The impact of brief, rapid onset COVID-19 on executive functions in Maltese working-age adults

Abstract

Executive functioning (EF) is the ability to respond effectively to novel or changing conditions while maintaining emotional, cognitive, and social functioning. Emerging evidence suggests that even mild COVID-19 may impair EF domains such as inhibition, planning, and cognitive flexibility, yet few studies have explored this in non-hospitalised populations. The present study investigated the EF performance of working-age adults in Malta who had experienced mild/moderate COVID-19. A quantitative design was utilised, comparing individuals who previously tested positive for COVID-19, referred to as the COVID-19 group (n = 27) with those who had never tested positive, the NON-COVID-19 group (n = 43). Participants completed a demographic questionnaire as well as four performance-based neuropsychological assessments—Colour-Word Interference Test (CWIT), Trail Making Test (TMT), Zoo Map Test, and Rule Shift Cards (RSC)—and were assessed on key EF domains. No significant group differences were found across most EF measures. Both groups performed similarly in inhibition, planning, and task-switching. A single statistically significant result was found on the Rule Shift Cards test, with the COVID-19 group outperforming the non-COVID-19 group (p = .021). This result may reflect limitations in test sensitivity or the influence of psychological factors such as anxiety and motivation. As the first study to investigate this topic within a Maltese sample, the findings provide preliminary insight into post-COVID executive functioning. Nonetheless, methodological constraints warrant cautious interpretation. Future research should incorporate a broader range of performance-based and self-report EF measures, alongside longitudinal and ecologically valid designs, to better capture potential cognitive effects.