Cognitive dysfunction after COVID-19 is a common and disabling condition, with symptoms often persisting for more than 12 months. Symptoms may fluctuate and can include memory, attention, concentration, and executive function impairments. Assessment should focus on documenting the nature and trajectory of the impairment and excluding alternative diagnoses. Self-management techniques may help patients manage their condition. As of March 2023, over 1.8 million individuals in the UK self-reported long COVID symptoms, with 42% experiencing symptoms lasting two years or more. Systematic reviews suggest up to a third of long COVID patients have persistent cognitive impairment, though estimates vary due to methodological differences. The underlying mechanisms and potential treatments for cognitive impairment in long COVID are not well understood, with most evidence being mechanistic, observational, or hypothetical. Randomized controlled trials of potential treatments are ongoing. Cognitive performance is typically assessed in terms of functional domains, including memory, attention, and executive functioning. Patients often experience difficulties in multiple domains, which may or may not correlate with self-reported symptoms. Systemic symptoms such as fatigue, insomnia, and "brain fog" are commonly reported and may fluctuate with physical fatigue. These symptoms are often associated with mood disorders or post-traumatic stress disorder. Longitudinal studies show that many individuals improve over time, but cognitive symptoms can fluctuate unpredictably, causing uncertainty and anxiety. These impairments can have significant impacts on daily life, relationships, and work. Patients with long COVID often find it challenging to communicate the fluctuating nature of their symptoms. Practical strategies to manage cognitive impairment include limiting distractions, using lists, identifying "homes" for items, maintaining a routine, breaking tasks into smaller components, and asking for help. Self-management strategies also include cognitive exercises and mindfulness. Primary care teams play a crucial role in managing comorbid conditions and providing support. Physical rehabilitation should incorporate pacing rather than traditional exercise therapy. Clinical trials are ongoing for various therapeutic agents, but no large-scale randomized controlled trials have shown effectiveness in treating cognitive impairment in long COVID. Patients with persistent cognitive impairment may benefit from referral to a specialist multidisciplinary long COVID service or cognitive disorders clinic. Support and guidance around returning to work is vital, as many employers lack formalised return-to-work policies. Patients may also be interested in participating in research studies. GPs can provide essential longitudinal support and encourage patients to manage their condition, including education on a healthy lifestyle and sleep patterns. The article provides a practical guide for GPs to help them approach cognitive dysfunction in long COVID patients, based on the evolving evidence base.Cognitive dysfunction after COVID-19 is a common and disabling condition, with symptoms often persisting for more than 12 months. Symptoms may fluctuate and can include memory, attention, concentration, and executive function impairments. Assessment should focus on documenting the nature and trajectory of the impairment and excluding alternative diagnoses. Self-management techniques may help patients manage their condition. As of March 2023, over 1.8 million individuals in the UK self-reported long COVID symptoms, with 42% experiencing symptoms lasting two years or more. Systematic reviews suggest up to a third of long COVID patients have persistent cognitive impairment, though estimates vary due to methodological differences. The underlying mechanisms and potential treatments for cognitive impairment in long COVID are not well understood, with most evidence being mechanistic, observational, or hypothetical. Randomized controlled trials of potential treatments are ongoing. Cognitive performance is typically assessed in terms of functional domains, including memory, attention, and executive functioning. Patients often experience difficulties in multiple domains, which may or may not correlate with self-reported symptoms. Systemic symptoms such as fatigue, insomnia, and "brain fog" are commonly reported and may fluctuate with physical fatigue. These symptoms are often associated with mood disorders or post-traumatic stress disorder. Longitudinal studies show that many individuals improve over time, but cognitive symptoms can fluctuate unpredictably, causing uncertainty and anxiety. These impairments can have significant impacts on daily life, relationships, and work. Patients with long COVID often find it challenging to communicate the fluctuating nature of their symptoms. Practical strategies to manage cognitive impairment include limiting distractions, using lists, identifying "homes" for items, maintaining a routine, breaking tasks into smaller components, and asking for help. Self-management strategies also include cognitive exercises and mindfulness. Primary care teams play a crucial role in managing comorbid conditions and providing support. Physical rehabilitation should incorporate pacing rather than traditional exercise therapy. Clinical trials are ongoing for various therapeutic agents, but no large-scale randomized controlled trials have shown effectiveness in treating cognitive impairment in long COVID. Patients with persistent cognitive impairment may benefit from referral to a specialist multidisciplinary long COVID service or cognitive disorders clinic. Support and guidance around returning to work is vital, as many employers lack formalised return-to-work policies. Patients may also be interested in participating in research studies. GPs can provide essential longitudinal support and encourage patients to manage their condition, including education on a healthy lifestyle and sleep patterns. The article provides a practical guide for GPs to help them approach cognitive dysfunction in long COVID patients, based on the evolving evidence base.