If you’ve found yourself wondering, What is brain fog? you’re not alone. The issue is increasingly common—as many as one in four people who contract COVID-19 may develop brain fog, per a study in the journal Cell—yet there’s no single definition of it at the moment. (The term is colloquial, not scientific, BTW; experts label it cognitive impairment.)
When you picture what brain fog looks like, you may think of those moments when you can’t put together a sentence or you lose your train of thought. Or maybe it’s a general malaise, a lack of focus. Yep, brain fog is perplexing, even to those in medicine, and it’s unique to each person who suffers from it.
COVID-related brain fog tends to affect attention, memory, and executive function. These first two are pretty self-explanatory. Jacqueline H. Becker, PhD, a clinical neuropsychologist at Mount Sinai Health System, describes executive function as the CEO of the brain. It oversees the other tasks and helps with more difficult ones, such as organizing info, making plans, and solving problems.
So, What’s Actually Happening In Your Brain When You Have Brain Fog?
The cognitive functions affected by brain fog are all regulated by the frontal lobe, the processing center of the brain, which is—evolutionarily speaking—a larger, newer region that develops only in humans and is responsible for our more advanced cognitive abilities. It is the last brain network to develop (it doesn’t fully mature until you’re 25 years old!), and it remains fluid and vulnerable to change throughout your life, says Erica Cotton, PsyD, a neuropsychologist at Northwestern Memorial Hospital.
Even people who don’t think they deal with fogginess know what not-so-great frontal lobe functioning feels like. “At the end of a long day, when we get home, and we’ve been doing a million different things, we’re tired, hungry, and can’t think as well. That’s a frontal lobe issue,” says Cotton.
What Causes Brain Fog?
The frontal lobe doesn’t work smoothly when we’re in pain, overwhelmed, or sick. Plus, brain fog is a term patients use to refer to cognitive difficulties that can also be associated with central nervous system disorders like multiple sclerosis, medications like topiramate, and treatments such as chemotherapy.
“Even though we’ve known that people can develop chronic cognitive symptoms from other diseases, it was relatively rare,” says Gina Perez-Giraldo, MD, a neurologist at Northwestern Memorial. “But now, with long COVID, we’re seeing a lot more people impacted.”
The assumed culprit behind all the probs? The enemy within, so to speak: inflammation. When that internal fire rages (from, say, chemo), it impedes your brain’s ability to communicate with the rest of your bod, according to recent research in Cell.
Okay, How Do You Know If You Actually Have Brain Fog?
The main criterion to consider is whether you’re having difficulty returning to a baseline level of functioning, says Becker. This will look different for everyone. Maybe you were a straight-A student before, and now you have to work extra hard to get the same grades. Perhaps you are in your late 30s and have been in the work world awhile, yet you’re struggling with going back after a viral infection because you just don’t feel like yourself anymore.
Another way to test yourself: Compare against others. (Really, this is the one time it’s acceptable and helpful!) Checking how you do with certain cognitive tasks provides a real-life benchmark.
In a study of 124 healthy younger adults (median age, 23), 57 percent had difficulty finding a word at least once a week, 50 percent went into a room and forgot why they walked in there, 48 percent forgot to buy something when they went shopping, and 33 percent forgot an important conversation, appointment, or errand. So, “if you went into a room and forgot what you needed once or twice a week, that’s pretty normal. If you routinely forget things, have trouble completing sentences or finding words in ways that other people have noticed, it might be worth a checkup,” says Cotton.
Is There Any Way To Get Rid Of Brain Fog?
Truth be told, there is no quick cure for brain fog, but experts recommend adopting specific lifestyle tweaks to address the fixable causes in addition to strategies to cope with long-term ones.
First, take care of obvious needs, like sleep and ongoing pain, and see if the fog lifts. “When sleep is good, we feel clear-headed, efficient, and quick,” Cotton notes. Sleep needs vary, but generally, you need between seven and nine hours. (We know, you’ve heard this before! But in this case, it’s imperative to actually do it.)
Pain is one of the most reliably distracting stimuli, says Cotton, and it takes over attention, making it hard to concentrate on anything else. Talk to your health-care provider about any chronic aches you’re experiencing. Some medications can also affect cognitive abilities. For example, meds that make you feel drowsy, such as OTC allergy drugs, can exacerbate brain fog, according to Dr. Perez-Giraldo. Check with your doctor about possible swaps if you think there might be a connection.
And generally, when you’re upset, it’s hard to focus because the limbic centers of the brain (which regulate emotion and memory) pull attention away from the frontal lobe, says Cotton. For those with brain fog, feeling highly emotionally activated makes it even harder to engage the frontal lobe well.
Cognitive behavioral therapy (CBT) can strengthen the frontal lobe so it can regulate the limbic system and prevent focus from getting swept away by feelings. CBT, by changing harmful thinking habits, can also help with anxiety and depression, both of which have been associated with brain fog.
If the fog is severely impacting your daily functioning and causing significant distress, you may benefit from an outpatient cognitive rehabilitation program, which involves occupational and speech therapies.
To qualify, you’ll need an evaluation and referral from a neurologist, neuropsychologist, or PCP. There is no age restriction, and insurance covers it, but the number of sessions included usually varies by plan. This type of rehab is typically offered at health facilities that provide speech-language pathology services, and it helps you build strategies in the areas you struggle with, says Alba Miranda Azola, MD, the codirector of the Johns Hopkins Post-Acute COVID-19 Team and an assistant professor of physical medicine and rehabilitation. For example, if you have memory issues, a therapist will guide you in creating extra checklists tailored to your work. “Patients report significant improvement after completing those therapies,” says Cotton. “They start to feel like themselves again.”
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