Metacognition and cognitive dysfunction in post-COVID condition

Background The mechanisms associated with cognitive issues in post-COVID condition (PCC) are still under debate. Metacognition refers to the ability to reflect and evaluate one’s cognitive functioning and remains unexplored in this condition. This study aimed to investigate both local and global metacognition in individuals with PCC according to the presence of objective cognitive impairment and to assess the relationship between metacognitive abilities and fatigue, depression, and anxiety. Methods A total of 74 PCC (mean age = 51.45 ± 8.74 years; 78.4% female) patients and 49 healthy controls (HC) (mean age = 49.55 ± 8.84 years; 85.7% female) were included in this cross-sectional study. All participants completed a comprehensive neuropsychological battery. Local metacognition was assessed through task-specific performance estimates, collected through predictions and postdictions of the performance in the neuropsychological assessment. Global metacognition was assessed via two self-report instruments. PCC patients were classified as cognitively preserved (PCC-CP = 43) and cognitively impaired (PCC-CI = 31). Results PCC patients showed reduced accuracy in both local and global metacognition compared to HC. Regarding local metacognition, PCC-CI patients significantly overestimated their performance in attention, executive function and memory. For global metacognition, both PCC-CP and PCC-CI underestimated their global cognitive abilities compared to HC. Global metacognitive scores were negatively correlated with fatigue and depression only in the PCC-CP group. Conclusion PCC exhibit impaired local and global metacognitive accuracy, with differences according to the presence of objective cognitive impairment. These findings underscore the importance of assessing cognitive performance and metacognitive abilities in PCC patients to better understand subjective cognitive complaints and inform targeted rehabilitation strategies.