text: SARS CoV 2 and the Brain What Do We Know about the Causality of Cognitive COVID The second year of the COVID 19 coronavirus disease pandemic has seen the need to identify and assess the long term consequences of a SARS CoV 2 infection on an individuals overall wellbeing including adequate cognitive functioning Cognitive COVID is an informal term coined to interchangeably refer to acute changes in cognition during COVID 19 and or cognitive sequelae with various deficits following the infection These may manifest as altered levels of consciousness encephalopathy like symptoms delirium and loss of various memory domains Dysexecutive syndrome is a peculiar manifestation of Cognitive COVID as well In the previous major outbreaks of viruses like SARS CoV MERS CoV and Influenza There have been attempts to understand the underlying mechanisms describing the causality of similar symptoms following SARS CoV 2 infection This review therefore is attempting to highlight the current understanding of the various direct and indirect mechanisms focusing on the role of neurotropism of SARS CoV 2 the general pro inflammatory state and the pandemic associated psychosocial stressors in the causality of Cognitive COVID Neurotropism is associated with various mechanisms including retrograde neuronal transmission via olfactory pathway a general hematogenous spread and the virus using immune cells as vectors The high amounts of inflammation caused by COVID 19 compounded with potential intubation are associated with a deleterious effect on the cognition as well Finally the pandemics unique psychosocial impact has raised alarm due to its possible effect on cognition Furthermore with surfacing reports of post COVID vaccination cognitive impairments after vaccines containing mRNA encoding for spike glycoprotein of SARS CoV 2 we hypothesize their causality and ways to mitigate the risk The potential impact on the quality of life of an individual and the fact that even a minor proportion of COVID 19 cases developing cognitive impairment could be a significant burden on already overwhelmed healthcare systems across the world make it vital to gather further evidence regarding the prevalence presentation correlations and causality of these events and reevaluate our approach to accommodate early identification management and rehabilitation of patients exhibiting cognitive symptoms 