# A cross-continental comparative analysis of the neurological manifestations of Long COVID

## TL;DR

This study compares neurological symptoms of Long COVID across four countries, finding differences in symptom frequency and cognitive outcomes influenced by region and healthcare access.

## Contribution

The study provides a cross-continental comparison of Neuro-PASC, revealing regional variations in symptom burden and cognitive impairment.

## Key findings

- Neurological symptoms like brain fog and dizziness were most frequent in the U.S. and least in India.
- Cognitive impairment varied across countries, with differences observed in both hospitalized and non-hospitalized groups.
- Symptom clustering showed regional patterns, with U.S./Colombia and Nigeria/India forming distinct groups.

## Abstract

To compare demographics, comorbidities, neurologic symptoms, quality of life, and cognitive outcomes among adult individuals with neurologic manifestations of post-acute sequelae of SARS-CoV-2 infection (Neuro-PASC) across countries with varying income levels: the United States (U.S.), Colombia, Nigeria, and India.

In this multi-country observational study, participants were evaluated in hospital clinics and recruited from institutional databases between 2020 and 2025. Patients were categorized as post-hospitalization Neuro-PASC (PNP) or non-hospitalized Neuro-PASC (NNP). Cognitive assessments were performed using the NIH Toolbox (U.S. and Colombia), the Montreal Cognitive Assessment (Nigeria), or the Mini-Mental State Examination (India).

A total of 3,157 participants were enrolled (652 PNP; 2,505 NNP). PNP patients were predominantly male except in the US, while NNP patients were predominantly female, except in India. The most frequent neurologic symptoms were brain fog, myalgia, dizziness, headache, and sensory disturbances, with frequency highest in the U.S. and lowest in India. There were significant differences for most neurologic and non-neurologic symptoms of PASC, driven by higher frequencies in U.S. and Colombia in both PNP and NNP cohorts. In addition, cognitive impairment measured with different instruments varied across countries for both PNP and NNP groups. Multiple correspondence analysis showed clustering of symptom burden between U.S./Colombia and Nigeria/India.

Neuro-PASC presents globally but symptom burden, and psychological distress vary across regions, likely influenced by sociocultural factors, healthcare access, and diagnostic tools. These findings highlight the need for culturally-adapted screening and post-COVID care worldwide.