2-8% of the US population report "long COVID" symptoms - including "brain fog," thinking
difficulties, memory problems, and psychiatric symptoms such as sleep disturbance, anxiety,
and depression. Rates of post-COVID-19 symptoms are nearly double in the Veteran population.
These cognitive symptoms contribute to functional impairments, reduced quality of life,
poorer self-reported health status, psychological distress, delayed return to work, new onset
disability, reduced community integration, and increased healthcare utilization. One
promising treatment to improve both everyday functioning and cognition secondary to
post-COVID-19 symptoms is Compensatory Cognitive Training (CCT). Previous studies have found
that CCT is feasible, acceptable, and efficacious in Veteran populations with multiple
sources of cognitive dysfunction. The proposed CDA provides a golden opportunity to evaluate
CCT for Veterans with prolonged COVID-19 symptoms (CCT-C), compared with a robust control
condition, Holistic Cognitive Education (HCE). The project closely aligns with current RR&D
priorities, by "examining COVID-19-specific rehabilitation interventions and responses to
treatment" and by addressing "late or delayed effects of secondary conditions related to
COVID-19 infections on impairment and disability." Specific aims are 1) to conduct a pilot
randomized controlled trial of remote CCT-C with 70 Veterans (35 CCT-C, 35 HCE) with
post-COVID-19 cognitive symptoms to examine feasibility, acceptability, and initial efficacy;
2) to examine the preliminary efficacy of CCT-C in this population on overall functioning, as
measured by the World Health Organization's Disability Assessment Schedule (WHODAS 2.0),
performance-based measures of functional capacity, and secondary outcomes (cognitive
performance, quality of life, self-reported cognitive problems, psychiatric symptoms, sleep
disturbance, and engagement in work/community activities); and 3) to explore moderators of
outcome (e.g., age, initial COVID-19 severity, baseline cognitive functioning, presence of
PTSD/mTBI history; biomarkers related to COVID-19 infection).