Cognitive rehab shows promise for long COVID brain fog

Clinical takeaway: Consider referral for structured, goal-oriented cognitive rehabilitation in patients with long COVID–related cognitive impairment. In this trial, individualized telehealth-based rehabilitation produced clinically meaningful functional gains that persisted for at least 6 months.

Long COVID–associated cognitive impairment affects more than 1 in 4 COVID-19 survivors and can substantially disrupt work, independence, and quality of life. Effective treatments have been lacking.

In the multicenter CICERO randomized trial, investigators enrolled 78 adults (mean age, 47 years; 69% women) with persistent cognitive symptoms and objectively verified cognitive impairment following COVID-19 infection. Participants were randomized to either 10 weekly 1-hour cognitive rehabilitation sessions delivered via telehealth or treatment as usual.

The intervention focused on helping participants achieve 3 personally meaningful goals—typically related to work performance, organization, attention, or daily functioning—using evidence-based cognitive strategies such as routine building, pacing, goal management, cueing, and environmental restructuring.

At 3 months, patients receiving cognitive rehabilitation reported substantially greater goal attainment than those receiving usual care, with scores nearly 60% higher (7.8 vs 5.0 on a 10-point scale). Improvements remained evident at 6 months (7.5 vs 5.7). Overall, 84% of patients in the rehabilitation group achieved a clinically meaningful improvement in goal attainment by 3 months, compared with 53% of controls. More stringent major improvements were seen in 66% vs 15%, respectively.

Cognitive rehabilitation also improved goal satisfaction and produced modest gains in executive function and processing speed. However, the intervention did not significantly improve fatigue, anxiety, depression, sleep quality, or most standard cognitive test measures. No treatment-related adverse events were reported.

As the authors noted, “goal-oriented cognitive rehabilitation improved self-reported goal attainment in people with long COVID and cognitive impairment,” with benefits that were “clinically meaningful and sustained at 6 months.” These findings provide some of the first randomized-trial evidence supporting cognitive rehabilitation as a treatment option for long COVID–related cognitive impairment.

Source: Vanova M, et al. (2026 July 1) JAMA Netw Open. Cognitive Rehabilitation and Functional Outcomes in Long COVID–Related Cognitive Impairment: A Randomized Clinical Trial