing yourself on material at gradually increasing intervals, and are among the most evidence based approaches to strengthening retention.
Support networks. Enlisting the help of family, friends, carers or colleagues can distribute the cognitive load. Organisations such as Long Covid Support and Long Covid SOS also provide community, information and advocacy.
How Recallify Could Support People With Long Covid
Recallify was originally developed by Dr Sarah Rudebeck, a senior clinical neuropsychologist with 15 years of NHS experience, to address a gap she identified in everyday cognitive support tools. The app brings together voice recording with AI transcription, automatic task extraction, smart summaries and a searchable memory bank into a single, accessible platform. It was designed for people with acquired brain injury, ADHD, and other neurological and neurodevelopmental conditions, and is currently being evaluated in an NIHR funded feasibility study for brain injury self management.
The cognitive challenges experienced by people with Long Covid overlap significantly with those the app was designed to address. Recording information through voice rather than typing reduces the cognitive and physical effort involved in capturing important details, whether from medical appointments, work meetings or personal thoughts. AI generated summaries mean that users do not need to re listen to entire recordings to retrieve key points. Automatic task detection removes the step of having to manually identify and organise to do items from notes, which is a particular area of difficulty for anyone experiencing executive function deficits. And having everything in one searchable place replaces the need to hunt through multiple notebooks, apps and sticky notes.
Our Long Covid Usability and Feasibility Pilot
Building on Charlie’s research, we are launching a pilot study to understand how easy, clear and helpful Recallify is for people with Long Covid. The study is designed to be accessible and respectful of the energy limitations that many pwLC experience.
The pilot involves three stages. First, an onboarding session where participants receive help with setup and guidance on using the app. This is a supportive, paced introduction, not a rushed tutorial. Questions are encouraged, and the app can be customised to individual needs from the start.
Second, two weeks of use in daily life, however works best for each individual. There are no requirements to use specific features or maintain particular patterns. The aim is to understand how the app integrates into real life, with all its variability and unpredictability.
Third, feedback sharing through a short questionnaire and a conversation about the experience. We want honest feedback: what worked, what didn’t, what was confusing, what was helpful. Critical perspectives are just as valuable as positive ones.
To participate, you need to be:
• Over 18 years of age
• Living with Long Covid
• Able to use a smartphone
Participation is free. The app and all support are provided at no cost for pilot participants, and your feedback will directly shape how Recallify develops for the Long Covid community. If you are interested in taking part or would like more information, please contact charlie@recallify.ai.
Download our Long Covid information leaflet Charlie has also created a printable information leaflet covering what Long Covid is, its cognitive effects on the brain, risk factors, management strategies and support services. Download the leaflet (PDF)
Looking Ahead
Living with Long Covid cognitive symptoms can be exhausting and isolating. The daily struggle with memory, concentration and mental fog touches every aspect of life. But that struggle does not have to be faced alone, and it does not have to be faced without tools.
Technology cannot cure Long Covid or eliminate cognitive symptoms. But it can reduce the burden of remembering, provide structure when thinking feels disorganised, and help restore some measure of independence and confidence. Recallify was built on this principle: that practical, everyday support, designed by clinicians who understand cognitive challenges, can make a meaningful difference.
If you or someone you know is living with Long Covid and struggling with cognitive symptoms, we would love to hear from you. Whether through our pilot study, or simply as someone who could benefit from a cognitive support app designed with these challenges in mind, you are welcome.
Note: Recallify is designed as an everyday support tool and is not a medical device. It does not provide diagnosis or clinical decision support, and is intended to complement, not replace, professional medical care.
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Frequently Asked Questions
What are the cognitive symptoms of Long Covid?
The most common cognitive symptoms include brain fog (difficulty thinking clearly), memory problems affecting both short term and long term recall, reduced concentration and processing speed, word finding difficulties, and executive function deficits that affect planning and decision making. Fatigue often worsens these symptoms, particularly after physical or mental exertion.
How long does Long Covid brain fog last?
The duration varies significantly between individuals. Research following patients for 42 months found that while most cognitive domains improved over time, processing speed and executive functioning remained below normal ranges even three and a half years after infection (Jaywant et al., 2024). For some people symptoms resolve within months, while for others they persist much longer.
Can Long Covid cause permanent memory problems?
Current research suggests that most people experience gradual cognitive improvement, but the timeline can be extended. A large study published in the New England Journal of Medicine found cognitive effects equivalent to a 6 point IQ reduction in people with unresolved symptoms (Hampshire et al., 2024). Ongoing research is investigating whether certain cognitive changes may be long lasting, which is why sustained support strategies are important.
What helps with Long Covid brain fog?
Strategies that have shown benefit include pacing and energy management to avoid cognitive overload, using external memory aids such as voice recordings, notes and reminders, establishing consistent daily routines, and practising active recall and spaced repetition for information retention. Cognitive rehabilitation, recommended by the NHS as part of Long Covid treatment, can also help.
How common is Long Covid in the UK?
The 2025 GP Patient Survey found that 4.2% of respondents in England reported experiencing Long Covid, with a further 9.5% unsure. The Long Covid Support status report published in February 2025 estimated approximately 2.5 million people aged 16 and over in England are affected, with over a third having symptoms lasting more than two years.
References
Aretouli, E., Malik, M., Widmann, C., Parker, A. M., Oh, E. S., & Vannorsdall, T. D. (2025). Cognitive and mental health outcomes in long covid. BMJ, 390, e081349. https://doi.org/10.1136/bmj-2024-081349
Baazaoui, N., & Iqbal, K. (2022). COVID 19 and Neurodegenerative Diseases: Prion Like Spread and Long Term Consequences. Journal of Alzheimer’s Disease, 88(2), 399–416.
Calabria, M., Garcia Sanchez, C., Grunden, N., et al. (2022). Post COVID 19 fatigue: the contribution of cognitive and neuropsychiatric symptoms. Journal of Neurology. https://doi.org/10.1007/s00415-022-11141-8
Callard, F., & Perego, E. (2021). How and why patients made Long Covid. Social Science & Medicine, 268, 113426.
Davis, H. E., McCorkell, L., Vogel, J. M., & Topol, E. J. (2023). Long COVID: major findings, mechanisms and recommendations. Nature Reviews Microbiology, 21(6), 408.
di Filippo, L., Frara, S., Nannipieri, F., et al. (2023). Low Vitamin D Levels Are Associated With Long COVID Syndrome in COVID 19 Survivors. The Journal of Clinical Endocrinology and Metabolism, 108(10), e1106–e1116.
Greenhalgh, T., Sivan, M., Perlowski, A., & Nikolich, J. Ž. (2024). Long COVID: A clinical update. The Lancet, 404(10453), 707–724.
Guo, P., Benito Ballesteros, A., Yeung, S. P., et al. (2022). COVCOG 2: Cognitive and Memory Deficits in Long COVID. Frontiers in Aging Neuroscience, 14.
Hampshire, A., Azor, A., Atchison, C., et al. (2024). Cognition and Memory after Covid 19 in a Large Community Sample. The New England Journal of Medicine, 390(9), 806–818.
Jaywant, A., Gunning, F. M., Oberlin, L. E., et al. (2024). Cognitive Symptoms of Post COVID 19 Condition and Daily Functioning. JAMA Network Open, 7(2), e2356098.
Jennings, G., Monaghan, A., Xue, F., Duggan, E., & Romero Ortuño, R. (2022). Comprehensive Clinical Characterisation of Brain Fog in Adults Reporting Long COVID Symptoms. Journal of Clinical Medicine, 11(12), 3440.
Miners, S., Kehoe, P. G., & Love, S. (2020). Cognitive impact of COVID 19: Looking beyond the short term. Alzheimer’s Research & Therapy, 12(1), 170.
Poletti, S., Palladini, M., Mazza, M. G., et al. (2022). Long term consequences of COVID 19 on cognitive functioning up to 6 months after discharge. European Archives of Psychiatry and Clinical Neuroscience, 272(5), 773–782.
Premraj, L., Kannapadi, N. V., Briggs, J., et al. (2022). Mid and long term neurological and neuropsychiatric manifestations of post COVID 19 syndrome: A meta analysis. Journal of the Neurological Sciences, 434, 120162.
Roberts, C., et al. (in preparation). [Doctoral research on Long Covid and memory].
Taquet, M., Sillett, R., Zhu, L., et al. (2022). Neurological and psychiatric risk trajectories after SARS CoV 2 infection. The Lancet Psychiatry, 9(10), 815–827.