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In the first year of the COVID-19, there was a significant drop in working memory and executive function in older individuals, which is linked to known dementia risk factors including increased alcohol use and a more sedentary lifestyle. The trend persisted into the second year of the pandemic after social restrictions had eased.


  • 3140 participants (54% women; mean age, 68 years) in the PROTECT study, a longitudinal aging study in the United Kingdom, completed annual cognitive assessments and self-reported questionnaires related to mental health and lifestyle.

  • Investigators analyzed cognition across three time periods: during the year before the pandemic (March 2019 to February 2020), during pandemic year 1 (March 2020 to February 2021), and pandemic year 2 (March 2021 to February 2022).

  • Investigators conducted a sub-analysis on those with mild cognitive impairment (MCI) and those with a history of COVID-19 (n = 752).


  • During the first year of the pandemic, 6 months of which included societal lockdowns, significant worsening of executive function and working memory were observed across the entire cohort (effect sizes, cyclophosphamide review pdf 0.15 and 0.51, respectively), in people with MCI (effect sizes, 0.13 and 0.40, respectively), and in those with a history of COVID-19 (effect sizes, 0.24 and 0.46, respectively).

  • Worsening of working memory was sustained across the whole cohort in the second year of the pandemic after the lockdowns were lifted (effect size, 0.47).

  • Even after investigators removed data on those with MCI and COVID-19, the declines persisted for the remaining cohort for executive function (effect size, 0.15; P < .0001) and working memory (effect size, 0.53; P < .0001).

  • Cognitive decline was significantly associated with known risk factors for dementia, such as reduced exercise (P = .0049) and increased alcohol use (P = .049) across the whole cohort as well as depression (P = .011) in those with a history of COVID-19 and loneliness (P = .0038) with MCI.


Investigators say the data add to existing knowledge of long-standing health consequences of COVID-19, especially for older people with mild memory problems. “On the positive note, there is evidence that life-style changes and improved health management can positively influence mental functioning,” study co-author Dag Aarsland, MD, PhD, professor of old-age psychiatry at King’s College London Institute, England, said in a press release. “The current study underlines the importance of careful monitoring of people at risk during major events such as the pandemic.”


Anne Corbett, PhD, of University of Exeter Medical School in Exeter, United Kingdom, led the study, along with Aarsland and others. It was published online November 1, 2023 in The Lancet Healthy Longevity and was funded by the National Institute for Health and Care Research Biomedical Research Centre and the NIHR Exeter Biomedical Research Centre.


The study relied on self-reported data, which are subject to some uncertainty. In addition, the PROTECT cohort is self-selected and may be biased toward participants with higher education levels.


Corbett reported funding from the National Institute for Health and Care Research and grants from Synexus, reMYND, and Novo Nordisk. Other disclosures are noted in the original article.

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