Executive Dysfunction in Older Adults Following Covid-19: Evidence From a Longitudinal Neuropsychological Study in Brazil

Abstract SARS-CoV-2 infection causes long-term cognitive issues, including impairments in attention, memory, and processing speed, affecting 30%-80% of individuals soon after infection, with roughly one-third experiencing these effects for two years. Nevertheless, older adults, more susceptible to cognitive decline, are still underrepresented in post-COVID neuropsychology research. This longitudinal cohort study (2021–2023) assessed cognitive outcomes in older adults aged 60–80 without previous cognitive impairment. Participants included 57 individuals infected with SARS-CoV-2 pre-vaccination and 135 unexposed controls. Neuropsychological tests were conducted every six months, up to 20 months post-infection. Data were analysed using linear mixed-effect models and regression analyses to identify prognostic factors influencing cognitive trajectories. Participants´ mean age was 66.97 ± 4.64 years, with 70% being female. Significant differences in executive function trajectories were observed between the COVID-19 and control groups (Frontal Assessment Battery, p-interaction = 0.051). The COVID-19 group exhibited poorer performance in inhibitory control, cognitive flexibility, and working memory. Protective factors against executive dysfunction included being married (p-interaction = 0.065) and engaging in cognitively stimulating activities (p-interaction = 0.069). These suggest that SARS-CoV-2 infection poses long-term cognitive challenges for older adults, particularly affecting executive functions, regardless of severity. Psychosocial and lifestyle factors may mitigate these effects. Post-COVID neuropsychological monitoring and rehab are crucial to preserving cognitive health in ageing populations.