Background <p>The COVID-19 pandemic represented a healthcare challenge of unparalleled magnitude worldwide. As patients recovered from the acute infection, a new challenge emerged, i.e., the development of post-acute symptoms. The main goal of this study was to evaluate the trajectory of cognitive symptoms since the acute phase of COVID-19 among patients followed through a telehealth program in Brazil.</p> Methods <p>A retrospective cohort study was conducted with confirmed COVID-19 patients followed by a Brazilian telehealth program who presented cognitive symptoms in the acute phase of infection. The objective of the current analysis was to assess the persistence or remission of cognitive symptoms at 24 weeks after the onset of acute COVID-19 symptoms, as well as the factors associated with such manifestations. The study used chi-square tests and multivariate logistic regression models to assess the association between patients’ parameters and the presence of cognitive symptoms. A backward stepwise method was applied to define significant characteristics, which were then evaluated using odds ratios and 95% confidence intervals.</p> Results <p>Among 319 patients who had cognitive symptoms during acute COVID-19, 89 (27.9%) reported persistence of cognitive symptoms for more than 24 weeks from the acute onset of the infection. Female sex (OR 2.33 [95% CI 1.23–4.43]) and having been infected during the second wave of COVID-19 (OR 2.30 [95% CI 1.34–3.96]) were associated with the persistence of symptoms beyond 24 weeks.</p> Conclusions <p>Approximately one-third of patients with COVID-19, mainly women and people infected during the second wave of infection, experienced persistent cognitive symptoms.</p>