Cognitive rehabilitation can help long Covid sufferers regain control of their lives, a major trial has shown — offering the first clinically meaningful and lasting treatment for the cognitive symptoms that have left millions struggling with brain fog, memory loss and exhaustion.
Adrian Black, a 62-year-old from Brighton, knows that battle intimately. After catching Covid in spring 2020 and then several more times, he began noticing “weird symptoms” in November 2021. “On a bad day I would get up and have breakfast before going back to bed,” he said. “I was stammering and I was forgetting appointments, which I’ve never done in my life.” The fatigue became so severe that during a day trip to London with his wife, he ended up slumped over a café table, unable to move.
A GP referred Mr Black to a neurologist to test whether his brain fog and anxiety were caused by a tumour or a degenerative disease. Doctors found nothing wrong and suggested the culprit could be long Covid. Before the illness, Mr Black had run a property business, chaired a local charity and managed an Airbnb. Afterwards, he could no longer work full-time and struggled to keep track of even basic appointments.
How the cognitive rehabilitation programme works
Mr Black was among 78 participants in a trial led by researchers at University College London, published in JAMA Network Open. The study targeted cognitive long Covid symptoms — such as brain fog, attention lapses and memory problems — that can persist for months or even years. The treatment was delivered through hour-long, one-to-one video sessions with a therapist over ten weeks. Participants set three personal goals they wanted to achieve, such as being able to concentrate on a full film or read a book without losing focus. Therapists then helped them devise tailored strategies to reach those goals.
The results were striking. Three months after completing the programme, 84% of those who received cognitive rehabilitation had attained their goals, compared with 53% of a control group who continued with standard NHS care. After six months, 53% of the rehabilitation group maintained substantial improvement — defined as a four-point gain on a ten-point scale — against just 15% in the comparison group. Measured improvements also appeared in executive functions including cognitive flexibility and processing speed. Early analysis suggests the programme is cost-effective, raising the possibility of wider rollout.
Dr Martina Vanova, the lead author who has since moved to Kingston University, said: “As many as one in three people with Covid go on to develop long Covid, and cognitive difficulties are among the most common symptoms that can persist for months, disrupting day-to-day functioning and quality of life. People might find it hard to focus or hold on to their thoughts as they struggle with memory, attention and planning, often compounded by fatigue.” The trial was co-led by Dr Aida Suarez-Gonzalez from UCL Queen Square Institute of Neurology and Professor Dennis Chan from UCL Institute of Cognitive Neuroscience.
For Mr Black, the approach was transformative. One of his goals was to remember where he had left an activity after being distracted; another was to talk to groups of people again after his stammer had made even family conversations difficult. By planning tasks and using structured routines, he succeeded in speaking at a charity event. “I was getting in a mess because I was starting things and forgetting things,” he said. “I was used to being someone who was quite productive, but by putting a structure and plan in place, I was making fewer mistakes.”
Ongoing challenges and wider impact
Despite the progress, Mr Black estimates he is still only 80% of who he used to be. His story reflects a far larger crisis. An estimated two million people in the UK — about 3.3% of the population in England and Scotland as of March 2024 — are living with long Covid. The condition is diagnosed when symptoms persist for more than twelve weeks after infection and cannot be explained by another cause. It is a complex illness with multiple subtypes and shares features with other post-viral syndromes. Factors that increase the risk include pre-existing health conditions, severity of the initial infection, being female, aged 35–69, living in more deprived areas, and working in health and social care. Vaccination has been shown to reduce the risk.
The impact on the workforce has been severe. An estimated 80,000 people have left employment because of long Covid, while 62% of those affected have had to take sick leave, reduce hours, change roles or quit altogether. Lost income is a significant problem, and the economic burden — including GDP losses, household income falls and higher healthcare spending — is substantial. The NHS in England has set up specialist post-COVID services offering multidisciplinary assessments and onward referrals, though responsibility for commissioning these services shifted to local integrated care boards in April 2024, which may lead to variations in provision. Government support is available through Statutory Sick Pay, Universal Credit, Employment and Support Allowance and Personal Independence Payment, while charities such as Long Covid Support and Long Covid SOS continue to campaign for better healthcare, research and employment rights.
Research into treatments is accelerating. Investigators are exploring potential autoimmune responses in which antibodies attack brain and nerve tissues, and clinical trials are testing immune-modulating agents, anti-inflammatory drugs, low-dose naltrexone and even EEG-sensing headbands for sleep disorders. UCL is also running the larger STIMULATE-ICP trial, which aims to develop integrated care pathways and drug treatments. For now, the cognitive rehabilitation programme offers a concrete, evidence-backed way forward — but it is not a cure, and many people remain without access to such specialist help.