{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T16:14:21Z","timestamp":1791562461512,"version":"4.3.4"},"reference-count":37,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,1,28]],"date-time":"2026-01-28T00:00:00Z","timestamp":1769558400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Hum. Neurosci."],"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>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).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fnhum.2025.1760173","type":"journal-article","created":{"date-parts":[[2026,1,28]],"date-time":"2026-01-28T06:43:02Z","timestamp":1769582582000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":3,"title":["A cross-continental comparative analysis of the neurological manifestations of Long COVID"],"prefix":"10.3389","volume":"19","author":[{"given":"Millenia","family":"Jimenez","sequence":"first","affiliation":[{"name":"The Ken and Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine","place":["Chicago, IL, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melissa","family":"Lopez","sequence":"additional","affiliation":[{"name":"The Ken and Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine","place":["Chicago, IL, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Janet","family":"Miller","sequence":"additional","affiliation":[{"name":"The Ken and Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine","place":["Chicago, IL, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Njideka U.","family":"Okubadejo","sequence":"additional","affiliation":[{"name":"Faculty of Clinical Sciences, Department of Medicine, College of Medicine, University of Lagos","place":["Lagos, Nigeria"]},{"name":"Department of Medicine, Lagos University Teaching Hospital","place":["Lagos, Nigeria"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carolina","family":"Hurtado","sequence":"additional","affiliation":[{"name":"School of Medicine, CES University","place":["Medellin, Colombia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anurag Kumar","family":"Singh","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Practice, National Institute of Medical Science and Research","place":["Jaipur, India"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oluwadamilola O.","family":"Ojo","sequence":"additional","affiliation":[{"name":"Faculty of Clinical Sciences, Department of Medicine, College of Medicine, University of Lagos","place":["Lagos, Nigeria"]},{"name":"Department of Medicine, Lagos University Teaching Hospital","place":["Lagos, Nigeria"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diego F.","family":"Rojas-Gualdron","sequence":"additional","affiliation":[{"name":"School of Medicine, CES University","place":["Medellin, Colombia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Iorhen","family":"Akase","sequence":"additional","affiliation":[{"name":"Faculty of Clinical Sciences, Department of Medicine, College of Medicine, University of Lagos","place":["Lagos, Nigeria"]},{"name":"Department of Medicine, Lagos University Teaching Hospital","place":["Lagos, Nigeria"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Osigwe P.","family":"Agabi","sequence":"additional","affiliation":[{"name":"Faculty of Clinical Sciences, Department of Medicine, College of Medicine, University of Lagos","place":["Lagos, Nigeria"]},{"name":"Department of Medicine, Lagos University Teaching Hospital","place":["Lagos, Nigeria"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kamlesh","family":"Kumar","sequence":"additional","affiliation":[{"name":"Department of Neurology, National Institute of Medical Sciences and Research","place":["Jaipur, India"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Balvir Singh","family":"Tomar","sequence":"additional","affiliation":[{"name":"Institute of Pediatric Gastroenterology and Hepatology, National Institute of Medical Sciences and Research","place":["Jaipur, India"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deepak","family":"Nathiya","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Practice, National Institute of Medical Science and Research","place":["Jaipur, India"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rebecca","family":"Jules","sequence":"additional","affiliation":[{"name":"The Ken and Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine","place":["Chicago, IL, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric M.","family":"Liotta","sequence":"additional","affiliation":[{"name":"The Ken and Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine","place":["Chicago, IL, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Igor J.","family":"Koralnik","sequence":"additional","affiliation":[{"name":"The Ken and Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine","place":["Chicago, IL, United States"]},{"name":"Global Neurology Program, Havey Institute for Global Health, Northwestern University","place":["Chicago, IL, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,1,28]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","DOI":"10.1007\/s13365-024-01232-9","article-title":"A systematic analysis of neurologic manifestations of long COVID in Nigeria","author":"Akase","year":"2024","journal-title":"J. Neurovirol."},{"key":"ref2","doi-asserted-by":"publisher","first-page":"2148","DOI":"10.1038\/s41591-024-03173-6","article-title":"Long COVID science, research and policy","volume":"30","author":"Al-Aly","year":"2024","journal-title":"Nat. Med."},{"key":"ref3","doi-asserted-by":"publisher","first-page":"100984","DOI":"10.1016\/j.lana.2024.100984","article-title":"SARS-COV-2 re-infection and incidence of post-acute sequelae of COVID-19 (PASC) among essential workers in New York: a retrospective cohort study","volume":"42","author":"Babalola","year":"2025","journal-title":"Lancet Reg. Health Am."},{"key":"ref4","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjmed.2023.05.002","article-title":"Multidisciplinary center care for long COVID syndrome - a retrospective cohort study","author":"Bailey","year":"2023","journal-title":"Am. J. Med."},{"key":"ref5","doi-asserted-by":"publisher","first-page":"2092","DOI":"10.1002\/art.22641","article-title":"Prevalence of adult systemic lupus erythematosus in California and Pennsylvania in 2000: estimates obtained using hospitalization data","volume":"56","author":"Chakravarty","year":"2007","journal-title":"Arthritis Rheum."},{"key":"ref6","doi-asserted-by":"publisher","first-page":"1593","DOI":"10.1093\/infdis\/jiac136","article-title":"Global prevalence of post-coronavirus disease 2019 (COVID-19) condition or long COVID: a Meta-analysis and systematic review","volume":"226","author":"Chen","year":"2022","journal-title":"J. Infect. Dis."},{"key":"ref7","doi-asserted-by":"publisher","DOI":"10.1002\/ana.27128","article-title":"Neurologic manifestations of long COVID disproportionately affect young and middle-age adults","volume":"97","author":"Choudhury","year":"2024","journal-title":"Ann. Neurol."},{"key":"ref8","doi-asserted-by":"publisher","first-page":"1047","DOI":"10.1002\/alz.12644","article-title":"Changes in cognitive functioning after COVID-19: a systematic review and meta-analysis","volume":"18","author":"Crivelli","year":"2022","journal-title":"Alzheimers Dement."},{"key":"ref9","doi-asserted-by":"publisher","first-page":"3345","DOI":"10.1257\/aer.20230521","article-title":"Women left behind: gender disparities in utilization of government health insurance in India","volume":"114","author":"Dupas","year":"2024","journal-title":"Am. Econ. Rev."},{"key":"ref10","doi-asserted-by":"publisher","first-page":"466","DOI":"10.1017\/S0317167100041664","article-title":"The increased susceptibility of women to multiple sclerosis","volume":"19","author":"Duquette","year":"1992","journal-title":"Can. J. Neurol. Sci."},{"key":"ref11","doi-asserted-by":"publisher","first-page":"250","DOI":"10.1186\/s12883-025-04174-9","article-title":"Long-term neurological and cognitive impact of COVID-19: a systematic review and meta-analysis in over 4 million patients","volume":"25","author":"Elboraay","year":"2025","journal-title":"BMC Neurol."},{"key":"ref12","doi-asserted-by":"publisher","first-page":"e29","DOI":"10.1017\/gmh.2024.19","article-title":"Mental health challenges in Nigeria: bridging the gap between demand and resources","volume":"11","author":"Fadele","year":"2024","journal-title":"Glob. Ment. Health"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"189","DOI":"10.1016\/0022-3956(75)90026-6","article-title":"\"Mini-mental state\". A practical method for grading the cognitive state of patients for the clinician","volume":"12","author":"Folstein","year":"1975","journal-title":"J. Psychiatr. Res."},{"key":"ref14","doi-asserted-by":"publisher","first-page":"538","DOI":"10.1186\/s12888-020-02937-x","article-title":"Stigma associated with mental health problems among young people in India: a systematic review of magnitude, manifestations and recommendations","volume":"20","author":"Gaiha","year":"2020","journal-title":"BMC Psychiatry"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"138","DOI":"10.1016\/S1474-4422(09)70335-7","article-title":"Assessment of neurological and behavioural function: the NIH toolbox","volume":"9","author":"Gershon","year":"2010","journal-title":"Lancet Neurol."},{"key":"ref16","doi-asserted-by":"publisher","first-page":"S2","DOI":"10.1212\/WNL.0b013e3182872e5f","article-title":"NIH toolbox for assessment of neurological and behavioral function","volume":"80","author":"Gershon","year":"2013","journal-title":"Neurology"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"1604","DOI":"10.1001\/jama.2022.18931","article-title":"Estimated global proportions of individuals with persistent fatigue, cognitive, and respiratory symptom clusters following symptomatic COVID-19 in 2020 and 2021","volume":"328","author":"Wulf Hanson","year":"2022","journal-title":"JAMA"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"158","DOI":"10.1016\/j.jad.2009.04.030","article-title":"Depression in adult Nigerians: results from the Nigerian survey of mental health and well-being","volume":"120","author":"Gureje","year":"2010","journal-title":"J. Affect. Disord."},{"key":"ref19","doi-asserted-by":"publisher","first-page":"1450110","DOI":"10.3389\/fnhum.2024.1450110","article-title":"Neurologic manifestations of long COVID in Colombia: a comparative analysis of post-hospitalization vs. non-hospitalized patients","volume":"18","author":"Hurtado","year":"2024","journal-title":"Front. Hum. Neurosci."},{"key":"ref20","doi-asserted-by":"publisher","first-page":"S20","DOI":"10.1016\/j.apmr.2010.08.033","article-title":"How item banks and their application can influence measurement practice in rehabilitation medicine: a PROMIS fatigue item bank example","volume":"92","author":"Lai","year":"2011","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref21","doi-asserted-by":"publisher","first-page":"1133","DOI":"10.1002\/pon.3522","article-title":"Self-reported cognitive concerns and abilities: two sides of one coin?","volume":"23","author":"Lai","year":"2014","journal-title":"Psychooncology"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"fcae448","DOI":"10.1093\/braincomms\/fcae448","article-title":"Vaccination prior to SARS-CoV-2 infection does not affect the neurologic manifestations of long COVID","volume":"7","author":"Mukherjee","year":"2025","journal-title":"Brain Commun."},{"key":"ref23","doi-asserted-by":"publisher","first-page":"1576","DOI":"10.1002\/art.27425","article-title":"Is the incidence of rheumatoid arthritis rising?: results from Olmsted County, Minnesota, 1955-2007","volume":"62","author":"Myasoedova","year":"2010","journal-title":"Arthritis Rheum."},{"key":"ref24","doi-asserted-by":"publisher","first-page":"695","DOI":"10.1111\/j.1532-5415.2005.53221.x","article-title":"The Montreal cognitive assessment, MoCA: a brief screening tool for mild cognitive impairment","volume":"53","author":"Nasreddine","year":"2005","journal-title":"J. Am. Geriatr. Soc."},{"key":"ref25","volume-title":"A long COVID definition: A chronic, systemic disease state with profound consequences","year":"2024"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"53","DOI":"10.1186\/s12877-015-0040-1","article-title":"Validation of the identification and intervention for dementia in elderly Africans (IDEA) cognitive screen in Nigeria and Tanzania","volume":"15","author":"Paddick","year":"2015","journal-title":"BMC Geriatr."},{"key":"ref27","doi-asserted-by":"publisher","DOI":"10.1136\/bmjgh-2024-015245","article-title":"Long covid: a global health issue - a prospective, cohort study set in four continents","volume":"9","author":"Pazukhina","year":"2024","journal-title":"BMJ Glob. Health"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"146","DOI":"10.1002\/ana.26649","article-title":"Neurologic manifestations of long COVID differ based on acute COVID-19 severity","volume":"94","author":"Perez Giraldo","year":"2023","journal-title":"Ann. Neurol."},{"key":"ref29","doi-asserted-by":"publisher","first-page":"362","DOI":"10.1177\/00207640221091187","article-title":"Stigma and mental health problems in an Indian context. Perceptions of people with mental disorders in urban, rural and tribal areas of Kerala","volume":"69","author":"Raghavan","year":"2023","journal-title":"Int. J. Soc. Psychiatry"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"107105","DOI":"10.1016\/j.ijid.2024.107105","article-title":"The global clinical studies of long COVID","volume":"146","author":"Ramonfaur","year":"2024","journal-title":"Int. J. Infect. Dis."},{"key":"ref31","doi-asserted-by":"publisher","first-page":"105","DOI":"10.1186\/s12888-023-05481-6","article-title":"The global prevalence of depression, anxiety, and sleep disorder among patients coping with post COVID-19 syndrome (long COVID): a systematic review and meta-analysis","volume":"24","author":"Seighali","year":"2024","journal-title":"BMC Psychiatry"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"e2455430","DOI":"10.1001\/jamanetworkopen.2024.55430","article-title":"Sex differences in long COVID","volume":"8","author":"Shah","year":"2025","journal-title":"JAMA Netw. Open"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"1704801","DOI":"10.3389\/fneur.2025.1704801","article-title":"Neuropsychiatric manifestations of long COVID in India: a persistent problem 2.5 years after disease onset","volume":"16","author":"Singh","year":"2025","journal-title":"Front. Neurol."},{"key":"ref34","volume-title":"The world by income and region","year":""},{"key":"ref35","doi-asserted-by":"publisher","first-page":"344","DOI":"10.1016\/j.jclinepi.2007.11.008","article-title":"The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies","volume":"61","author":"von Elm","year":"2008","journal-title":"J. Clin. Epidemiol."},{"key":"ref36","doi-asserted-by":"publisher","first-page":"S54","DOI":"10.1212\/WNL.0b013e3182872ded","article-title":"Cognition assessment using the NIH toolbox","volume":"80","author":"Weintraub","year":"2013","journal-title":"Neurology"},{"key":"ref37","volume-title":"Coronavirus (COVID-19) dashboard","year":""}],"container-title":["Frontiers in Human Neuroscience"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fnhum.2025.1760173\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,24]],"date-time":"2026-02-24T08:32:02Z","timestamp":1771921922000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fnhum.2025.1760173\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,28]]},"references-count":37,"alternative-id":["10.3389\/fnhum.2025.1760173"],"URL":"https:\/\/doi.org\/10.3389\/fnhum.2025.1760173","relation":{},"ISSN":["1662-5161"],"issn-type":[{"value":"1662-5161","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,28]]},"article-number":"1760173"}}