Although Covid- 19 is primarily classied as a type of severe respiratory illness, more than two- thirds of patients hospitalized with the disease have suered from damage to the central nervous system (CNS) in addition to respiratory symptoms (Lahiri & Ardila, 2020). CNS damage associated with Covid- 19 is oen ischemic, with cases of hemorrhagic and encephalitic damage also recorded (Bodro et al., 2021). A possible pathological route of entry from early data suggested inammatory impacts on CNS vasculature via nasal mucosa and olfactory bers and spread through hematogenous routes, infecting pericytes, neurons, and endothelial cells (Bauer et al., 2022; Hu et al., 2021). Multiple reports of Covid- 19 impacting the brain and causing neurolog­ical disruption were recorded during the early emergence of the disease. Evidence of microstructural damage in the brain, seen on neuroradiological investigation with diusion tensor imaging and T1- weighted magnetic resonance sequences, in­dicated higher gray matter volumes and reduced diusivity in white matter, which specically correlated with brain regions involved in memory and olfaction. is demonstrated potential long- term neurological consequences in patients aer re­covering from the disease (Lu et al., 2020). e most frequently reported forms of CNS damage associated with Covid- 19 include acute cerebrovascular disease pre­senting as ischemic strokes, intracerebral or intracranial haemorrhage, encephalitis (causing damage to the brainstem), Guillain– Barré syndrome, CNS vasculitis (men­ingitis, myelitis), and other forms of acute disseminated encephalomyelitis associ­ated with SARS- CoV- 2 infection and other acute neuropathies (Ellul et al., 2020). In addition, increased gliosis possibly from inammation or other types of damage has been reported in the dorsal putamen and ventral striatum aer mild or moderate Covid- 19 infection (Braga et al., 2023). Other peripheral nervous system manifest­ations reported include anosmia, ageusia, and skeletal system involvement causing myalgia or myasthenia gravis (Ousseiran et al., 2023). A recent prospective multisite observational study assessing 158,267 adults found that among neurological compli­cations aer Covid- 19, the prevalence of stroke increased with increasing age; how­ever, a rapid decline over the duration of the pandemic (between 2020 and 2023) was

Various aspects of Covid- 19 infection can likely impact cognition. White matter in the cerebrum is critical in cognitive control and function. Cerebral white matter is vulnerable to damage from ischemic strokes commonly recorded in Covid- 19. Evidence also points toward the acceleration of amyloid- β accumulation, linked to tau and TAR DNA- binding protein 43 (TDP- 43) pathology. TDP- 43 is an RNA/ DNA binding protein that plays a role in regulating RNA processing. Accumulation of TDP- 43 aggregates is commonly seen in the CNS in several neurodegenerative conditions such as frontotemporal dementia and Alzheimer’s disease (Jo et al., 2020; Miners et al., 2020). Cortical atrophy involving the limbic system of the brain be­fore and aer Covid- 19 infection in UK Biobank participants was visualized using magnetic resonance imaging (Douaud et al., 2022). Signicant long- term conse­quences were observed, which included reduction in gray matter thickness of the