Neurological Manifestations of Long COVID: Current Evidence, Emerging Concepts, and Future Perspectives

Six years after the onset of the COVID-19 pandemic, many individuals continue to experience persistent neurological symptoms that extend beyond the acute phase of infection, affecting daily life, work, and overall functioning, thereby representing a substantial long-term health burden. Cognitive impairment, fatigue, headache, and autonomic dysfunction are among the most frequently reported neurological features, often persisting despite the absence of clear diagnostic findings. Although Long COVID is recognized as a distinct clinical entity, the underlying pathophysiological mechanisms remain incompletely understood. This narrative review provides a critical synthesis of current literature regarding the clinical presentations, potential mechanisms, and biomarkers associated with neurological involvement in Long COVID. Reflecting the high heterogeneity of the available evidence, it is important to note that no neurological biomarker or disease-modifying therapy has yet been clinically validated. Ultimately, characterizing these pathways may help define disease heterogeneity, support patient stratification, and guide future personalized therapeutic approaches.