What is “Brain Fog”? #MyalgicEncephalomyelitis #BrainFog #ME #CognitiveDysfunction

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Okay, so I wrote a blog about Post Exertional Malaise (PEM) recently and in that I mentioned “brain fog” which is a particular symptom of M.E. I suffer from quite severely.

(NOTE: Due to brain fog all my blogs take quite some time to write and may still contain some typo’s. I always check ad nauseum to try and pick out and correct all errors but apologise if some still remain.)

You may be asking ~ what is brain fog? For this there are two answers; one for the average healthy person who may suffer from the odd “foggy” episode and the other specifically relating to ME.

So, the general definition is; Clouding of consciousness, also known as brain fog or mental fog, is a term used in medicine denoting an abnormality in the regulation of the overall level of consciousness that is mild and less severe than a delirium. The sufferer experiences a subjective sensation of mental clouding described as feeling “foggy”.

For people with ME it’s like “Brain and Central Nervous System symptoms include cognitive dysfunction (problems with short-term memory, concentration and maintaining attention), clumsiness, disequilibrium likened to ‘walking on rubber’, and word finding abilities. Problems with control of the autonomic nervous system results in palpitations, sweating episodes and symptoms associated with low blood pressure/postural hypotension (e.g. fainting).” taken from ME Association.

For me personally the term brain fog relates to numerous cognitive issues. I suffer from poor short-term memory, little stamina and concentration ~ reading a book is impossible for me right now and reading Facebook posts or comments requires the assistance of my PA who goes by the name of “Siri” on my phone. I get Siri to read posts out to me over and over ~ I need to listen more than once to register what has been said and process the information. To reply is even harder, trying to formulate sentences, reaching for words to express what I want to say and then dictating to Siri to write it for me, checking, rechecking and even then usually end up with typo’s. It’s not just down to the written word though I find following a TV programme, films, discussions with groups of people are all taxing. Difficulty processing and grasping the gist of what is going on , especially if you add outside inteferences which cause over stimulation of the senses and then all is lost!

For me there are times when even a one to one conversation can be a challenge, I find myself glazing over and completely zoning out and missing what is being said which makes me feel horribly rude. Then struggle to reply and grasp the correct phrases or words ~ verbally stumbling about as if punch drunk. On top of all this I find that I am thinking one word but say another out loud. I am always struggling to find the right words and also embarrassingly (on occasion) I sometimes say out loud what I think I am thinking and think I have said something out loud when I haven’t! I also have real difficulty writing which means Siri is invaluable along with spell check to help me with this.

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My cognitive function became a matter of real concern for my husband that he marched me off to the GP to have me assessed for dementia (I kid you not, that is how severe it is at times, especially when stressed or totally exhausted). The GP and then later ME Clinic both confirmed that no, thankfully not the onset of dementia but severe brain fog due to the ME.

Brain fog doesn’t stop at word finding and processing words being a challenge, it also affects my behaviour. I do so many silly things, put milk in the cupboard, flour  or cereal winds up in the fridge. Pouring cold water from the kettle into my coffee because I forgot to boil it, wearing clothes inside out.

The list of silly things I do is endless and some can be amusing but for me mostly it is hugely frustrating. I don’t feel in control of my brain and therefore my behaviour because I am easily confused and that in turn makes me flustered which then causes more acute brain fog.  I don’t always know what I am going to say or do next.  My husband keeps saying he needs to write down all the silly things I say and do because my family, now they know it’s not dementia, find my foggy brain highly amusing!

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Professor James Baraniuk (Washington DC, USA) at the 7th Invest in ME conference held in London on June 1st 2012 discussed brain fog and why he thinks it occurs…

“Brain fog – He discussed the findings in the grey matter, in particular the midbrain reticular substance and periaqueductal grey matter. Changes indicated that the body’s alarm clock is damaged. There was decrease in the white matter depending on the duration of fatigue, and it was found to shrink by about 1% per year.”

Dr Mady Hornig who is working on research into proving ME is a real biological illness said “The more that we can demonstrate with objective evidence that there’s something biologically different in the blood and in the brain in individuals with ME/CFS, the more advances we can make toward upending that entrenched and mistakedn view of the illness.”

Dr Myhill has co-authored three medical papers on ME/CFS and mitochondrial dysfunction. She is a specialist in ME and has a website with all her tips, advice and information she can offer to help improve health, not just for ME but other conditions too ~ plus you can order tests and follow dietary advice and supplement considerations. What she says about the brain with ME/CFS is interesting

Effects on the Brain ~ In October 2007 I attended a conference sponsored by the late Dr John Richardson. A Canadian physician Dr Byron Hyde showed us some functional scans of the brains of CFS patients. If I had not known the diagnosis, I would have diagnosed strokes. This is because the blood supply to some area of the brain was so impaired. The default is temporary and with rest, blood supply recovers. However, this explains the multiplicity of brain symptoms suffered from, such as poor short term memory, difficulty multi-tasking, slow mental processing and so on. Furthermore, brain cells are not particularly well stocked with mitochondria and therefore they run out of energy very quickly”

For me, personally, I find the brain fog eases if I am not stressed, have rested, am not in a “crash” and am relaxed. If I start to feel pressured and tired then the brain fog begins to flare again. It’s not great but, for me, along with the post exertional malaise (PEM), brian fog is one of my worst ME symptoms which makes life difficult for me. If I make a phone call and it is picked up by an answer phone I have two options, one hang up or two try and formulate a coherent message in the time given. Often I panic and leave a totally garbled message, which means I then have to calm myself, sit down and write a response then ring back and try to calmly read it out.

There are many other ways you could try to reduce your brain fog and I found a great website with some top tips on how to reduce it ~ it’s not a case of having to take on board each and every tip, but to mix and match to see what best suits and works for you. Like I said previously, for me it’s rest, reduce stress and keeping socialising to a minimum and when I do it’s in small groups and not in busy, noisy crowded areas. If I have sensory overload then I may as well forget it and go home to bed as it is such a barrier, personally for me and increases my brain fog.

As I said, this is a great website with an awful lot of useful information for ME and Fibromyalgia sufferers which I found useful it’s called “Lifting the Fog: Treating Cognitive Problems” and so I will share it with you…

“Treatments
Cognitive problems are sometimes treated with stimulants, such as Provigil (modafinil) or caffeine, but these substances can produce a push/crash cycle. In the words of one patient, “Taking stimulants is like borrowing energy you don’t really have. You feel better while you’re on it, but when it wears off, you crash.” This article describes 14 non-drug strategies for lifting the fog, divided into three categories.

1.) Pacing

  • Take a Rest Break
    Cognitive difficulties can be caused by overactivity. As one person in our program said, “Brain fog helps me to recognize when I’m outside my energy envelope and need a break. Even if I don’t feel tired, the fact that I can’t think clearly tells me that I am beyond my limit.” A brief rest may be enough to end the fog for some people. For more on the power of rest, see
    Nurture Yourself with Pre-Emptive Rest.
  • Use Routine
    Reduce fog by living a predictable life with routines: doing the same things every day in the same way. For example, always put your keys in your purse when you arrive home. If your fog is thickest in the morning, put out your clothes the night before.
  • Pick Your Best Time of Day
    Most of us have better and worse times of the day. Do the tasks that require concentration and mental clarity during the hours you are sharpest. The best time of day varies from person to person. For many CFS patients, that time is mid-afternoon to early evening. Many fibromyalgia patients find mornings the best. Find the time that’s best for you.
  • Postpone, Switch Tasks or Cancel Activities
    If you’re not thinking clearly, postpone jobs that are mentally challenging, switch to a simpler task or take a break. As one person in our program said, “When I’m too tired and foggy to think, I put things off until the next day and get extra rest instead.” You can also use the presence of brain fog as a signal to cut back. As another person said, “If I’m pretty far gone, that’s a sign that I need to cancel some activities.”

2.) Simplifying

  • Use Lists and Other Reminders
    Write out your tasks for the day on a To Do list . Use Post-It notes in prominent places to jog your memory. Use a calendar or the alarm on your watch, computer or smartphone to keep track of appointments and tell you when to do things (or to set limits and remind you to stop). Organize your house and possessions so that they give you built-in reminders. For example, keep your medicines where you dress, so you will see them and remember to take them when getting up in the morning and getting ready for bed at night.
  • Do One Thing at a Time (Avoid Multi-Tasking)
    Many patients experience fog when they try to do more than one thing at a time, such as reading while watching TV or talking while fixing dinner. The solution: instead of multi-tasking, do only one thing at a time. To avoid interruptions, teach family members to wait by saying things like, “I’m [fixing dinner, talking on the phone, etc.] right now, but I’ll help you as soon as I’m done.
  • Avoid Over Stimulation
    If you are sensitive to noise, to light or to sensory input coming from more than one source at the same time (for example, trying to have a discussion with the TV on), limit sensory input by moving to a quiet place and avoiding distractions.
  • Organize and De-Clutter
    If you find your physical environment overwhelming, organizing your house and removing clutter can be a way to control brain fog. See the article
    Illness and Housekeeping.

3.) Other Fog Busters

  • Do Something Physical
    Physical activity can increase energy and clear your mind. Activity includes exercise and other things such as laughing, singing and deep breathing. For some people, fog may be triggered by lack of nutrition. For them, eating counteracts mental fogginess
    .
  • Improve Your Sleep
    The problems associated with fog are found in people who are sleep-deprived. Getting restorative sleep can help limit cognitive problems. For ideas on improving sleep, see the article
    Solutions for Sleep.
  • Control Stress
    Stress can trigger or intensify brain fog. You can reduce fog by avoiding stressful situations, by learning how to relax in response to stress and by training yourself to mute the production of adrenaline. For more, see the articles in the
    Stress Management archive or the chapter on controlling stress in our self-help book.
  • Reframe
    Brain fog can be frightening and embarrassing. Many students have told us that they have learned to speak reassuringly or lightheartedly to themselves and to others at times when they lack mental clarity. If thinking you have to do something leaves you flustered, try slowing down. For more on reframing, see the article
     Taming Stressful Thoughts.
  • Plan Your Response
    Deal with the fact that brain fog is confusing by planning your response ahead of time. Develop rules to guide you when you’re feeling lost, so you have standard, habitual responses you can fall back on. For example, you might decide that you will respond to fog by lying down or by changing to a simpler task.
  • Do a Medication Check
    Confusion can be a side effect of some medications. If you think this might apply to you, check with your physician about adjusting the dosage levels of your medications or changing to other drugs. Also, discuss with your doctor the use of medications to increase attention and concentration.

Whether you have ME, Fibro or any other chronic illness which causes you to have brain fog moments I hope the above can help you in some way. For me having a ready supply of post~it notes and magnets to attach said notes to fridge (as the sticky side doesn’t always hold) help as does setting alarms on my phone with the simple description as the alarm title of what I have to do!

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