If you ask people what brain fog is, chances are you’ll hear it described as having trouble concentrating or following conversations, feeling tired or sluggish, being unable to think of a correct word, or forgetting why you walked into a room.
“Brain fog is more of colloquialism,” said Nicholas Mathenia, DO, the director of general neurology at the Endeavor Health Neurosciences Institute in Naperville. “It’s not a medical term. It’s a term used to describe very vague and myriad symptoms. When someone says to me, ‘I have brain fog,’ I have to clarify what they mean because it means different things to different people. It’s more of a term used by the public to describe many different symptoms.”
When questioned further, he finds patients often have several symptoms. “There are multiple things associated with it, which makes them difficult to parse out and treat,” he said. “There could be a number of different symptoms lumped into two words — brain fog.”
What can cause brain fog?
Dr. Mathenia said it could be almost anything. Stress or anxiety, depression, psychosocial or psychiatric issues, illness like COVID-19, or even any other viral illness. Then there’s vitamin deficiencies, thyroid disease, metabolic disturbances, low sodium levels, anemia, diabetes and even certain medications can cause cognitive slowing, he said.
If you’re frequently experiencing brain fog, should you be concerned?
“That’s a difficult question because of the different number of conditions that can cause it,” Dr. Mathenia said. “If you are severely anemic and have hypothyroid disease, yeah, that’s got to be fixed. But if this is due to poor sleep and being stressed out, well, that’s a concern but much less of a medical concern or immediate concern than say someone who has uncontrolled diabetes.”
That being said, if something is bothering you, go see your doctor, he said.
“Best-case scenario, I’m able to say, hey this really isn’t anything too significant. Maybe you should try to get more sleep. Maybe you should drink less alcohol or less caffeine or something like that. Maybe that nullifies any anxiety or concern with a patient,” Dr. Mathenia said.
“Worst-case scenario, it may be very well justified. I’ve absolutely seen people who come in to me for brain fog, thinking it’s just COVID and they never really recovered, and they have diabetes and hypothyroid disease. The brain fog may clear up if we can get the other medical conditions under control.”
Can brain fog be reversed?
It depends on what the underlying etiology is, Dr. Mathenia said. “Reversal of any symptoms or syndromes really comes down to finding out what the root cause is and then deciding whether or not it can be treated.”
“Someone who has vitamin B12 deficiencies and has brain fog may feel much better after taking even a simple over-the-counter vitamin B12 supplement or a vitamin B12 injection. With hypothyroid disease, you may need to start a different medication.”
“This is what makes it so difficult to treat entirely and I think what probably makes it so difficult for patients to get an appropriate diagnostic workup or even to be believed, honestly — it’s so vague,” he said. “Blood tests and brain scans may not show anything wrong. It doesn’t mean the symptoms aren’t real, it means we haven’t found a clear reason.”
How is it diagnosed?
Sometimes, a diagnosis can be as simple as asking a patient about their lifestyle — how much sleep they get, for instance. That kind of brain fog can be helped with a better sleep schedule, a better diet and getting proper exercise, Dr. Mathenia said.
“I think it really comes down to talking with your doctor — and it doesn’t have to be a neurologist, I usually tell people to start with their primary doctor — to discuss it with them,” he said.
Be ready with examples — you’re more tired than usual, you’re under a lot of stress, you have poor time concentrating, you can’t remember why you walked into the kitchen. Have your list of medications and supplements available and be ready to answer questions about your lifestyle (sleep, exercise, diet).
“If you feel concerned, check it out,” he said. “I’m happy to talk to patients even if at the end of the day I say, ‘This is probably nothing medically significant.’ Notice I said ‘medically significant,’ not personally significant. I’m very clear to make that distinction.”
In addition to blood work, Dr. Mathenia could perform a simple cognitive test. He recently gave a neurocognitive test to a person who scored better than 75 percent of her peers, he said.
“I said, ‘Everything on here was fantastic, you’re a great student.’ And she said, ‘But I’m not though. I feel like I have brain fog. So, we have to figure out what she means by brain fog,” he said.
“Brain fog has been around for as long as viral illness and medications and poor sleep and bad habits and stress and anxiety — it’s been around for as long as those have been around. So forever, basically,” he said.
“I think it’s more in the spotlight these days because of COVID and long-COVID syndrome, but the topic is bigger than just COVID. More people hear about it and are aware of it, but understanding it and treating it comes down to the root of what is causing brain fog. It is so vague and has no specific medical meaning.”
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