Q: I have a hard time remembering things and often feel drained like I can’t clear my head at all. Is the brain fog
and is there anything i can do about it?
A: The blank space in your mind, when it appears, can be confusing. What did you just say? Did you have to pick up chicken and carrots on the way home, or was it just the chicken? Why is it suddenly so hard to pay attention to what you’re doing and why does it feel like your brain is suddenly 30 years older than yourself?
When you feel sluggish, forgetful, easily distracted, or completely overwhelmed by everyday tasks, you may be experiencing a common phenomenon known as brain fog. While not an official clinical diagnosis that would end up on a medical record, brain fog can occur after several sleepless nights, while taking certain medications like antihistamines, or as a result of jet lag – among many other scenarios. Some people experience a type of brain fog after a heavy meal, in particularly stressful phases of life, or when there are major hormonal changes, such as during pregnancy or menopause.
Brain fog can also be a symptom of illness; It can occur with Lyme disease, lupus and multiple sclerosis, after cancer treatment, or even during a particularly bad cold.
In recent years, the term has also become closely associated with the cognitive impairment that many people experience during or after a bout with Covid-19. About 20% to 30% of Covid-19 patients have some brain fog that persists or develops in the three months after their initial infection, and more than 65% of long-Covid patients also report neurological symptoms. “It’s developing into a neurological health crisis,” said Dr. Michelle Monje, a neurologist at Stanford University who has studied both chemotherapy- and coronavirus-related cognitive impairment.
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When should you see a doctor?
Brain fog can be frustrating and worrying no matter when or how you get it. The cognitive problems can wax and wane — in Covid-19-related brain fog as well as other types, said Jacqueline Becker, clinical neuropsychologist at Mount Sinai Hospital in New York. But if your symptoms last for several weeks or make life painfully difficult, you should have a medical examination.
“There are some people who can get on with their work and normal life, but they may need to take breaks between tasks more frequently,” Becker said. “And then there are other people who are just completely handicapped by it.”
How is it diagnosed?
Although brain fog sounds vague and temporary, like inclement weather that clears up over time, research is beginning to show that it can affect some people for months and take over many aspects of life compared to ordinary sluggishness or forgetfulness. Brain fog tends to impair executive functions — a set of skills essential for planning, organizing information, following directions, and multitasking, among other things. “When executive function is impaired, it often affects multiple areas of cognitive ability,” Becker said.
Many clinicians prefer to use the term “cognitive impairment” to lend more medical legitimacy to what patients are going through, and begin the diagnostic process with cognitive assessments, which are used to measure executive function in serious illnesses like dementia, added Becker added. The main difference is that brain fog doesn’t get progressively worse as mental abilities degenerate in dementia. You may have some days that are worse than others, but brain fog tends to impair your cognitive function to the same degree each time.
A variety of blood tests can also help point to some causes of cognitive impairment, such as sleep apnea, vitamin B deficiency, or other hormone and thyroid problems, said Dr. Joanna Hellmuth, a neurologist at the University of California, San Francisco. But because brain fog can occur in so many different ways and because it has so many different causes, the diagnostic tests have limitations, she added.
Sometimes brain fog can be difficult to diagnose because it is caused by several different factors, even in a patient who has an overarching condition. Someone with lupus or multiple sclerosis, for example, may experience cognitive impairment due to direct damage to their brain cells — but they may also not be getting enough sleep, be overly tired, or take medications that contribute to brain fog.
Unlike lupus and multiple sclerosis, direct damage to brain cells is much less common in Covid-19. But some patients’ brains show dysregulation in their endothelial cells, which line the blood vessels in the brain. This could lead to a more permeable blood-brain barrier, allowing contaminants to pass through to the brain and altering cognitive function, Hellmuth said.
Researchers are finding that a more common cause of brain fog in Covid-19 patients, as well as in patients who have been infected with other viruses such as HIV and Ebola, and even in people undergoing chemotherapy for cancer, is inflammation – a steep one and unwarranted increases in immune cell activity that can wreak havoc – in the brain and body. Studies show that patients with persistent cognitive impairment after Covid-19 have high levels of inflammatory markers in their blood and cerebrospinal fluid. “We’re seeing a new virus causing the same old problem,” said Dr. Avindra Nath, clinical director at the National Institute of Neurological Disorders and Stroke.
How do you clear brain fog?
Even if doctors can’t find a physical cause for your brain fog, there are steps you can take to deal with it, Hellmuth said. Start with short-term adaptive strategies to cope with everyday tasks. Write notes and set alarms so you don’t miss appointments. Take regular breaks from long projects to help you focus and get things done. You can also try tracking your daily activity using an app on your phone or just a notebook to find out what times of the day you feel most energetic and clear. Then reserve that time for more difficult or complicated tasks.
Your doctor may also suggest lifestyle changes to improve your overall health and energy levels. “We’re trying to encourage cardiovascular exercise, good nutrition, sleep and social activities, which are known to be good for the brain,” Hellmuth said.
Physical activity can help improve your ability to focus, as well as increase neural connectivity and memory formation in the brain. If rigorous workouts aren’t your thing, try doing them in small chunks so you can build your aerobic fitness slowly. Make sure you stay hydrated and eat a variety of foods rich in vitamins and antioxidants. And reach out to friends and family for support. Studies have shown that maintaining a rich social network not only helps relieve stress during difficult times, but can also improve intellectual stimulation and the health of your brain.
You’ll also want to get better rest, which of course is easier said than done for long Covid patients, those undergoing chemotherapy, or those experiencing life changes like pregnancy or menopause. Take steps to relax your mind at night. Unplug your electronics and create a restful environment.
Monje said some patients have also found relief from taking medication to treat ADHD and other attention problems. And ongoing clinical trials for drugs that help with chemotherapy-related cognitive impairment may offer new treatments in the future.
Becker’s team at Mount Sinai is leading a clinical trial of a cognitive rehabilitation program in hopes they can teach the brain to rewire itself and reduce symptoms of brain fog. Rehab involves learning and practicing skills to improve memory and attention, as well as training in emotion regulation to help patients, she said.
“The brain is extremely malleable,” said Becker. “There is substantial evidence that the brain can recover from traumatic brain injury and stroke, and this gives me hope that brain fog recovery is possible.”