Predictors of non-recovery from fatigue and cognitive deficits after COVID-19: a prospective, longitudinal, population-based study

Background
Fatigue and cognitive deficits are common after SARS-CoV-2 infection, but long-term trajectories and risk factors for non-recovery are poorly understood. We assessed these outcomes over time and identified predictors of persistent symptoms.

Methods
We analyzed longitudinal data from the population-based COVIDOM/NAPKON-POP cohort in Germany. Participants with confirmed SARS-CoV-2 infection were assessed ≥6 months (baseline) and ≥18 months (follow-up) post-infection using the FACIT-Fatigue Scale (≤30) and Montreal Cognitive Assessment (MoCA ≤25). Recovery predictors were evaluated via univariate and multivariable logistic regression. The study is registered at DRKS00023742 and NCT04679584.

Findings
From 15 Nov 2020 to 9 May 2023, 3038 participants were assessed at baseline (median 9 months post-infection), with 83% responding at follow-up (median 26 months). At baseline, 21% had fatigue and 23% had cognitive deficits. Fatigue improved significantly at follow-up (Hedges’ g = 0.73) with 46% recovering. Cognitive deficits also improved (g = 1.12) with 57% recovering. Non-recovery from fatigue was associated with higher baseline depressive symptoms and headache, while cognitive non-recovery was linked to male sex, older age, and <12 years of education. SARS-CoV-2 reinfection did not affect recovery.

Interpretation
Fatigue and cognitive deficits are common post-COVID-19 but improve over time, with about half of patients recovering within two years. Identified risk factors can inform targeted strategies for treatment and prevention.

Funding
German Federal Ministry of Education and Research (BMBF; 01KX2121) and DFG Excellence Cluster “Position Medicine in Information.”

Rights

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