TY - JOUR
T1 - Cognitive and Psychological Symptoms in Post-COVID-19 Condition
T2 - A Systematic Review of Structural and Functional Neuroimaging, Neurophysiology, and Intervention Studies
AU - Pettemeridou, Eva
AU - Loizidou, Maria
AU - Trajkovic, Jelena
AU - Constantinou, Maria
AU - De Smet, Stefanie
AU - Baeken, Chris
AU - Sack, Alexander T.
AU - Williams, Steven C.R.
AU - Constantinidou, Fofi
N1 - Publisher Copyright:
© 2025 The Authors
PY - 2025
Y1 - 2025
N2 - Objective: To investigate the structural, functional, and neurophysiological brain changes associated with post-COVID-19 condition (PCC)-related cognitive and psychological issues and evaluate the efficacy of noninvasive brain stimulation (NIBS) and cognitive rehabilitation interventions. Data Sources: Electronic databases, including Web of Science, PubMed, and Embase, were systematically searched for articles published before February 1, 2025, using terms such as “post-COVID-19 condition,” “cognitive dysfunction,” “brain changes,” “noninvasive brain stimulation,” and “cognitive rehabilitation.” Language was restricted to English, and only studies involving human participants were included. Study Selection: Studies with human participants aged ≥18 years diagnosed with PCC, employing magnetic resonance imaging, functional magnetic resonance imaging, positron emission tomography, and electroencephalography, and interventions such as NIBS and cognitive rehabilitation were included. Articles were selected through independent review by multiple authors, with consensus resolving discrepancies. Of the 123 studies initially identified, 78 met the inclusion criteria. Data Extraction: Data on participant demographics, methodologies, neurophysiological changes, and intervention outcomes were extracted by 2 independent reviewers using predefined guidelines. Study quality was assessed using the Newcastle-Ottawa Scale and Critical Appraisal Skills Program tools. Data Synthesis: Seventy-eight studies with over 5900 participants met the inclusion criteria. Significant cognitive impairments were observed in attention, executive function, and memory (N=78). Key findings included mixed evidence of gray matter (N=16) and white matter volume changes (N=20), cortical thickness alterations (N=9), variations in functional connectivity (N=14), electrophysiology (N=9), and blood flow (N=8). NIBS, including transcranial magnetic stimulation (N=8) and transcranial direct current stimulation (N=2), showed potential benefits for managing depression and cognitive impairments. Although cognitive rehabilitation (N=3) showed promise, it requires further investigation. Conclusions: This review highlights the complex neurologic underpinnings of PCC and the potential of NIBS and cognitive rehabilitation as interventions. Further research is essential to refine these interventions and establish evidence-based strategies for addressing long-term cognitive and psychological effects of PCC.
AB - Objective: To investigate the structural, functional, and neurophysiological brain changes associated with post-COVID-19 condition (PCC)-related cognitive and psychological issues and evaluate the efficacy of noninvasive brain stimulation (NIBS) and cognitive rehabilitation interventions. Data Sources: Electronic databases, including Web of Science, PubMed, and Embase, were systematically searched for articles published before February 1, 2025, using terms such as “post-COVID-19 condition,” “cognitive dysfunction,” “brain changes,” “noninvasive brain stimulation,” and “cognitive rehabilitation.” Language was restricted to English, and only studies involving human participants were included. Study Selection: Studies with human participants aged ≥18 years diagnosed with PCC, employing magnetic resonance imaging, functional magnetic resonance imaging, positron emission tomography, and electroencephalography, and interventions such as NIBS and cognitive rehabilitation were included. Articles were selected through independent review by multiple authors, with consensus resolving discrepancies. Of the 123 studies initially identified, 78 met the inclusion criteria. Data Extraction: Data on participant demographics, methodologies, neurophysiological changes, and intervention outcomes were extracted by 2 independent reviewers using predefined guidelines. Study quality was assessed using the Newcastle-Ottawa Scale and Critical Appraisal Skills Program tools. Data Synthesis: Seventy-eight studies with over 5900 participants met the inclusion criteria. Significant cognitive impairments were observed in attention, executive function, and memory (N=78). Key findings included mixed evidence of gray matter (N=16) and white matter volume changes (N=20), cortical thickness alterations (N=9), variations in functional connectivity (N=14), electrophysiology (N=9), and blood flow (N=8). NIBS, including transcranial magnetic stimulation (N=8) and transcranial direct current stimulation (N=2), showed potential benefits for managing depression and cognitive impairments. Although cognitive rehabilitation (N=3) showed promise, it requires further investigation. Conclusions: This review highlights the complex neurologic underpinnings of PCC and the potential of NIBS and cognitive rehabilitation as interventions. Further research is essential to refine these interventions and establish evidence-based strategies for addressing long-term cognitive and psychological effects of PCC.
KW - Brain injuries
KW - Cognitive rehabilitation
KW - EEG
KW - Functional connectivity
KW - Long COVID
KW - MRI
KW - Neuropsychological impairment
KW - Noninvasive brain stimulation
KW - Rehabilitation
KW - White matter changes
UR - http://www.scopus.com/inward/record.url?scp=105006948494&partnerID=8YFLogxK
U2 - 10.1016/j.arrct.2025.100461
DO - 10.1016/j.arrct.2025.100461
M3 - Review article
AN - SCOPUS:105006948494
SN - 2590-1095
JO - Archives of Rehabilitation Research and Clinical Translation
JF - Archives of Rehabilitation Research and Clinical Translation
M1 - 100461
ER -