Neurocognitive Rehabilitation: Effective Therapy for Post-COVID Cognitive Symptoms
Behavioral Health Insights
By Micah Hoffman, MD, DABPN, FAPA, QME, CIME, CHCQM
AllMed Behavioral Health Medical Director
Approximately 10 percent of people who have had COVID-19 develop lingering symptoms, known as long COVID.1 Among the most frequently cited complaints are problems with attention, language, information processing, memory, and visual-spatial orientation. Such long-term symptoms often interact with neurological and mental health to affect a person’s daily functioning, from their ability to communicate clearly to their capacity for work to the stability of their relationships. Given the impact, it’s not surprising that patients with long COVID regularly rank cognitive function and mental health at the top of their concerns.2 Medical professionals and researchers working in this area are finding that neurocognitive rehabilitation, a familiar form of therapy effective in treating individuals with brain injury, is helping many post-COVID patients make significant gains.3
Treatment Plans Individualized to Meet Specific Needs
Neurocognitive rehabilitation—also referred to as cognitive rehabilitation therapy, or CRT— is therapy originally developed for people whose brains have been injured by concussions, traumatic accidents, strokes, or neurodegenerative conditions such as Parkinson’s disease. Rather than a singular, one-size-fits-all approach, it’s a set of interventions designed to rehabilitate cognitive functioning. CRT usually involves several experts working together to develop a comprehensive plan to restore as much function as possible. Services are typically provided by a combination of speech and occupational therapists, neuropsychologists, and neurorehabilitation experts.
CRT comes in many different forms. Some examples include:
Attention processing training (APT), which uses progressively more challenging tasks to help a person improve their attentiveness; and
Computer-assisted learning, for example with computer memory and attention games, to help a person regain attention and memory.
For many long COVID patients, CRT offers a comprehensive treatment approach that can target their specific needs.
Identifying When Neurocognitive Rehabilitation Is Appropriate
Specialists emphasize that before trying CRT, it’s important to consider whether there are other problems that may need to be addressed. Getting sufficient sleep, maintaining nutrition and hydration, and getting physical exercise that maintains blood flow and oxygenation to the brain all impact cognitive function and communication. Post-COVID patients should continue to see physicians and medical specialists to rule out or address any underlying physiological issues.
Once other causes have been ruled out and an individual is referred to CRT, the first step is typically an assessment by a rehabilitation professional. This assessment helps to identify specific cognitive tasks that need help and determine the severity of a person’s difficulties. A person may need help with planning or processing information. Another may need help finding the right words while speaking. It’s possible for more than one deficit to co-occur.
The next step is to identify how the person’s cognitive issues are impacting their daily life. Then, to restore the brain circuits that have been damaged, patients may be prescribed a series of repetitive exercises—a sort of muscle building for the brain—and work with therapists on practical strategies including making lists, setting alarms or reminders, breaking down tasks into steps, balancing activity with rest, and learning how to slow down and assess what needs to be done before taking action.
Studies to date show that neurocognitive rehabilitation can improve or maintain patients’ cognitive abilities related to daily task performance, so as to prevent or delay cognitive decline.4 As awareness of the treatment’s potential spreads, researchers are exploring new approaches enabled by technology. Neurocognitive rehabilitation traditionally has taken place under face-to-face guidance by rehabilitation therapists, but recent experiences with remote home rehabilitation show its promise as a cost-effective alternative for meeting the needs of certain patients.5
Optimizing Treatment for Members Affected by Long COVID
Increasingly, scientific literature points to neurocognitive rehabilitation as a uniquely positioned form of therapy to provide intervention in the acute, subacute, and chronic stages of neuropsychological recovery.6 As recognition grows, health plans and providers are putting this familiar model to work, using a variety of approaches, for the benefit of their members and patients. Leveraging the expertise of the board-certified specialists on the AllMed behavioral health panel can strengthen these efforts. Evidence-based guidance from AllMed experts helps plans develop the most effective cognitive rehabilitation and other interventions to optimize outcomes for members affected by persistent post-COVID cognitive symptoms.
- Greenhalgh, T., Knight, M., et al. Management of post-acute covid-19 in primary care. Aug 11, 2020. BMJ 2020;370:m3026. Accessed September 20, 2022.
- Schreiber, Melody. Treating patients with long COVID. American Psychological Association. Jul 21, 2021. https://www.apa.org/monitor/2021/07/treating-long-covid. Accessed September 20, 2022.
- Graham, Judith. Cognitive Rehab May Help Older Adults Clear Covid-Related Brain Fog. Kaiser Health News. Aug 5, 2022. https://khn.org/news/article/cognitive-rehab-older-adults-covid-brain-fog/. Accessed September 20, 2022.
- Irazoki E., Contreras-Somoza L. M., Toribio-Guzmán J. M., Jenaro-Río C., van der Roest H., Franco-Martín M. A. (2020). Technologies for cognitive training and cognitive rehabilitation for people with mild cognitive impairment and dementia. A systematic review. Front. Psychol. 11:648.