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Background Chimeric antigen receptor T-cell (CAR-T) therapy has transformed the treatment landscape of haematological malignancies and is being trialled for autoimmune neurological disorders. However, CAR-T therapy is associated with immune effector cell-associated neurotoxicity syndrome (ICANS). Few studies have provided detailed assessment of cognition in the acute and chronic stages post-CART.Methods In this prospective longitudinal study, patients treated with CAR T-cell therapy at The Alfred Hospital, Melbourne, underwent cognitive testing at pre-infusion, 3-, 6-, and 12-months post-discharge. Psychometric tests measured attention, processing speed, visuospatial function, language, memory, and executive function. Raw scores were converted into z-scores based on normative data adjusted for age, sex, and education.Results 191 cognitive evaluations were conducted on 96 participants (61% male, 65.87 ±10.58 years old). Thirty-two (33%) patients developed ICANS. Linear mixed-effects models predicting test z-scores found significant interactions between time and ICANS group ( p<.05) for tests of language (DKEFS Category Fluency) and visuospatial function (WAIS-IV Block Design). Patients in the ICANS group demonstrated decline relative to the non-ICANS group, but the magnitude of this effect was small. All other linear mixed models—including additional tests of language (SYDBAT naming) and visuospatial function (Rey Complex Figure Copy)— found no significant interactions between time and ICANS group (p>.05).Conclusion Patients who develop ICANS demonstrate relatively stable cognitive function across time in the long term (days 87 to 360 post-CART), similar to patients who do not develop ICANS. Our data is reassuring, revealing that ICANS-related cognitive impairment resolves sometime in the first three months post-CAR-T therapy.