Brain fog is a term that describes problem with focus, memory, logic and problem solving. It is a constellation of symptoms that include reduced cognition and loss of short and long term memory. It is an uncomfortable mental state which can be a sign of several conditions. Often labelled as “ senior moments” due to ageing process, brain fog can occur at any age with momentary lapses of memory or mental capacity.  Patients describe brain fog as “not being as mentally sharp or having a slower processing speed, loss of attention and memory lapse. “Where did I leave my keys” or “Why did I come into this room” are usual lapses that one can find on day to day basis.     

Brain fog needs a doctor’s care if characterized by sense of confusion, disorganisation and disorientation.  

The following conditions can lead to brain fog affecting cognition, concentration and mental health.

Stress, anxiety & depression: Anxiety, sadness or hopelessness for more than two weeks affect clear thinking and cause mental exhaustion.

Menopause or other hormonal changes: Hormone changes in women can cause brain  fog during perimenopause, menopause, pregnancy or oral contraception. Fluctuating levels of estrogens and progestins during these phases dull the cognition and mental precision.

Medications: Some of the medications that are likely to cause brain  fog include anticholinergics, antidepressants, diphenhydramine (Benadryl), antihypertensives, anti-anxiety and chemotherapy of cancer. Poly-pharmacy or the taking several medications at once, can also be a source of brain fog as different medications interact with one another.

Hypothyroidism: Patient will low thyroid hormone manifests with physical and mental weakness, fatigue and cognitive dysfunction.  

Hypoglycaemia: Patients with diabetes mellitus receiving antidiabetic medicines are prone to develop hypoglycemia i.e. low blood sugar levels. Hypoglycaemia may lead to brain fog and lack of concentration.

Deficiency of Vitamin B12: Vitamin B12 is important for maintaining healthy nerves and blood. Deficiency of vitamin B12 causes cognitive dysfunction, muscular weakness, difficulty walking, numbness & tingling in hands/feet and feeling of tiredness.

Chronic Fatigue Syndrome: Brain fog is a constant problem of chronic fatigue syndrome. It is diagnosed after at least six months of physical or mental fatigue.

Fibromyalgia: It causes physical and mental exhaustion. There is a dull body pain all over that lasts for a few months, extreme tiredness, sleep problems etc.

Dehydration: Dehydration is a common cause of brain fog. The person is unbale to recall the numbers and easily get confused with surroundings. Both acute and chronic dehydration may cause brain fog.

Post-Covid-19: National Institute of Health (NIH) calls symptoms of post-acute sequalae SAR-COV2 (PASC) that includes various symptoms after a patient suffered Covid-19. The studies have shown that more than one third of Covid-19 patients who experienced severe disease may develop neuropsychiatric symptoms. Brain fog was found a common symptom in all stages of Covid-19 patients.  

Early sign of Alzheimer’s disease: Brain fog could be an early sign of Alzheimer’s disease with mild cognitive impairment (MCI). Elderly persons without any evidence of other illnesses should be investigated for the development of this disease.   

Multiple Sclerosis: This is an autoimmune disorder affecting brain and spinal cord. Patient develops several sensory and motor symptoms along with cognitive impairment.

Lack of sleep: Less than 7-8 hours of sleep steals the memory and concentration of a person.

Air Pollution: Neurotoxicity of air pollution impairs cognition and an important cause of brain fog. Air pollutants that comprises of particulate matter (PM), ground level ozone, sulphur dioxide, nitrogen dioxide, carbon monoxide and lead affects employee productivity, school performance and mental health in the urban areas. Particulate matter contains solids & droplets emitted by vehicles, factories, wildfires, anthropogenic and natural sources. Ultrafine particles of these pollutants may reach the brain directly through olfactory bulb or by crossing the blood brain barrier and damage highly specialized cells. Lung Brain Axis suggests that peripheral pulmonary damage impacts the brain through circulating serum factors that communicate biological effects to the brain. Several studies have confirmed the role of air pollution in day to day performances, making right decisions and mental health.

There are several diseases like autism spectrum disorder (ASD), coeliac disease,  mast cell disorders, postural tachycardia syndrome (POTS), obesity, autoimmune disorders and impaired immune-metabolism are associated  with symptoms of brain fog.

It is important to figure out the cause of brain fog. Brain fog related to multiple sclerosis has a very different set of treatments than brain fog caused by stress and anxiety. A professional work up is needed to make sure that the symptom is attributed to the right thing.

The doctor may ask for blood  tests, CT scan or MRI of the brain depending on the duration of symptoms, severity of dysfunction and other associated features.

Treatment of brain fog depends on its cause and doctor helps to alleviate the symptoms. It is recommended to find ways to reinforce your cognitive powers in your environment. Carrying a note book and writing down the things that really matters is an useful strategy to relieve  the suffering of frequent memory lapses. Digital calendar is highly useful to remind for medications, appointments and organising your day. Try to avoid unnecessary distractions. Having good night sleep and incorporating more activity into daily routine are remarkable ways of being alert and productive.

Natural remedies in form of herbal supplements, vitamins or other OTC products have not shown a significant role in alleviating the symptoms of brain fog. It is recommended to consult your doctor before taking such preparations to prevent any harm or possible interaction with other ongoing drugs.     Adequate nutrition, hydration and exercise are smart ways to tackle the symptoms of brain fog. Decrease in caffeine intake is found useful in this condition.