Tehran University of Medical Sciences (TUMS) Academic Journal of Surgery 2423-3218 9 1 2026 10 25 6 11 Hannan Ebrahimi Department of Neurosurgery, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran. Mohammad Javad Ebrahimi Department of Neurosurgery, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran Amir Kian Moaveni Department of Neurosurgery, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran Maral Moafi Department of Neurosurgery, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran Ahmad Pour-Rashidi 1. Department of Neurosurgery, Sina Hospital, Tehran University of Medical Sciences (TUMS), Tehran, Iran Azar Hadadi Department of Infectious Disease, Sina hospital, Tehran University of Medical Sciences (TUMS), Tehran, Iran Mahnaz Montazeri Department of Infectious Disease, Sina hospital, Tehran University of Medical Sciences (TUMS), Tehran, Iran Marziyeh Pakozi Department of Pulmonary Disease, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran Samira Kafan Department of Pulmonary Disease, Sina hospital, Tehran University of Medical Sciences (TUMS), Tehran, Iran Shahin Nasseri Department of Neurosurgery, Sina Hospital, Tehran University of Medical Sciences (TUMS), Tehran, Iran Zeinab Gholami Department of Neurosurgery, Sina Hospital, Tehran University of Medical Sciences (TUMS), Tehran, Iran Maryam Aghayerashti Faculty of Mathematical Science, Shahid Beheshti University, Tehran, Iran Gilda Kianimehr Department of Psychiatry, Sina hospital, Tehran University of Medical Sciences (TUMS), Tehran, Iran Abbas Amirjamshidi Department of Neurosurgery, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran 2025 11 06 Background: Different patterns and severity of neuropsychological symptoms are reported in patients with COVID-19. The exact pathophysiologic mechanisms responsible for the neuropsychological manifestations of COVID-19 remain unknown. This study aimed to compare the cognitive impairments between hospitalized and non-hospitalized patients with COVID-19. Methods: This cross-sectional study was performed in a referral hospital in Iran from March 2020 to March 2021. Neuropsychiatric assessments were conducted using the Addenbrooke’s Cognitive Examination (ACE) test. Demographic factors, medical history, hospitalization duration, and ACE scores were assessed. Statistical analysis was performed using SPSS. Results: In this study, 219 patients with COVID-19 (114 hospitalized and 105 non-hospitalized) were evaluated. The mean age of hospitalized patients was significantly higher than that of outpatient participants (48.46 vs. 34.32 years; P < 0.001). Gender, handedness, education level, and habitual history did not differ significantly between the two groups. Dexamethasone administration was significantly more common in hospitalized patients. The total and subgroup ACE scores in hospitalized patients were significantly lower than those in the outpatient group. Cognitive impairments were detected significantly more frequently in hospitalized patients. Multivariate analysis showed that cognitive impairments were significantly more common among hospitalized patients (P < 0.001). Conclusions: The cognitive ability of hospitalized patients with COVID-19 is lower than that of their outpatient counterparts regarding executive function, verbal fluency, memory, language, and visual perception. Hospitalized patients with COVID-19 should undergo more detailed neuropsychological evaluations and receive appropriate treatments accordingly. https://ajs.tums.ac.ir/index.php/ajs/article/view/332