Neurological, Cognitive, and Systemic Manifestations of Post-COVID Syndrome: A Cross-Sectional Study in a Caucasian Cohort

Abstract

BACKGROUND. Post-COVID syndrome is increasingly recognized as a heterogeneous clinical condition characterized by persistent neurological, cognitive, and systemic symptoms. While individual manifestations have been widely reported, the overall clinical phenotype and symptom distribution remain insufficiently characterized, particularly in specific regional populations. OBJECTIVES. To characterize the neurological, cognitive, and systemic manifestations of post-COVID syndrome in a Caucasian cohort and to evaluate their association with acute COVID-19 severity. METHODS. This cross-sectional study included 360 individuals with prior SARS-CoV-2 infection and persistent post-COVID symptoms. Demographic, clinical, and disease-related variables were collected, including disease severity, hospitalization status, and comorbidities. Neurological, cognitive, and systemic symptoms were assessed using patient-reported outcomes and clinical evaluation. Neuropsychological status was evaluated using validated instruments, including PHQ-9, BDI, STAI, and MoCA. Statistical analyses were performed to describe symptom distribution and to assess differences across disease severity groups. RESULTS. Neurological and systemic symptoms were highly prevalent, with anosmia (78.9%) and ageusia (59.4%) representing the most common manifestations. Cognitive symptoms were also frequent, including memory complaints (45.8%) and executive dysfunction (30.8%). Fatigue was reported in 42.8% of participants. Symptom burden varied according to disease severity, with significantly higher prevalence of cognitive impairment, fatigue, and neuropathic symptoms observed in patients with severe acute COVID-19 (p < 0.05). In contrast, sensory symptoms such as anosmia and ageusia were distributed relatively evenly across severity groups. Neurological and systemic symptoms demonstrated substantial heterogeneity across the study population. CONCLUSIONS. A heterogeneous clinical phenotype with a high prevalence of sensory, cognitive, and systemic symptoms characterizes Post-COVID syndrome. Disease severity is associated with increased burden of cognitive and systemic manifestations, while sensory dysfunction appears independent of severity. These findings highlight the importance of comprehensive clinical assessment and support the need for multidisciplinary management strategies in post-COVID populations.