COVID-19 Leaves Lasting Marks on Everyday Self-Control, Study of Executive Behavior Finds

More than four years after the acute phase of the COVID-19 pandemic receded from headlines, researchers are still mapping the quieter, longer shadow that SARS-CoV-2 casts on the brain and behavior. A new brief report published in Discover Psychology by Juan Antonio Becerra-García and Maëlle Delphine Frédérique Laval of the Universidad Internacional de La Rioja in Spain adds an important behavioral dimension to that map. Rather than focusing narrowly on performance on cognitive tests, the study asks a deceptively simple question: do people themselves notice changes in everyday behaviors that depend on the frontal lobes, the brain regions that govern planning, motivation, and self-control? The answer, based on self-reports from 69 adults with different post-infection trajectories, is that many do, and that the pattern of those changes differs depending on whether a person recovered from an acute episode or went on to develop post-COVID-19 syndrome.

The research team set out to characterize what neuropsychologists call dysexecutive behavioral changes, a term that describes disruptions in the suite of behaviors orchestrated by the frontal systems of the brain. Executive functions encompass the ability to initiate activity, sustain effort toward goals, inhibit inappropriate impulses, organize sequences of actions, and adapt behavior to changing circumstances. When these systems falter, the consequences show up not as failures on a laboratory puzzle but as changes in daily life: a person may become apathetic and lose the drive to begin tasks, may struggle to organize and complete multi-step activities, or may find themselves saying and doing things that a previously well-regulated sense of social restraint would have suppressed. The study’s central premise is that capturing these changes requires a multidimensional behavioral assessment, complementing the cognitive testing that has dominated much of the post-COVID literature to date.

To do this, the researchers conducted a cross-sectional study of 69 participants, dividing them into two groups according to their clinical trajectory after infection. Forty-five participants had a history of acute COVID-19, meaning they had been infected and had experienced the acute illness, while 24 participants had post-COVID-19 syndrome, the condition in which symptoms persist well beyond the acute phase. The instrument at the heart of the study was the Frontal Systems Behavior Scale, known in the field as the FrSBe. This standardized questionnaire is designed to quantify behaviors associated with damage or dysfunction in frontal brain systems, and it yields scores along three well-characterized dimensions: apathy, executive dysfunction, and disinhibition. Crucially, the scale asks respondents to rate behavior both before and after the event of interest, which in this case was SARS-CoV-2 infection, allowing each participant to serve as their own baseline for comparison.

The three dimensions measured by the FrSBe map onto distinct aspects of frontal-lobe function. Apathy reflects a loss of motivation, initiative, and emotional engagement, and it is classically associated with damage to medial frontal regions and their connections to deep brain circuits involved in drive and reward. Executive dysfunction captures difficulties with planning, organization, working memory in the service of action, and the flexible shifting of strategies when circumstances change. Disinhibition, by contrast, reflects a failure of inhibitory control, manifesting as impulsivity, socially inappropriate behavior, and difficulty restraining emotional or appetitive responses. Because these dimensions can be affected independently, a profile-based assessment can reveal patterns that a single global measure of cognitive impairment would obscure. This is precisely the kind of granularity the Spanish team sought in comparing the two post-infection groups.

The findings were consistent in one broad respect and revealing in another. Across both groups, the mean standardized scores, expressed as z-scores, for the FrSBe behavioral dimensions increased in the period after infection compared with participants’ retrospective ratings of their own pre-infection functioning. In other words, on average, people in both the acute COVID-19 group and the post-COVID-19 syndrome group reported more dysexecutive behaviors after their infection than before it. This uniform direction of change suggests that SARS-CoV-2 infection, regardless of the subsequent clinical course, may be associated with perceived alterations in behaviors that depend on frontal systems, a conclusion that aligns with the broader literature documenting neuropsychological alterations, particularly executive dysfunction, as frequently reported consequences of the infection.

The differences between the groups, however, were where the study’s most clinically interesting signal emerged. Participants with post-COVID-19 syndrome showed significant increases in all three dysexecutive symptom dimensions, and their post-infection scores reached the range of clinical difficulty on the apathy and disinhibition dimensions. This means that individuals living with the persistent form of the illness not only noticed changes in their capacity for organized, goal-directed activity but also reported meaningful losses of motivation and initiative alongside weakened behavioral inhibition. For a condition whose day-to-day burden is often described in terms of fatigue and cognitive fog, the finding that apathy, a motivational rather than purely cognitive construct, features prominently offers a potentially important reframing: some of what patients experience as exhaustion or loss of drive may be measurable as a distinct frontal-systems behavioral syndrome.

The acute COVID-19 group presented a subtler picture. These participants, who had been infected but had not developed the persistent syndrome, exhibited slight perceived behavioral changes on the executive dysfunction dimension, and more marked changes on the dimension of disinhibition. The prominence of disinhibition in this group is noteworthy because it suggests that even people whose infection resolves without a chronic syndrome may perceive changes in impulse control and behavioral regulation. The authors’ interpretation, as reflected in their reported results, is that the two trajectories carry distinct patterns of self-reported alteration: a broader and clinically elevated profile in post-COVID-19 syndrome, and a narrower, milder profile dominated by disinhibitory features in those with a history of acute infection alone.

From these observations, the researchers draw two practical conclusions. First, they propose that SARS-CoV-2 infection may be associated with perceived changes in dysexecutive behavior, with distinct patterns across individuals on different post-infection trajectories. Second, they suggest that the Frontal Systems Behavior Scale may be a useful tool for identifying behavioral alterations across the different clinical spectra of the disease. The second point has real methodological weight. Much of the post-COVID assessment literature relies on neuropsychological batteries that measure cognitive performance under structured testing conditions, which can miss changes that manifest primarily in spontaneous, real-world behavior. A validated behavioral instrument with established norms and a built-in pre-post comparison offers clinicians and researchers a complementary lens, one that may be particularly sensitive to the motivational and inhibitory changes that patients themselves notice but that standard testing may not capture.

The authors are careful, appropriately, to frame their conclusions as exploratory. The study is a cross-sectional comparison with a modest sample size, and the FrSBe’s pre-infection ratings are retrospective, which means they depend on participants’ memory and self-perception of how they functioned before falling ill. Retrospective self-report is vulnerable to bias, particularly in a population experiencing fatigue, low mood, or cognitive complaints, and the design cannot establish that the behavioral changes were caused by the infection itself rather than by illness-related stress, lifestyle disruption, or other confounding factors. The researchers explicitly state that these exploratory findings should be interpreted with caution and justify further research using a more robust methodological approach, a caveat that responsible readers should take seriously. Larger longitudinal studies, ideally with pre-infection behavioral data collected prospectively, would be needed to confirm and extend the reported patterns.

Even with those limitations, the study makes a contribution that fits into a growing scientific effort to understand the full neurological and psychological footprint of SARS-CoV-2. Executive dysfunction has been widely reported after infection, but behavioral dimensions such as apathy and disinhibition have received less systematic attention. By showing that these dimensions can be measured, that they change in self-reported terms after infection, and that their profiles differ between acute and persistent clinical courses, Becerra-García and Laval provide a template for how behavioral neuropsychology can sharpen the characterization of post-COVID conditions. The work was funded by the Universidad Internacional de La Rioja’s call for grants for scientific publication, was approved by the institution’s research ethics commission, and is published open access, making the full report available to clinicians, researchers, and patients alike. As the field moves toward more rigorous designs, instruments like the FrSBe may help ensure that the behavioral consequences of COVID-19, not just its cognitive ones, are neither overlooked nor underestimated.

Subject of Research: Perceived dysexecutive behavioral changes after SARS-CoV-2 infection in acute COVID-19 versus post-COVID-19 syndrome

Article Title: Characterizing perceived dysexecutive behavioral changes following SARS-CoV-2 infection in individuals with different clinical trajectories

Article References: Characterizing perceived dysexecutive behavioral changes following SARS-CoV-2 infection in individuals with different clinical trajectories. (n.d.). https://doi.org/10.1007/s44202-026-00933-y

Image Credits: AI Generated

DOI: 10.1007/s44202-026-00933-y

Keywords: SARS-CoV-2, post-COVID-19 syndrome, dysexecutive behavior, executive dysfunction, apathy, disinhibition, Frontal Systems Behavior Scale, neuropsychology, behavioral assessment, frontal lobes, COVID-19, mental health