{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T08:55:23Z","timestamp":1781772923840,"version":"3.54.5"},"reference-count":71,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T00:00:00Z","timestamp":1781740800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: Neurological complications of SARS-CoV-2 infection frequently impair patients\u2019 long-term quality of life. This study aimed to identify clinical and laboratory risk factors\u2014including inflammatory markers and micronutrients\u2014for the occurrence or worsening of neurocognitive disorders in long COVID patients. Materials and Methods: In this prospective observational study, patients presenting with long COVID neurological manifestations were stratified by baseline MoCA score into two groups (\u226523 and &lt;23). Clinical, laboratory (inflammatory markers, 25-hydroxy vitamin D, vitamin B12, folic acid), and neuroimaging assessments (global cortical atrophy scale, Fazekas score) were performed over 24 months. Propensity score matching (PSM) for age, gender, and neurological comorbidities yielded 54 patients per group. Results: In the MoCA \u2265 23 group, significant predictors of cognitive decline included severe COVID-19 (OR = 2.211, 95% CI = 1.819\u20135.973, p = 0.012), autoimmune comorbidities (OR = 1.676, 95% CI = 1.191\u20132.390, p = 0.043), and elevated neutrophil-to-lymphocyte ratio (NLR; OR = 1.586, 95% CI = 1.431\u20132.122, p = 0.011). In the MoCA &lt; 23 group, independent predictors were diabetes mellitus (OR = 3.021, 95% CI = 2.65\u201314.004, p = 0.016), autoimmune comorbidities (OR = 4.987, 95% CI = 1.412\u20136.033, p = 0.021), and NLR (OR = 5.944, 95% CI = 2.353\u201319.321, p = 0.015). Serum vitamin D levels were significantly associated with MoCA scores in both groups. Conclusions: COVID-19 severity, autoimmune comorbidities, NLR, and serum vitamin D represent key risk factors for neurocognitive decline in long COVID, highlighting potential targets for early intervention.<\/jats:p>","DOI":"10.3390\/medicina62061180","type":"journal-article","created":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T07:33:54Z","timestamp":1781768034000},"page":"1180","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Clinical and Inflammatory Predictors of Neurocognitive Decline in Long COVID: A Two-Year Longitudinal Study with Propensity Score Matching"],"prefix":"10.3390","volume":"62","author":[{"given":"Iulia Elena","family":"Diaconu","sequence":"first","affiliation":[{"name":"Doctoral School, Grigore T. Popa University of Medicine and Pharmacy, 700115 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2363-4933","authenticated-orcid":false,"given":"Maria Ioana","family":"Onofrei","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Grigore T. Popa University of Medicine and Pharmacy, 700454 Iasi, Romania"},{"name":"Clinic of Infectious Diseases, \u201cSf. Parascheva\u201d Clinical Hospital of Infectious Diseases, 700116 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8357-7048","authenticated-orcid":false,"given":"Andrei","family":"V\u00e2\u021b\u0103","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Grigore T. Popa University of Medicine and Pharmacy, 700454 Iasi, Romania"},{"name":"Clinic of Infectious Diseases, \u201cSf. Parascheva\u201d Clinical Hospital of Infectious Diseases, 700116 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Florin Manuel","family":"Ro\u0219u","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Grigore T. Popa University of Medicine and Pharmacy, 700454 Iasi, Romania"},{"name":"Clinic of Infectious Diseases, \u201cSf. Parascheva\u201d Clinical Hospital of Infectious Diseases, 700116 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6952-9741","authenticated-orcid":false,"given":"Emilian Bogdan","family":"Ignat","sequence":"additional","affiliation":[{"name":"Department of Neurology, Grigore T. Popa University of Medicine and Pharmacy, 700454 Iasi, Romania"},{"name":"Department of Neurology, Clinical Rehabilitation Hospital, 700661 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Iulian Dan","family":"Cuciureanu","sequence":"additional","affiliation":[{"name":"Department of Neurology, Grigore T. Popa University of Medicine and Pharmacy, 700454 Iasi, Romania"},{"name":"Department of Neurology, \u201cProf. Dr. N. Oblu\u201d Clinical Emergency Hospital, 700309 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mihnea Eudoxiu","family":"Hurmuzache","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Grigore T. Popa University of Medicine and Pharmacy, 700454 Iasi, Romania"},{"name":"Clinic of Infectious Diseases, \u201cSf. Parascheva\u201d Clinical Hospital of Infectious Diseases, 700116 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4694-9177","authenticated-orcid":false,"given":"Mihaela C\u0103t\u0103lina","family":"Luca","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Grigore T. Popa University of Medicine and Pharmacy, 700454 Iasi, Romania"},{"name":"Clinic of Infectious Diseases, \u201cSf. Parascheva\u201d Clinical Hospital of Infectious Diseases, 700116 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,6,18]]},"reference":[{"key":"ref_1","first-page":"351","article-title":"COVID-19: A course through stormy waters","volume":"124","author":"Miftode","year":"2020","journal-title":"Med. Surg. J."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"C1","DOI":"10.1152\/ajpcell.00375.2021","article-title":"Long-term complications of COVID-19","volume":"322","author":"Desai","year":"2022","journal-title":"Am. J. Physiol. Cell Physiol."},{"key":"ref_3","unstructured":"Department of Health and Human Services, and Office of the Assistant Secretary for Health (2026, April 15). National Research Action Plan on Long COVID, Available online: https:\/\/www.covid.gov\/assets\/files\/National-Research-Action-Plan-on-Long-COVID-08012022.pdf."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"e102","DOI":"10.1016\/S1473-3099(21)00703-9","article-title":"A clinical case definition of post-COVID-19 condition by a Delphi consensus","volume":"22","author":"Soriano","year":"2022","journal-title":"Lancet Infect. Dis."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"ofaf533","DOI":"10.1093\/ofid\/ofaf533","article-title":"Global Prevalence of Long COVID, Its Subtypes, and Risk Factors: An Updated Systematic Review and Meta-analysis","volume":"12","author":"Hou","year":"2025","journal-title":"Open Forum Infect. Dis."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Talkington, G.M., Kolluru, P., Gressett, T.E., Ismael, S., Meenakshi, U., Acquarone, M., Solch-Ottaiano, R.J., White, A., Ouvrier, B., and Par\u00e9, K. (2025). Neurological sequelae of long COVID: A comprehensive review of diagnostic imaging, underlying mechanisms, and potential therapeutics. Front. Neurol., 15.","DOI":"10.3389\/fneur.2024.1465787"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1093\/arclin\/acae042","article-title":"Neurocognitive Impairment in Long COVID: A Systematic Review","volume":"40","author":"Panagea","year":"2025","journal-title":"Arch. Clin. Neuropsychol."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Almeria, M., Cejudo, J.C., Deus, J., and Krupinski, J. (2024). Neurocognitive and Neuropsychiatric Sequelae in Long COVID-19 Infection. Brain Sci., 14.","DOI":"10.3390\/brainsci14060604"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"10","DOI":"10.4103\/neurol-india.Neurol-India-D-24-00337","article-title":"Effect of COVID-19 Related Social Isolation on Cognitive Decline in Neurocognitive Disorder Patients: A Systematic Review and Meta-Analysis","volume":"73","author":"Landsteiner","year":"2025","journal-title":"Neurol. India"},{"key":"ref_10","first-page":"642","article-title":"Analysis of risk factors for neurological complications of SARS-CoV-2 infection: Focus on chronic fatigability","volume":"129","author":"Diaconu","year":"2025","journal-title":"Med. Surg. J."},{"key":"ref_11","unstructured":"WHO Working Group on the Clinical Characterisation and Management of COVID-19 Infection (2020). A minimal common outcome measure set for COVID-19 clinical research. Lancet Infect. Dis., 20, e192\u2013e197."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1002\/gps.5227","article-title":"Diagnostic accuracy of the Montreal Cognitive Assessment (MoCA) for cognitive screening in old age psychiatry: Determining cutoff scores in clinical practice. Avoiding spectrum bias caused by healthy controls","volume":"35","author":"Dautzenberg","year":"2020","journal-title":"Int. J. Geriatr. Psychiatry"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"18","DOI":"10.5152\/imj.2017.46704","article-title":"Evaluation of MoCA Scale Ratings with Cognitive Level Correlation in Mild Cognitive Disorders","volume":"18","author":"Emre","year":"2017","journal-title":"Istanb. Med. J."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"274","DOI":"10.1007\/s10354-021-00825-x","article-title":"Neuroimaging in dementia","volume":"171","author":"Furtner","year":"2021","journal-title":"Wien. Med. Wochenschr."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"78","DOI":"10.1186\/s42466-025-00439-3","article-title":"Fazekas score predicts cognitive decline & frailty in older adults: Insights from the SAGE-AF cohort study","volume":"7","author":"Srichawla","year":"2025","journal-title":"Neurol. Res. Pract."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Tan, H.H., Xu, J., Teoh, H.L., Chan, B.P., Seet, R.C., Venketasubramanian, N., Sharma, V.K., Chen, C.L., and Dong, Y. (2017). Decline in changing Montreal Cognitive Assessment (MoCA) scores is associated with post-stroke cognitive decline determined by a formal neuropsychological evaluation. PLoS ONE, 12.","DOI":"10.1371\/journal.pone.0173291"},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Zanza, C., Romenskaya, T., Manetti, A.C., Franceschi, F., La Russa, R., Bertozzi, G., Maiese, A., Savioli, G., Volonnino, G., and Longhitano, Y. (2022). Cytokine Storm in COVID-19: Immunopathogenesis and Therapy. Medicina, 58.","DOI":"10.3390\/medicina58020144"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"745","DOI":"10.1007\/s11357-024-01487-4","article-title":"Cerebromicrovascular mechanisms contributing to long COVID: Implications for neurocognitive health","volume":"47","author":"Fekete","year":"2025","journal-title":"Geroscience"},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Barajas, A., Riquelme-Alacid, G., Vera-Montecinos, A., and Ramos, B. (2026). Cognition, Cytokines, Blood-Brain Barrier, and Beyond in COVID-19: A Narrative Review. Int. J. Mol. Sci., 27.","DOI":"10.3390\/ijms27010546"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"112189","DOI":"10.1016\/j.celrep.2023.112189","article-title":"SARS-CoV-2 Spike protein induces TLR4-mediated long-term cognitive dysfunction recapitulating post-COVID-19 syndrome in mice","volume":"42","author":"Fernandes","year":"2023","journal-title":"Cell Rep."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"445","DOI":"10.1007\/s12035-021-02593-6","article-title":"SARS-CoV-2 Spike Glycoprotein S1 Induces Neuroinflammation in BV-2 Microglia","volume":"59","author":"Olajide","year":"2022","journal-title":"Mol. Neurobiol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"115020","DOI":"10.1016\/j.expneurol.2024.115020","article-title":"SARS-CoV-2 spike S1 protein induces microglial NLRP3-dependent neuroinflammation and cognitive impairment in mice","volume":"383","author":"Jiang","year":"2025","journal-title":"Exp. Neurol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"852","DOI":"10.1007\/s10495-022-01754-9","article-title":"COVID-19 causes neuronal degeneration and reduces neurogenesis in human hippocampus","volume":"27","author":"Bayat","year":"2022","journal-title":"Apoptosis"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"110","DOI":"10.1186\/s13195-021-00850-3","article-title":"Network medicine links SARS-CoV-2\/COVID-19 infection to brain microvascular injury and neuroinflammation in dementia-like cognitive impairment","volume":"13","author":"Zhou","year":"2021","journal-title":"Alzheimers Res. Ther."},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Popa, E., Popa, A.E., Poroch, M., Poroch, V., Ungureanu, M.I., Slanina, A.M., Bacusca, A., and Coman, E.A. (2025). The Molecular Mechanisms of Cognitive Dysfunction in Long COVID: A Narrative Review. Int. J. Mol. Sci., 26.","DOI":"10.3390\/ijms26115102"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"e58","DOI":"10.1002\/brx2.58","article-title":"COVID-19 and cognitive impairment: From evidence to SARS-CoV-2 mechanism","volume":"2","author":"Pan","year":"2024","journal-title":"Brain-X"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1038\/s41591-024-03309-8","article-title":"Posthospitalization COVID-19 cognitive deficits at 1 year are global and associated with elevated brain injury markers and gray matter volume reduction","volume":"31","author":"Wood","year":"2025","journal-title":"Nat. Med."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"3484","DOI":"10.1016\/j.neuron.2022.10.006","article-title":"The neurobiology of long COVID","volume":"110","author":"Monje","year":"2022","journal-title":"Neuron"},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Li, Z., Zhang, Z., Zhang, Z., Wang, Z., and Li, H. (2023). Cognitive impairment after long COVID-19: Current evidence and perspectives. Front. Neurol., 14.","DOI":"10.3389\/fneur.2023.1239182"},{"key":"ref_30","first-page":"4","article-title":"Overview of Neurocognitive Disorders","volume":"15","author":"McDonald","year":"2017","journal-title":"Focus Am. Psychiatry Publ."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"302","DOI":"10.1016\/S1474-4422(23)00447-7","article-title":"European intersocietal recommendations for the biomarker-based diagnosis of neurocognitive disorders","volume":"23","author":"Frisoni","year":"2024","journal-title":"Lancet Neurol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"3235","DOI":"10.1002\/alz.13040","article-title":"Accuracy of the Montreal Cognitive Assessment tool for detecting mild cognitive impairment: A systematic review and meta-analysis","volume":"19","author":"Islam","year":"2023","journal-title":"Alzheimers Dement."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1186\/s13195-020-00603-8","article-title":"Enhanced diagnostic accuracy for neurocognitive disorders: A revised cut-off approach for the Montreal Cognitive Assessment","volume":"12","author":"Thomann","year":"2020","journal-title":"Alzheimers Res. Ther."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1093\/arclin\/acab029","article-title":"Performances on the Montreal Cognitive Assessment Along the Cardiovascular Disease Continuum","volume":"37","author":"Gagnon","year":"2022","journal-title":"Arch. Clin. Neuropsychol."},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Cri\u015fan, A.F., Oancea, C., Timar, B., Fira-Mladinescu, O., Cri\u015fan, A., and Tudorache, V. (2014). Cognitive impairment in chronic obstructive pulmonary disease. PLoS ONE, 9.","DOI":"10.1371\/journal.pone.0102468"},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Oprescu, A.C., Grosu, C., and Bild, W. (2023). Correlations between Cognitive Evaluation and Metabolic Syndrome. Metabolites, 13.","DOI":"10.3390\/metabo13040570"},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Andreasson, I., Persson, H.C., and Bj\u00f6rkdahl, A. (2024). Fatigue and cognitive dysfunction in previously hospitalized patients with COVID-19: A 1-year follow-up. PLoS ONE, 19.","DOI":"10.1371\/journal.pone.0314131"},{"key":"ref_38","first-page":"268","article-title":"Inter- and intraobserver reproducibility of cerebral atrophy assessment on MRI scans with hemispheric infarcts","volume":"36","author":"Pasquier","year":"1996","journal-title":"Eur. Neurol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"119","DOI":"10.3233\/ADR-220090","article-title":"The Effects of SARS-CoV-2 Infection on the Cognitive Functioning of Patients with Pre-Existing Dementia","volume":"7","author":"Dubey","year":"2023","journal-title":"J. Alzheimers Dis. Rep."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"12609","DOI":"10.2340\/jrm.v55.12609","article-title":"Effect of oxygen therapy duration on cognitive impairment 12 months after hospitalization for SARS-COV-2 infection","volume":"55","author":"Rapin","year":"2023","journal-title":"J. Rehabil. Med."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1239","DOI":"10.3233\/JAD-215506","article-title":"Clinical and Imaging Determinants of Neurocognitive Disorders in Post-Acute COVID-19 Patients with Cognitive Complaints","volume":"87","author":"Andriuta","year":"2022","journal-title":"J. Alzheimers Dis."},{"key":"ref_42","first-page":"100836","article-title":"Post-COVID cognitive dysfunction: Current status and research recommendations for high risk population","volume":"38","author":"Quan","year":"2023","journal-title":"Lancet Reg. Health West. Pac."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"e091352","DOI":"10.1002\/alz.091352","article-title":"Post-COVID Cognitive impairment in a large hospital-based multi-ethnic sample during the COVID-19 pandemic","volume":"20","author":"Neal","year":"2025","journal-title":"Alzheimers Dement."},{"key":"ref_44","doi-asserted-by":"crossref","unstructured":"Sama, S.R., Gore, R., Bauer, A.Z., Garber, L., Rosiello, R., Fair, M., and Kriebel, D. (2025). Autoimmune diseases as pre-existing conditions and sequelae of post COVID-19 condition in a Massachusetts community based observational study of COVID-19 patients. PLoS ONE, 20.","DOI":"10.1371\/journal.pone.0337848"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"152805","DOI":"10.1016\/j.semarthrit.2025.152805","article-title":"Risk of new onset of immune-mediated diseases after SARS-CoV-2 infection: A systematic review and meta-analysis","volume":"74","author":"Gil","year":"2025","journal-title":"Semin. Arthritis Rheum."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"576","DOI":"10.1136\/jech-2016-207809","article-title":"Associations between specific autoimmune diseases and subsequent dementia: Retrospective record-linkage cohort study, UK","volume":"71","author":"Wotton","year":"2017","journal-title":"J. Epidemiol. Community Health"},{"key":"ref_47","doi-asserted-by":"crossref","unstructured":"Trofin, F., Nastase, E.V., V\u00e2\u021b\u0103, A., Iancu, L.S., Lunc\u0103, C., Buzil\u0103, E.R., Vlad, M.A., and Dorneanu, O.S. (2023). The Immune, Inflammatory and Hematological Response in COVID-19 Patients, According to the Severity of the Disease. Microorganisms, 11.","DOI":"10.3390\/microorganisms11020319"},{"key":"ref_48","doi-asserted-by":"crossref","unstructured":"Paranga, T.G., Pavel-Tanasa, M., Constantinescu, D., Plesca, C.E., Petrovici, C., Miftode, I.L., Moscalu, M., Cianga, P., and Miftode, E.G. (2023). Comparison of C-reactive protein with distinct hyperinflammatory biomarkers in association with COVID-19 severity, mortality and SARS-CoV-2 variants. Front. Immunol., 14.","DOI":"10.3389\/fimmu.2023.1213246"},{"key":"ref_49","doi-asserted-by":"crossref","unstructured":"Enache-Leonte, G., V\u00e2\u021b\u0103, A., Onofrei, M.I., Hurmuzache, M.E., Rusu Zota, G., Trofin, D., Harja-Alexa, I.A., and Luca, M.C. (2026). The Clinical Utility of Serum Biomarkers in the Differentiation and Prognostic Assessment of Viral Meningitis. Pathogens, 15.","DOI":"10.3390\/pathogens15020234"},{"key":"ref_50","doi-asserted-by":"crossref","unstructured":"Aprile, D., De Marchi, F., Menegon, F., Comi, C., and Tondo, G. (2025). Neutrophil-to-Lymphocyte Ratio in the Alzheimer\u2019s Disease Continuum. Int. J. Mol. Sci., 26.","DOI":"10.3390\/ijms26115157"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"648","DOI":"10.1055\/s-0039-3399489","article-title":"Neutrophil-to-Lymphocyte Ratio: Can It Be Used as an Adjunct Tool to Predict Histopathological Grade of Brain Tumor?","volume":"10","author":"Ashwath","year":"2019","journal-title":"J. Neurosci. Rural Pract."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"59217","DOI":"10.18632\/oncotarget.19484","article-title":"Prognostic role of neutrophil lymphocyte ratio in patients with glioma","volume":"8","author":"Zhang","year":"2017","journal-title":"Oncotarget"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"16667","DOI":"10.2147\/JIR.S561080","article-title":"Neutrophil-to-Lymphocyte Ratio as a Prognostic Marker for Hospital-Acquired Infections in Neurosurgical Patients","volume":"18","author":"Sokal","year":"2025","journal-title":"J. Inflamm. Res."},{"key":"ref_54","doi-asserted-by":"crossref","unstructured":"Ghozy, S., El-Qushayri, A.E., Varney, J., Kacimi, S.E.O., Bahbah, E.I., Morra, M.E., Shah, J., Kallmes, K.M., Abbas, A.S., and Elfil, M. (2022). The prognostic value of neutrophil-to-lymphocyte ratio in patients with traumatic brain injury: A systematic review. Front. Neurol., 13.","DOI":"10.3389\/fneur.2022.1021877"},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"949","DOI":"10.1016\/S1474-4422(06)70598-1","article-title":"Vitamin B12, folic acid, and the nervous system","volume":"5","author":"Reynolds","year":"2006","journal-title":"Lancet Neurol."},{"key":"ref_56","doi-asserted-by":"crossref","unstructured":"Plantone, D., Primiano, G., Manco, C., Locci, S., Servidei, S., and De Stefano, N. (2022). Vitamin D in Neurological Diseases. Int. J. Mol. Sci., 24.","DOI":"10.3390\/ijms24010087"},{"key":"ref_57","doi-asserted-by":"crossref","unstructured":"Caliman-Sturdza, O.A., Gheorghita, R.E., and Soldanescu, I. (2025). Vitamin D and COVID-19: Clinical Evidence and Immunological Insights. Life, 15.","DOI":"10.3390\/life15050733"},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"3011","DOI":"10.3390\/nu7043011","article-title":"Vitamin D and 1,25(OH)2D regulation of T cells","volume":"7","author":"Cantorna","year":"2015","journal-title":"Nutrients"},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1016\/j.yfrne.2012.07.001","article-title":"Vitamin D, effects on brain development, adult brain function and the links between low levels of vitamin D and neuropsychiatric disease","volume":"34","author":"Eyles","year":"2013","journal-title":"Front. Neuroendocr."},{"key":"ref_60","doi-asserted-by":"crossref","unstructured":"Leng, A., Shah, M., Ahmad, S.A., Premraj, L., Wildi, K., Li Bassi, G., Pardo, C.A., Choi, A., and Cho, S.M. (2023). Pathogenesis Underlying Neurological Manifestations of Long COVID Syndrome and Potential Therapeutics. Cells, 12.","DOI":"10.3390\/cells12050816"},{"key":"ref_61","first-page":"e92683","article-title":"1,25-Dihydroxyvitamin D Testing in Clinical Practice: A Literature Review on Diagnostic Challenges Arising From Analytical Variability","volume":"17","author":"Farag","year":"2025","journal-title":"Cureus"},{"key":"ref_62","first-page":"462","article-title":"Reference values of 25-hydroxyvitamin D revisited: A position statement from the Brazilian Society of Endocrinology and Metabolism (SBEM) and the Brazilian Society of Clinical Pathology\/Laboratory Medicine (SBPC)","volume":"64","author":"Moreira","year":"2020","journal-title":"Arch. Endocrinol. Metab."},{"key":"ref_63","first-page":"595","article-title":"Effects of an 8-week high-dose vitamin D supplementation on fatigue and neuropsychiatric manifestations in post-COVID syndrome: A randomized controlled trial","volume":"78","author":"Charoenporn","year":"2024","journal-title":"Psychiatry Clin. Neurosci."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1684\/mrh.2023.0519","article-title":"Hypomagnesemia and 25-hydroxyvitamin D deficiency in patients with long COVID","volume":"36","author":"Orrante","year":"2023","journal-title":"Magnes. Res."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"27","DOI":"10.5578\/tt.20229904","article-title":"Subacute neurological sequelae in mild COVID-19 outpatients","volume":"70","author":"Canlar","year":"2022","journal-title":"Tuberk. Toraks"},{"key":"ref_66","doi-asserted-by":"crossref","unstructured":"Fernandes, A.L., Sales, L.P., Santos, M.D., Caparbo, V.F., Murai, I.H., and Pereira, R.M.R. (2022). Persistent or new symptoms 1 year after a single high dose of vitamin D3 in patients with moderate to severe COVID-19. Front. Nutr., 9.","DOI":"10.3389\/fnut.2022.979667"},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"426","DOI":"10.1159\/000540919","article-title":"Gender Disparities in Neurological Symptoms of Long COVID: A Systematic Review and Meta-Analysis","volume":"59","author":"Gorenshtein","year":"2025","journal-title":"Neuroepidemiology"},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"3470","DOI":"10.3390\/nu5093470","article-title":"Increased Plasma Concentrations of Vitamin D Metabolites and Vitamin D Binding Protein in Women Using Hormonal Contraceptives: A Cross-Sectional Study","volume":"5","author":"Streym","year":"2013","journal-title":"Nutrients"},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"1243","DOI":"10.3233\/JAD-221223","article-title":"Vitamin D, Cognition, and Alzheimer\u2019s Disease: Observational and Two-Sample Mendelian Randomization Studies","volume":"99","author":"Ilboudo","year":"2024","journal-title":"J. Alzheimers Dis."},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"70041","DOI":"10.1111\/acel.70041","article-title":"Cellular Senescence Is a Central Driver of Cognitive Disparities in Aging","volume":"24","author":"Baier","year":"2025","journal-title":"Aging Cell"},{"key":"ref_71","doi-asserted-by":"crossref","unstructured":"M\u00fcller, L., and Di Benedetto, S. (2024). Inflammaging, immunosenescence, and cardiovascular aging: Insights into long COVID implications. Front. Cardiovasc. Med., 11.","DOI":"10.3389\/fcvm.2024.1384996"}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/62\/6\/1180\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T08:32:42Z","timestamp":1781771562000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/62\/6\/1180"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,18]]},"references-count":71,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2026,6]]}},"alternative-id":["medicina62061180"],"URL":"https:\/\/doi.org\/10.3390\/medicina62061180","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,18]]}}}