Adrian Black remembers when he got the news from the neurologist: “We definitely think there’s something wrong with your brain,” the specialist said. It was 2022, and Black, who worked as a mediator in Brighton in the U.K., had been to doctors for unusual fatigue, brain fog, and a peculiar stutter that had crept into his speech. In the end, he was diagnosed with Long Covid, the umbrella diagnosis for symptoms that arise or persist long after an initial Covid infection and that has affected hundreds of millions worldwide.
There is no lab test for Long Covid yet, nor are there widely accepted treatments. A small clinical trial published July 1 in JAMA Network Open explores whether cognitive rehabilitation, a technique used to help people recover from strokes and other neurological injuries, can help Long Covid patients—like Black, who was a participant in the trial—with some of their symptoms. Although the treatment didn’t affect people’s scores on cognitive tests, the team found that it positively affected their ability to achieve their goals.
What is cognitive rehabilitation?
Cognitive rehabilitation therapy involves learning new strategies for achieving tasks, says Martina Vanova, a researcher at Kingston University London and lead author of the new paper. For people with Long Covid symptoms that include having difficulty completing tasks—like cooking dinner, for instance—that can mean dividing them up into small chunks, taking frequent short breaks, and narrating each step to themselves as they go, a technique called “self instruction” that can help minimize distraction.
“We usually tell them, ‘Talk to yourself, describe to yourself what you’re doing,’” Vanova says. “If, for example, if they are cooking, we say, ‘Pretend that you are in a cooking show, and talk yourself through the instructions, so you stay in touch with what you’re actually doing.’” It’s also important to learn how to take a cognitive break, which can be focused breathing for a period of 5 minutes for every 10 minutes of activity, for instance, says Vanova.
To be included in the study, Long Covid patients had to have objective cognitive impairment. Vanova or a colleague met with about 40 people for one hour a week for ten weeks, helping them set a series of personalized goals (like writing a report for 30 minutes without needing to stop), and teaching them strategies to try out to achieve them. A separate control group received no treatment.
Can cognitive rehab make a difference for Long Covid?
Three months after the study began, and again at six months, the researchers ran a series of tests on the participants. While there was no difference between the two groups on most measures, the group that had received treatment scored higher on a measure called “goal attainment,” which is used in assessing treatment effectiveness in Alzheimer’s patients. People who’d had rehabilitative therapy made more progress toward their goals than those who hadn’t, and they sustained that difference over time.
That might sound like not much of an effect. But a larger study published in 2025 found that Long Covid patients who received cognitive rehabilitation performed no better than patients in the control group who were told to work on computer games instead of receiving therapy. This discrepancy in findings might in part be due to the fact that patients in the 2025 study did not have to have a cognitive abnormality to participate, so the patients in the new study may have been more severely affected to start with, says Dr. David Knopman, a clinical neurologist at the Mayo Clinic in Rochester, Minnesota, and an author of that study.
The new study also gave people in the control group no treatment at all, a difference from the 2025 study. “The fact that their active treatment had human contact and the control group had zip could explain the findings that they observed,” says Knopman, “because in our study, where we had what we thought was a comparison that had no therapeutic benefit, the participants benefited from it to the same degree.” In other words, everybody gradually got better regardless of the treatment.
These investigations are just the beginning
Beyond the context of clinical trials, doctors have been testing similar treatment approaches to Long Covid for some time, says Dr. Lindsay McAlpine, a neurologist at Yale School of Medicine who was not involved in the new study. “Overall, the findings are not surprising, but they are extremely encouraging because they validate what many of us have observed clinically,” she wrote in an email, noting that such therapies must be tailored to the individual patients and should take care to avoid triggering post-exertional malaise, where exertion, either cognitive or physical, can have negative aftereffects for patients. “These findings support the concept that the Long COVID brain retains substantial neuroplasticity and capacity for recovery, even in the setting of an ongoing disease process, similar to what we observe after stroke or in multiple sclerosis.”
However, Hannah Davis, a Long Covid researcher and co-founder of the Patient-Led Research Collaborative (PLRC), says that while positive results can gain attention, there are larger questions that need to be answered about the illness. “In the broader landscape of Long COVID treatment, cognitive rehabilitation falls well short of what is needed,” she wrote in an email. “The Long COVID patient community wants resources directed toward more curious and promising treatments and trials.” She points to a recent symposium where research on molecular tests for Long Covid and insights into the syndrome’s biology were presented.
For Adrian Black, the trial marked the beginning of a substantial improvement in his cognitive symptoms. “I was willing to try anything,” he recalls. His goals involved being able to give a short presentation without having to stop and being able to remember where he was in an activity after being distracted. After the sessions, “I thought, ‘Actually, that would have been really useful if I’d done that at age 20,’” he reflects—at that age, you take your cognitive abilities for granted. “But if you [lose that], you have to relearn.”
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