Elaine K. Howley
US News & World Report
May 25, 2022

A few months ago, Gianna Biscontini, a board-certified behavior analyst, author and coach based in Los Angeles, noticed a change in how her brain was working. “I noticed a cognitive decline. I began to miss meetings, leave my stove and sprinkler on and stumble over my words.” When thinking back on things that had occurred earlier in the day, everything seemed “hazy, barely there,” she says.

Initially, Biscontini says she felt embarrassed. “No one expects a 40-year-old woman to have trouble forming thoughts or to stumble over her words.”

But she soon discovered she was experiencing brain fog, a common symptom associated with a range of illnesses, conditions and even some medications. In Biscontini’s case, her brain fog stemmed from a COVID-19 infection, and that mental fuzziness has altered the way she moves through the world.

What Is Brain Fog?
“Brain fog is a mild but important form of neurocognitive impairment,” says Henry Mahncke, a neuroscientist and CEO of Posit Science, a San Francisco-based company that offers brain-training exercises designed by scientists to improve cognitive performance.

Brain fog “is very likely to be a sign or symptom of another issue,” says Dr. Freda C. Lewis-Hall, a life science leader and co-editor of the book “Psychiatric Illness in Women: Emerging Treatments and Research.”

People who experience brain fog often describe it as a sense of confusion or disorganization, disorientation or feeling scattered. A diminished ability to react and difficulty thinking, expressing your thoughts or thinking through complex situations or calculations can all be considered brain fog.

Dr. Emily Huang, a physical medicine and rehabilitation specialist with Santa Clara Valley Medical Center in San Jose, California, says that “while the term ‘brain fog’ is not a phrase we use medically to define a specific condition, the term can be used to describe an experience associated with mental fatigue, memory issues and decreased focus throughout the day.”

Patients who are experiencing brain fog often describe it as “not being as mentally sharp or having a slower processing speed, loss of attention and memory lapses,” says Laura Boxley, director of clinical neuropsychology training in the department of psychiatry and behavioral health at the Ohio State University Wexner Medical Center.

What’s actually occurring in the brain, Mahncke says, is that your brain’s processing capacity has slowed because there’s more interference than in a brain that’s functioning optimally. “It’s like if you had an old radio where you had to tune the dial and you weren’t quite on the station and there was some static.”

That static impedes the brain’s ability to process information quickly and that can impact how you make sense of the world around you.

What Causes Brain Fog?
Brain fog is a symptom that can have a variety of origins. “There is no specific cause of brain fog as there is relative ambiguity regarding this symptom, and it is typically a result of other medical conditions,” Huang says. These conditions may include:

  • Alzheimer’s disease, other forms of dementia and age-related cognitive decline. Changes in the brain associated with Alzheimer’s and dementia often cause brain fogginess to develop.
  • High blood pressure. High blood pressure can damage blood vessels, making them less efficient at carrying blood and the oxygen and nutrients it contains to hard-working cells in the brain.
  • Viral infections, such as COVID-19 and HIV. Inflammation from viral infections can impede normal brain function and cause brain fog.
  • Autoimmune disorders such as multiple sclerosis and lupus. Inflammation is also a factor in the development of brain fog related to autoimmune disorders. In the case of MS, lesions that develop as part of the disease’s course also impede normal brain function.
  • Lack of sleep. Fatigue related to poor sleep can impair your brain’s ability to function optimally.
  • Low blood sugar levels. If your brain doesn’t have enough glucose to fuel its work, that can lead to feeling fuzzy.
  • Vitamin deficiencies, such as low levels of vitamin B12 or vitamin D. Without the right levels of nutrients, your brain can’t process information optimally.
  • Hormonal changes, such as those that occur with menopause, pregnancy and thyroid disorders. Hormones are involved in many bodily processes, including cognition. So as their levels shift throughout life, that can impact how the brain functions.
  • Stress. Stress increases blood pressure and can lead to exhaustion, two key factors that can lead to brain fog.
  • Depression and other mental health conditions. Depression and other mental illnesses occur when the levels of certain neurotransmitters, such as serotonin, aren’t adequate. These chemicals are also related to cognition and mental clarity.

Brain fog can be a side effect of many medications, too, such as:

  • Chemotherapy for cancer, which is often referred to as chemo-brain.
  • Antihistamines.
  • Blood pressure medications.
  • Anti-anxiety medications.
  • Anti-nausea medications.
  • Some sleep aids.

Feeling Foggy?
Lewis-Hall says that if you experience brain fog, “even if you think it’s easily explained by something that’s happening in your life, talk to your health care provider about it.”

She says that for many people, this recognition that something is a little off may come from a loved one or a co-worker. “Have someone help you identify periods when you feel foggy or appear foggy. Having someone to tell you, ‘Yes, you kind of lost yourself in that sentence,’ or ‘You seem more forgetful to me than you usually do,'” might help you identify the source of the brain fog.

The key is figuring out what’s causing the fogginess, because “brain fog related to multiple sclerosis has a very different set of treatments than brain fog caused by stress and anxiety. That’s why you have to have a professional really work you up and make sure the symptom is attributed to the right thing,” Boxley says.

This diagnostic work-up may include your health care provider:

  • Asking about which prescription medications you’re taking. If a medication is the culprit, your provider may be able to adjust the dose or substitute another medication that doesn’t cause those symptoms.
  • Ordering a blood test. A blood test can provide insight to how your body is working, and whether something like low blood sugar levels or an autoimmune disorder could be causing brain fog.
  • Ordering a CT scan or MRI of the brain. Structural changes inside the brain, such as those associated with dementia, can trigger symptoms of brain fog.
  • Asking about the timeline of symptoms, such as when symptoms first started and whether there was a triggering event. Knowing when and how symptoms first started can help your provider determine the cause.
  • Asking whether symptoms have changed significantly over time. If symptoms have changed, for example timed with menopause or pregnancy, that can also provide insight into that might be causing the brain fog.

To assist your doctor in getting to the bottom of the problem, it helps to keep a journal of your symptoms so you can recall details of past episodes.

All that detail is important because the more information you can provide about your symptoms, the more likely your provider will be able to pinpoint the problem and offer you helpful treatment.

Boxley notes that if your experience with brain fog changes, it’s even more important to talk to your doctor. Brain fog often “ebbs and flows, so if there’s been a recent change or shift, or if it seems like it doesn’t let up or it’s progressive and gets worse, that might be a different category of health problems than just feeling fatigued.”

How Is Brain Fog Treated?
Depending on what’s causing your symptoms, your doctor may be able to help alleviate them. Boxley says that although not every case of brain fog can be easily cleared up with a prescription, there are still some changes you can make to improve your situation.

“We tend to focus on helping patients learn cognitive compensatory strategies,” or simple ways to improve memory and attention, she says. “For example, whereas previously you’d just remember something, now you might have to write it down.” Carrying a notebook with you at all times and getting in the habit of using it can make a world of difference.

In this digital age, there are all sorts of technological tools that can help too. Whether it’s a programmable timer set to remind you to take your medications at a certain time, a digital calendar that reminds you of when and where you need to be next, an app that helps you shut off distractions when you’re working or a note-taking app on your phone that helps you organize your day, the key is to build in fail-safes that can support you as you go about your regular activities.

Boxley calls these tools “external memory,” and they can make a big difference in how you navigate the world when dealing with brain fog. She says it’s also helpful to “avoid too many distractions and recognize when you’re getting overwhelmed.”

Huang cautions that though it may seem like a lot of work to develop the kind of strategies Boxley recommends, it’s better to change your approach than just reach for a quick fix. “One of the most common ways people address the symptoms associated with brain fog is by drinking fluids high in caffeine like coffee or energy drinks to stay alert.”

However, ingesting too much caffeine can cause other problems, such as a racing heart or increased blood pressure. Too much caffeine can also interfere with your ability to focus, and many energy drinks are loaded with sugar.

How to Get Rid of Brain Fog?
Though you may come across many so-called “natural remedies” for brain fog online, it’s best to confer with your doctor before you add any over-the-counter or herbal supplements or vitamins to your diet to make sure they won’t cause further problems or interact negatively with other medications you may already be taking.

“I don’t know that there’s anything in the cupboard that can cure it,” Boxley says.

Still, there are some lifestyle changes you can make that can improve your experience with brain fog. These include:

Exercise
One of the best things you can do to help alleviate feelings of brain fog is to move more, Mahncke says. “It’s very clear now that there’s a link between physical activity and brain health and cognitive function. People who exercise more have better cognitive function and they tend to resist the onset of dementia. It’s extremely likely that that applies to brain fog as well.”

Diet
It’s long been said that what’s good for the heart is good for the brain, so many doctors and nutritionists recommend following a heart-healthy diet, such as the Mediterranean diet to improve brain health and function. The Mind diet is another well-studied eating pattern that supports brain health.

Sleep
“Countless published studies and research have shown that improved duration and quality of sleep have a myriad of benefits for your well-being, including cognitive function and alertness,” Huang says. “Ensuring you’re getting adequate levels of sleep would be one of the best recommendations I could give.”

Hydration
Being dehydrated even just a little bit can quickly impact cognitive function. A 2012 study noted that just a 2% decrease in hydration levels can lead to noticeable changes in mental clarity. Drink plenty of water each day to make sure your brain has the water it needs to perform.

Stress management
Managing stress through mediation or other means can also help alleviate brain fog. Mahncke says that social isolation can also impact brain function, so be sure to make time for friends and loved ones to keep your brain functioning optimally.

Brain training
Mahncke says that brain training exercises, such as those offered by Posit Science through its BrainHQ website can help speed up how your brain processes information and alleviate symptoms of brain fog.

Examples of these kinds of exercises include visual tests that require you to find matching birds or butterflies that appear for just a moment on the screen then disappear or tracking a specific trio of bubbles in a field of several other identical moving bubbles. Auditory-based games include listening to tones that fire in sequence and then trying to remember the number and type of tones you heard.

“What we’ve seen from study after study is that if you build the right kind of brain exercises – there’s lots of brain games on the market that don’t work – but if you build the right kind, that are designed to improve the speed and accuracy of neural performance, we can use brain training to make the brain faster and more accurate. We can take that noise out of the system and improve cognitive performance.”

Mahncke adds that as neuroscience advances and researchers’ understanding of how brain plasticity can be leveraged to improve cognitive performance, he expects that treatment of brain fog will evolve. “The future of treatment here isn’t with drugs and it’s not with putting electrodes inside your head. It’s with developing the right set of brain training exercises to treat the core problem, which is the brain information processing is noisy.”

In combination with a healthy diet, plenty of exercise, sleep and stress management, brain fog could become a thing of the past.

Advice for Dealing With Brain Fog
If you’re dealing with brain fog, Biscontini urges you to “be patient and give yourself some grace.” She says that while coping with brain fog for her has been challenging, “it’s given me the chance to learn about humility, to ask for help and to understand the value in accepting and adapting to where I am that day. Most of us push through fatigue, illness or stress, but with brain fog, there’s really no option for that.”

Strategies that have worked for her include:

  • Controlling stress levels and finding the humor in the situation.
  • Carrying around a notebook where she writes down everything “as the thoughts come.” She prefers a physical notebook to a phone app because “the notebook remains visible to me providing prompts throughout the day, unlike notes on my phone, which required me to find them first. I found that when I opened my phone to set reminders or take notes, I was highly distracted with social media and other notifications, so it was ineffective.”
  • Rearranging her daily tasks periodically throughout the day to stay on top of priorities and to limit distractions.
  • Changing how she prepares for interviews, podcasts and coaching calls to focus her energy on staying on track with what she wants to say.
  • Reducing time spent on social media. This was the biggest help, Biscontini says. “Once I began to remove it out of necessity, so much more life opened up before me. My mental health improved dramatically, and I slept better at night.”

Biscontini adds that while a visual prompt like a notebook can be super helpful, “we tend to habituate to visual prompts after seven to 10 days, and we become blind to them this way. Keep visual prompts somewhere in a clear visual field and move your lists around to keep your brain engaged in them.”