Language and Health 2 (2024) 1–21 Available online 2 October 2023 2949-9038/© 2023 The Author. Published by Elsevier B.V. on behalf of Shandong University. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). Cognitive-linguistic difficulties in adults with Long COVID: A follow-up study Louise Cummings *, 1 The Hong Kong Polytechnic University, Hong Kong, China A R T I C L E INFO Keywords: Cognition COVID-19 Language Long COVID Occupational health Post COVID-19 condition SARS-CoV-2 Speech-language pathology ABSTRACT As the emergency phase of the COVID-19 pandemic subsides, the long-term health problems caused by SARS- CoV-2 infection are becoming increasingly clear. So-called Long COVID, or post COVID-19 condition, is a debilitating illness that impacts functioning for months and even years after infection. Alongside physical symptoms, Long COVID has a particularly insidious effect on cognition and language. While many studies have documented non-linguistic cognitive impairments in people with Long COVID, what has not been documented to any significant extent is the presence and duration of language difficulties in Long COVID. This study addresses this lack of research by examining the cognitive-linguistic skills of 41 adults with Long COVID. These adults were assessed at two time points using a test protocol of 12 language tasks. This paper describes the findings of the 6- month follow-up study. Results indicate that difficulties in immediate and delayed verbal recall persist long after the onset of COVID symptoms, even as improvements occur in verbal fluency and the informativeness of spoken discourse. It is argued that these difficulties are a significant contributing factor in a lack of work return in these adults. Implications of these findings for the provision of speech-language pathology services to these adults and occupational health policies relating to Long COVID are discussed. 1. Introduction The COVID-19 pandemic has undoubtedly been the global health challenge of our time. But aside from the large number of deaths caused by SARS-CoV-2 (the virus that causes COVID-19), an even greater number of people with long-term debilitating illness could yet be the legacy of this pandemic. As we learn more about the pathophysiological effects of SARS-CoV-2 (Perumal et al., 2023), it is clear that a large burden of cognitive impairment exists alongside physical symptoms in people with Long COVID. Cognition is not a unitary phenomenon but consists of linguistic and non-linguistic components that interact in complex ways. While considerable research has been conducted into non-linguistic aspects of cognition such as memory and attention in people with Long COVID, there has been relatively little research un- dertaken into how language is compromised in this condition. The current paper addresses this lack of research by examining cognitive-linguistic difficulties in adults with Long COVID. The 41 adults examined in this study were previously assessed by the author, with the results reported in Cummings (2023a). These individuals were assessed again at six months after the first assessment with a view to determining if their cognitive-linguistic difficulties had improved, deteriorated, or remained static. This article reports the results of this 6-month follow-up study. It also considers the role that cognitive-linguistic difficulties play in low rates of work return in adults with Long COVID. The article unfolds along the following lines. Long COVID is intro- duced in Section 2. Cognitive dysfunction is a widely recognized feature "My partner is 41, a primary school teacher who previously would have been in the top 5 percent for expressive language and related cognitive tasks — and he can’t work out how to answer whether or not he wants a coffee when I ask." Partner of 41-year-old man with Long COVID, 12 months post onset (Australia) * Correspondence to: Department of English and Communication, Chung Sze Yuen Building, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong, China. E-mail address: louise.cummings@polyu.edu.hk. 1 Orcid ID: https://orcid.org/0000-0002-8947-8195 Contents lists available at ScienceDirect Language and Health journal homepage: www.sciencedirect.com/journal/language-and-health https://doi.org/10.1016/j.laheal.2023.09.001 Received 5 July 2023; Accepted 19 September 2023