Executive functioning after COVID-19: Associations between self-report, informant-report, objective cognition, and psychological factors. A prospective cohort study

BACKGROUND: COVID-19 has been associated with cognitive sequelae, particularly in executive functions (EFs). However, the relationship between subjective executive difficulties, objective cognitive performance, and psychological factors remains unclear. METHODS: 174 COVID-19 patients (ICU-, WARD-, or home-treated) and 51 non-COVID controls were assessed at 3 and 6 months post-infection. Executive function was measured with the Behavior Rating Inventory of Executive Function-Adults (BRIEF-A) self- and informant-report versions. Objective cognition was assessed across attention, memory, and executive domains. Psychological symptoms (depression PHQ-9, anxiety GAD-7, PTSD symptoms IES-6) and fatigue (MFI-20) were also evaluated. Group differences, self-informant agreement, and associations between measures were analyzed using linear mixed models, correlations, and regression analyses. RESULTS: Self-reported EF difficulties in COVID-19 patients were generally within the normal range and were not associated with objective cognition. In contrast, controls showed some correspondence between subjective and objective cognition. Self-reported EFs in patients were strongly associated with psychological symptoms and fatigue, with similar but weaker patterns in informant reports. In regression models, depressive symptoms emerged as a significant predictor of higher self-reported EF difficulties in COVID-19 patients. Self-informant agreement was highest in ICU-treated patients. CONCLUSIONS: Self-reported executive functioning difficulties after COVID-19 were more strongly associated with psychological factors than with objective cognitive deficits. These findings highlight the importance of considering psychological well-being when evaluating executive functioning after COVID-19.