What is brain fog

“Brain fog” is a constellation of symptoms that include reduced cognition, inability to concentrate and multitask, as well as loss of short and long term memory that is inappropriate for a person’s age ¹⁾. It may include forgetfulness, spaciness, confusion, decreased ability to pay attention, an inability to focus, and difficulty in processing information ²⁾. Remember that gradual cognitive decline from early adulthood is a fact of life.

Brain fog characterizes patients with autism spectrum disorders, neuroimmune diseases ³⁾, celiac disease ⁴⁾, chronic fatigue syndrome ⁵⁾, fibromyalgia, Sjögren’s syndrome ⁶⁾, mastocytosis ⁷⁾, disorders of mast cell activation ⁸⁾, and postural tachycardia syndrome ⁹⁾, as well as “minimal cognitive impairment,” an early clinical presentation of Alzheimer’s disease ¹⁰⁾ and other neuropsychiatric disorders ¹¹⁾. Moreover, patients on chemotherapy often experience brain “chemo fog” ¹²⁾.

Brain “fog” may be due to inflammatory molecules, including adipocytokines and histamine released from mast cells further stimulating microglia activation, and causing focal brain inflammation.

A recent survey of the symptoms experienced by patients with mast cell disorders reported that >90% of them experienced moderate to severe brain “fog” almost daily ¹³⁾ and cognitive impairment was confirmed using a validated instrument ¹⁴⁾. Patients with mast cell disorders also experience other related neurologic ¹⁵⁾ and psychiatric ¹⁶⁾ symptoms. It is interesting that children with mastocytosis were reported to have increased risk of developing autism spectrum disorders compared to the general population ¹⁷⁾. Children with autism spectrum disorders are also characterized by brain “fog” ¹⁸⁾ and focal brain inflammation ¹⁹⁾ with mast cell activation being implicated in their pathogenesis ²⁰⁾.

Even though Alzheimer’s disease has typically been associated with brain senile plaques and neurofibrillary tangles that involve amyloid-β (Aβ) and tau proteins ²¹⁾, recent evidence indicates that oxidative stress/mitochondrial dysfunction ²²⁾ and inflammation ²³⁾, are possibly involved in Alzheimer’s disease. In fact the immune system and inflammation are increasingly implicated in neuropsychiatric diseases ²⁴⁾.

What causes brain fog

Inflammatory molecules, secreted in the brain could contribute to the pathogenesis of such diseases ²⁵⁾ possibly including brain “fog.” Brain expression of pro-inflammatory genes was increased in the brains of deceased patients with neuropsychiatric diseases ²⁶⁾.

It is still not clear what triggers brain inflammation. Mounting evidence suggests that stress ²⁷⁾ and exposure to mold ²⁸⁾, especially airborne mycotoxins ²⁹⁾, may be involved. It is interesting that mold can potentiate histamine release from mast cells ³⁰⁾.

In fact, cross-talk between mast cells and microglia is being considered critical in the pathogenesis of neurodegenerative diseases ³¹⁾ (see Figure 1). Microglia activation is a common finding in brains of children with autism spectrum disorders ³²⁾, as well as in other psychiatric diseases ³³⁾. Activation of microglia directly or indirectly by corticotropin-releasing hormone (CRH) could contribute to the pathogenesis of mental disorders ³⁴⁾.

Figure 1. Schematic representation of the cross-talk between mast cells, microglia, and neurons

Obesity

Obesity has been associated with neuropsychiatric disorders ³⁵⁾. Adipocytokines are involved in neuroinflammation ³⁶⁾ and possibly in dementia ³⁷⁾ including Alzheimer’s disease ³⁸⁾.

Mast cells have been implicated in obesity ³⁹⁾, obesity-related asthma ⁴⁰⁾ and in cardiovascular disease (coronary artery disease) ⁴¹⁾, which involves local inflammation ⁴²⁾. Both mast cells ⁴³⁾ and histamine ⁴⁴⁾ have been reported to be increased in atherosclerotic coronary plaques ⁴⁵⁾. Mast cell-derived histamine is a coronary constrictor. Mast cell-derived IL-6 and TNF are independent risk factors for coronary heart disease ⁴⁶⁾ and can be released from mast cells under stress ⁴⁷⁾, which can precipitate myocardial infarction (heart attack) ⁴⁸⁾. Obesity leads to endothelial dysfunction and chronic inflammation ⁴⁹⁾, also associated with the metabolic syndrome ⁵⁰⁾.

Brain fog symptoms

Signs and symptoms of brain fog may include the following:

• Being unusually disorganized
• Confusion
• Difficulty concentrating
• Difficulty finding the right word
• Difficulty learning new skills
• Difficulty multitasking
• Fatigue
• Feeling of mental fogginess
• Short attention span
• Short-term memory problems
• Taking longer than usual to complete routine tasks
• Trouble with verbal memory, such as remembering a conversation
• Trouble with visual memory, such as recalling an image or list of words

When to see a doctor

If you experience troubling memory or thinking problems, make an appointment with your doctor. Keep a journal of your signs and symptoms so that your doctor can better understand how your memory problems are affecting your everyday life.

How to get rid of brain fog

It’s not clear what causes brain fog and no cure has been identified.

There are lifestyle habits that you can adopt to maintain or potentially improve your health as you age.

These habits, spanning four categories:

1. Physical health and exercise,
2. Diet and nutrition,
3. Cognitive activity, and
4. Social engagement.

Can help keep your body and brain healthy and potentially reduce your risk of cognitive decline.

Research has suggested that combining good nutrition with mental, social and physical activities may have a greater benefit in maintaining or improving brain health than any single activity.

Get regular medical care

• Make regular appointments with your primary care doctor or specialist (neurologist, neuropsychiatrist, geriatric psychiatrist).
• Consider going to a specialized memory disorders clinic. Ask your doctor for a referral if desired.

Manage your lifestyle to optimize your health and sense of well being. Always report changes in cognition/memory and mood (depression, anxiety).

Make sure your physician knows about all the prescription and OTC (over-the-counter) medications you are taking.

Especially in patients over 65-70 years of age, a major cause of cognitive dysfunction can be side effects of drugs and drug interactions.

• Inquire about your hormonal status, thyroid function, and blood pressure.

Adopt a Health Lifestyle with Healthy Diet and Regular Exercise

Eating a heart-healthy diet benefits both your body and your brain. In general, this is a diet that is lower in saturated fats. Research in the area of the relationship between diet and cognitive functioning is somewhat limited, but it does point to the benefits of two diets in particular: the DASH (Dietary Approaches to Stop Hypertension) diet and the Mediterranean diet. These diets can help reduce heart disease and may also be able to reduce risk of dementia.

• Dietary Approaches to Stop Hypertension (DASH) diet
• Mediterranean diet

The Dietary Approaches to Stop Hypertension (DASH)

The DASH diet aims to reduce blood pressure:

• Eat foods that are low in saturated fat, total fat and cholesterol, and high in fruits, vegetables and low-fat dairy.
• Consume whole grains, poultry, fish and nuts.
• Decrease your intake of fats, red meats, sweets, sugared beverages and sodium.

The Mediterranean diet

The Mediterranean diet incorporates different principles of healthy eating that are typically found in the areas bordering the Mediterranean Sea:

• Focus on fruit, vegetables, nuts and grains.
• Replace butter with healthy fats, like olive oil.
• Limit red meat.
• Use herbs to flavor food rather than salt.
• Eat fish and poultry at least twice a week.

Stay Physically Active

Exercise regularly. Adequate physical exercise enhances cognition/memory.

Physical activity is a valuable part of any overall body wellness plan and is associated with a lower risk of cognitive decline. If it’s safe for you, engage in cardiovascular exercise to elevate your heart rate. This will increase the blood flow to your brain and body, providing additional nourishment while reducing potential dementia risk factors such as high blood pressure, diabetes and high cholesterol.

• Physical activities
• Take care of your health

Physical activities

Consider physical activities that may also be mentally or socially engaging, such as walking with a friend, taking a dance class, joining an exercise group or golfing. Incorporate activity that you enjoy so you will continue to engage in it. For example, bike riding, gardening or walking the dog. Adopting healthy exercise habits today will allow you to enjoy the lifelong benefits of regular physical activity. However, it’s never too late to start — making healthy choices at any age is beneficial to your well-being. Always consult your doctor before starting any new exercise program.

Prevent falls

• Falls are the leading cause of fatal and non-fatal injuries in older adults, and one-third of adults over age 65 fall every year.
• Falls in which your head is injured may affect your brain’s ability to function normally, causing unconsciousness, confusion and other symptoms.
• Engage in regular physical activity to improve your strength and balance and reduce your risk of falling.
• At home, cover or put objects out of the way that may increase your risk of tripping and falling, such as shoes or electrical cords.
• Turn on lights when you enter a room so you can clearly see obstacles. Consider installing extra lighting in areas that tend to be dark.

Take care of your health

Keep your heart healthy to help keep your brain healthy. Growing evidence suggests that many factors that increase the risk of heart disease also may increase the risk of dementia. These factors include smoking, obesity, diabetes, high cholesterol and high blood pressure.

• Visit your doctor regularly.
• Get your “numbers” checked, including weight, blood sugar, blood pressure and cholesterol. Actively seek treatment to keep yourself within healthy ranges.
• Stay physically active
• If you have diabetes, manage it properly.
• Stop smoking. If you don’t smoke, don’t start.
• Take action to minimize stress. Studies have found that regular physical activity decreases stress, increases your ability to manage stress and leads to better mood overall.
• Get enough sleep. Inadequate sleep due to conditions like insomnia or sleep apnea can result in problems with memory and thinking. Rejuvenate with sufficient sleep. If after 8-9 hours of sleep you are still tired, tell your doctor.
• Avoid excess alcohol.
• Seek professional assistance to address anxiety, depression or other mental health concerns.
• Minimize stress and anxiety:
  • Set realistic expectations
  • Plan ahead
  • Take breaks throughout the day
  • Learn relaxation exercises and practice them at regular intervals
  • Balance work and leisure
  • Let yourself laugh
  • Talk about feelings
  • Limit multi-tasking and focus on one task at a time
  • Reduce caffeine and alcohol.
  • Manage effectively musculoskeletal and joint pain.

Stay Mentally and Socially Active

Embrace lifestyle habits that improve your overall health, such as exercising, consuming a nutritious diet — and staying cognitively and socially active. Science suggests these may support brain health as well. It’s never too late to make changes to achieve a healthier lifestyle — or too early to start.

• Mental activities
• Social Activities

Mental activities

Mentally challenging activities, such as learning a new skill, adopting a new hobby or engaging in formal education, may have short and long-term benefits for your brain. To keep your mind active, it is important to participate in activities that expose your mind to new topics. Boost your brain power: Continue to work into retirement (part time), learn new skills, volunteer, engage in social and men.

Challenge yourself to games with strategy or high-level reading material, or determine how to approach a familiar task in a more effective way. Selecting activities you enjoy will increase the likelihood that you will continue to engage in them over time.

Another way to stay mentally active is to get as much formal education as you can, at any point in life. Formal education is classroom-based learning administered by professionally trained teachers. Engaging in this type of education will help keep your brain healthy and may protect your brain from developing dementia. This could involve taking a class at a local college or community center that teaches a new topic, skill or hobby (e.g., learning a language or how to play an instrument).

Social activities

Social engagement is associated with reduced rates of disability and mortality, and may also reduce risk for depression. Remaining socially active may support brain health and possibly delay the onset of dementia. There are many ways to stay socially active in your community, and these activities will provide the greatest connection to others.

Stay socially active

Participation in clubs, volunteer efforts and other community pursuits may be valuable in maintaining your overall health. Many of these social activities are low-cost or free, such as joining a walking group or book club in your neighborhood. Staying socially active can also be as simple as engaging with friends and family on a regular basis.

Pursue social activities that are meaningful to you. For instance, if you love animals, consider volunteering at a local shelter or with a rescue group.