Cognitive sequelae in patients with severe COVID-19: preliminary evidence from Paraguay
Keywords:
Deterioro cognitivo, atención, memoria, fluidez verbal, COVID-19 graveAbstract
This preliminary study analyzed cognitive alterations in patients who had recovered from severe COVID-19, comparing them with patients who had experienced mild forms of the disease. Delayed memory, attention, verbal fluency, and global cognitive performance were assessed using the Montreal Cognitive Assessment (MoCA), administered after clinical recovery. The sample included 20 adults residing in Ciudad del Este, Paraguay, divided into two groups according to clinical severity. Patients with severe COVID-19 showed lower delayed memory scores than those with mild COVID-19 (3.1 ± 1.7 vs. 4.7 ± 0.7; p = 0.002), lower verbal fluency scores (1.7 ± 0.8 vs. 2.4 ± 0.5; p = 0.002), and lower total MoCA scores (20.5 ± 2.3 vs. 25.9 ± 1.9; p < 0.001). Differences in attention did not reach statistical significance (p = 0.11). These findings provide preliminary evidence of possible persistent cognitive sequelae following severe COVID-19 and support the need for neurocognitive follow-up. Longitudinal studies with larger samples and analyses adjusted for age, comorbidities, educational level, and length of hospitalization are recommended.
Downloads
References
Aboaja, A., Wahab, A., Cao, Y. Y., O’Higgins, M., & Torales, J. (2022). Mental health in the Republic of Paraguay. BJPsych International, 19(1), 10–12. https://doi.org/10.1192/bji.2021.24
Aguilar-Navarro, S. G., Mimenza-Alvarado, A. J., Palacios-García, A. A., Samudio-Cruz, A., Gutiérrez-Gutiérrez, L. A., & Ávila-Funes, J. A. (2018). Validity and reliability of the Spanish version of the Montreal Cognitive Assessment (MoCA) for the detection of cognitive impairment in Mexico. Revista Colombiana de Psiquiatría, 47(4), 237–243. https://doi.org/10.1016/j.rcp.2017.05.003
Alkodaymi, M. S., Omrani, O. A., Fawzy, N. A., Shaar, B. A., Almamlouk, R., Riaz, M., Obeidat, M., Obeidat, Y., Gerberi, D., Taha, R. M., Kashour, Z., Kashour, T., Berbari, E. F., Alkattan, K., & Tleyjeh, I. M. (2022). Prevalence of post-acute COVID-19 syndrome symptoms at different follow-up periods: A systematic review and meta-analysis. Clinical Microbiology and Infection, 28(5), 657–666. https://doi.org/10.1016/j.cmi.2022.01.014
Almeria, M., Cejudo, J. C., Sotoca, J., Deus, J., & Krupinski, J. (2020). Cognitive profile following COVID-19 infection: Clinical predictors leading to neuropsychological impairment. Brain, Behavior, & Immunity - Health, 9, 100163. https://doi.org/10.1016/j.bbih.2020.100163
American Psychological Association. (2017). Ethical principles of psychologists and code of conduct. https://www.apa.org/ethics/code
Becker, J. H., Lin, J. J., Doernberg, M., Stone, K., Navis, A., Festa, J. R., & Wisnivesky, J. P. (2021). Assessment of cognitive function in patients after COVID-19 infection. JAMA Network Open, 4(10), e2130645. https://doi.org/10.1001/jamanetworkopen.2021.30645
Boldrini, M., Canoll, P. D., & Klein, R. S. (2021). How COVID-19 affects the brain. JAMA Psychiatry, 78(6), 682–683. https://doi.org/10.1001/jamapsychiatry.2021.0500
Crivelli, L., Calandri, I., Corvalán, N., Carello, M. A., Keller, G., Martínez, C., Arruabarrena, M., & Allegri, R. (2022). Cognitive consequences of COVID-19: Results of a cohort study from South America. Arquivos de Neuro-Psiquiatria, 80(3), 240–247. https://doi.org/10.1590/0004-282X-ANP-2021-0320
Doskas, T., Vavougios, G. D., Kormas, C., Kokkotis, C., Tsiptsios, D., Spiliopoulos, K. C., Tsiakiri, A., Christidi, F., Aravidou, T., Dekavallas, L., Kazis, D., Dardiotis, E., & Vadikolias, K. (2025). Neurocognitive impairment after COVID-19: Mechanisms, phenotypes, and links to Alzheimer’s disease. Brain Sciences, 15(6), 564. https://doi.org/10.3390/brainsci15060564
Elboraay, T., Ebada, M. A., Elsayed, M., Aboeldahab, H. A., Salamah, H. M., Rageh, O., Elmallahy, M., AboElfarh, H. E., Mansour, L. S., Nabil, Y., Eltawab, A. K. A., Atwan, H., & Alkanj, S. (2025). Long-term neurological and cognitive impact of COVID-19: A systematic review and meta-analysis in over 4 million patients. BMC Neurology, 25(1), 250. https://doi.org/10.1186/s12883-025-04174-9
García-Molina, A., García-Carmona, S., Espiña-Bou, M., Rodríguez-Rajo, P., Sánchez-Carrión, R., & Enseñat-Cantallops, A. (2024). Neuropsychological rehabilitation for post-COVID-19 syndrome: Results of a clinical programme and six-month follow-up. Neurologia, 39(7), 592–603. https://doi.org/10.1016/j.nrleng.2022.06.007
Hampshire, A., Trender, W., Chamberlain, S. R., Jolly, A. E., Grant, J. E., Patrick, F., Mazibuko, N., Williams, S. C., Barnby, J. M., Hellyer, P., & Mehta, M. A. (2021). Cognitive deficits in people who have recovered from COVID-19. EClinicalMedicine, 39, 101044. https://doi.org/10.1016/j.eclinm.2021.101044
Hosp, J. A., Dressing, A., Blazhenets, G., Bormann, T., Rau, A., Schwabenland, M., Thurow, J., Wagner, D., Waller, C., Niesen, W. D., Frings, L., Urbach, H., Prinz, M., Weiller, C., Schroeter, N., & Meyer, P. T. (2021). Cognitive impairment and altered cerebral glucose metabolism in the subacute stage of COVID-19. Brain, 144(4), 1263–1276. https://doi.org/10.1093/brain/awab009
Jaywant, A., Vanderlind, W. M., Alexopoulos, G. S., Fridman, C. B., Perlis, R. H., & Gunning, F. M. (2021). Frequency and profile of objective cognitive deficits in hospitalized patients recovering from COVID-19. Neuropsychopharmacology, 46(13), 2235–2240. https://doi.org/10.1038/s41386-021-00978-8
Labos, E., Zabala, K., Renato, A., Trojanowski, S., Del Rio, M., Fustinoni, O., & Vázquez, N. (2021). Restricción cognitiva durante la cuarentena por COVID-19. Medicina (Buenos Aires), 81(5), 722–734. https://medicinabuenosaires.com/revistas/vol81-21/n5/indice.pdf
Manríquez-López, L., Saldaña García, C. N., Gómez Quiroz, R. M., Enríquez González, K. E., Aranda Montiel, S., García Ramírez, R., & Martínez Flores, F. G. (2021). Afectaciones cognitivo-lingüísticas en personas con COVID-19: Una revisión sistemática de la literatura empírica. Cuadernos de Neuropsicología (Panamerican Journal of Neuropsychology), 15(3), 37–53. https://doi.org/10.7714/CNPS/15.3.203
Mazza, M. G., Palladini, M., De Lorenzo, R., Magnaghi, C., Poletti, S., Furlan, R., Ciceri, F., COVID-19 BioB Outpatient Clinic Study Group, Rovere-Querini, P., & Benedetti, F. (2021). Persistent psychopathology and neurocognitive impairment in COVID-19 survivors: Effect of inflammatory biomarkers at three-month follow-up. Brain, Behavior, and Immunity, 94, 138–147. https://doi.org/10.1016/j.bbi.2021.02.021
Ministerio de Salud Pública y Bienestar Social. (2020). Plan Nacional de Respuesta a Virus Respiratorios 2020. https://www.mspbs.gov.py/dependencias/portal/adjunto/d7eb84ResolucinN91Seapruebaplannacionalderespuestaavirusrespiratorios2020.pdf
Ministerio de Salud Pública y Bienestar Social. (2021a, mayo 6). En casa: Rehabilitación respiratoria para pacientes. https://www.mspbs.gov.py/portal/23088/en-casa-rehabilitacion-respiratoria-para-pacientes.html
Ministerio de Salud Pública y Bienestar Social. (2021b, junio 20). Post COVID-19: Ejercicios de rehabilitación para hacerlos en casa. https://www.mspbs.gov.py/portal/23379/post-covid-19-ejercicios-de-rehabilitacion-parahacerlos-en-casa.html
Ministerio de Salud Pública y Bienestar Social. (2024). Plan Nacional de Respuesta ante Emergencias con Enfoque Multiamenazas (Resolución S. G. N.º 770/2024). https://www.mspbs.gov.py/portal/32902/salud-apruebaplan-nacional-de-respuesta-ante-emergencias-con-enfoque-multiamenazas.html
Miskowiak, K. W., Johnsen, S., Sattler, S. M., Nielsen, S., Kunalan, K., Rungby, J., Lapperre, T., & Porsberg, C. M. (2021). Cognitive impairments four months after COVID-19 hospital discharge: Pattern, severity and association with illness variables. European Neuropsychopharmacology, 46, 39–48. https://doi.org/10.1016/j.euroneuro.2021.03.019
Nasreddine, Z. S., Phillips, N. A., Bédirian, V., Charbonneau, S., Whitehead, V., Collin, I., Cummings, J. L., & Chertkow, H. (2005). The Montreal Cognitive Assessment, MoCA: A brief screening tool for mild cognitive impairment. Journal of the American Geriatrics Society, 53(4), 695–699. https://doi.org/10.1111/j.1532-5415.2005.53221.x
Organización Panamericana de la Salud. (2023). Condición post COVID-19 (COVID largo). https://www.paho.org/es/temas/coronavirus/brote-enfermedad-por-coronavirus-covid-19/condicion-postcovid-19
Pérez Sánchez, M. (2022). Síntomas cognitivos en la COVID-19 persistente: Un análisis neuropsicológico [Trabajo de máster, Universidad de Catalunya]. Repositorio UOC. http://hdl.handle.net/10609/139907
Taquet, M., Geddes, J. R., Husain, M., Luciano, S., & Harrison, P. J. (2021). 6-month neurological and psychiatric outcomes in 236,379 survivors of COVID-19: A retrospective cohort study using electronic health records. The Lancet Psychiatry, 8(5), 416–427. https://doi.org/10.1016/S2215-0366(21)00084-5
Thomas, M., Hameed, M., Hussein, M., George, S., Rajalekshmi, M. R., Akram, J., Sharma, R., Al Adab, A. H. O., Ahmad, M., Singh, R., & Raza, T. (2024). A prospective cohort study on cognitive and psychological outcomes in COVID-19 ICU survivors at 3 months of follow-up. Frontiers in Medicine, 11, 1288761. https://doi.org/10.3389/fmed.2024.1288761
Torales, J., & Barrios, I. (2023). Diseño de investigaciones: Algoritmo de clasificación y características esenciales. Medicina Clínica y Social, 7(3), 210–235. https://doi.org/10.52379/mcs.v7i3.349
World Medical Association. (2013). Declaration of Helsinki: Ethical principles for medical research involving human subjects. JAMA, 310(20), 2191–2194. https://doi.org/10.1001/jama.2013.281053
Downloads
Published
Issue
Section
License
Copyright (c) 2026 Eliana M. Jara Casco, Edgar Fernando Gamarra Silva, Ronaldo L. Rodas Jara, Liza R. Rodas Jara, Diana Báez Delvalle, María Isabel Rodríguez- Riveros, Julio Torales
This work is licensed under a Creative Commons Attribution 4.0 International License.
