Who among us hasn't experienced straying attention, trouble concentrating, or stumbling over the perfect word? A lot of the time brain fog is just a fact of life in the dizzying world we live in.
“Brain fog is present in many of us who are overworked, sleep-deprived, multitasking, or asked to remember too much,” says Gayatri Devi, MD, a psychiatrist and neurologist with Lenox Hill Hospital in New York City.
But brain fog is also part and parcel of many medical conditions, something that goes wrong with the 100 billion nerve cells and 100 trillion connections that make up your brain.
There is good news though: Once you pinpoint a cause, you can often find a treatment for brain fog, Dr. Devi says. And, comfortingly, the problem is rarely dementia.
Here’s a run-down of what might be causing your mental haze and how to fix it.
Lyme disease, transmitted through the bite of an infected tick, often starts with the classic “bulls-eye” rash and then can progress into multiple symptoms, including brain fog. One expert described as trying to do math problems after too much Benadryl.
The mental fuzziness can come on anytime after being infected and usually involves having a hard time keeping up with conversations, retaining information, or finding the right word.
If you have brain fog and you know you’ve been bitten by a tick, seek medical help right away. If you didn’t see a tick but you do see the bulls-eye rash, same deal. Most people who are treated early (usually with antibiotics) recover.
As many as 50% of people who have the autoimmune disease lupus also have “lupus fog,” with lapses in memory, difficulty concentrating, and confusion, according to the Cleveland Clinic. In some people, the symptoms are bad enough to interfere significantly with daily life. Lupus-related brain fog usually ebbs and flows but doesn’t get progressively worse. Talk to your healthcare provider about lupus treatments that can address your symptoms and ways to circumvent your memory issues.
Technology can be your friend here. Utilize your cell phone alarms for reminders and send texts or emails to yourself. Don’t forget about the “old-fashioned” strategies: Make lists, leave sticky-note messages for yourself, do one thing at a time, and reduce stress by taking time to relax and breathe.
People who have lupus also report being helped by reading books, doing puzzles, and using planners or color-coded calendars. Getting enough sleep and exercise seems to help too.
Multiple sclerosis damages the brain and spinal cord, which means the condition can affect pretty much everything from motor function to emotions and, of course, cognition or how clearly you think.
MS-related brain fog “commonly affects the speed at which people can process information and also their ability to recall things,” says certified registered nurse practitioner Kathleen Costello, associate vice president of healthcare access at the National Multiple Sclerosis Society in New York City. “If you tell me to call you tomorrow at 5, that is in and out of my head.”
Brain fog may get worse during flares and can be exacerbated by heat, like on a hot day, in a hot room, or when you have a fever, Costello says.
“Every situation has to be looked at really individually,” she adds. Check with your doctor to see if medication can help and to make sure nothing else (like depression or meds for other symptoms) is causing your brain fog. Then talk about work-around strategies. For instance, if your brain gets hazy at the end of the day, consider doing tough mental tasks sooner after you wake up. Take rests, avoid multitasking, and make sure you exercise, stick to a healthy diet, get enough sleep, and treat any mood disorders like depression.
It’s no surprise that a condition where fatigue is the main symptom also brings mental fuzziness. Up to 85% of people with chronic fatigue syndrome have including trouble focusing, forgetting words, and confusion.
No one is sure what causes CFS or the brain fog that often goes with it. Many people with CFS also experience depression and anxiety, which can aggravate cognitive issues.
Some strategies that might help: Control stress, do one thing at a time, keep sensory input like noise to a minimum, stick to a routine, and keep lists.
Scientists are only beginning to understand the myriad ways our gut influences different parts of our body. Celiac disease is a good example of a condition that starts with the gut but can result in symptoms all over.
When people with celiac disease eat gluten, a protein found in wheat and other grains, the immune system attacks the small intestine, producing an array of gut-related symptoms like abdominal pain or bloating, diarrhea, and constipation. But other symptoms, like fatigue, joint pain, or mouth sores, can also crop up–and some may even affect your brain.
People with celiac-related brain fog report feeling disoriented, unable to focus or pay attention, and forgetful. In one study, people with celiac disease had the same as someone with a blood alcohol level of 0.05. (The legal limit for driving is 0.08.)
People with celiac disease need to avoid gluten. Not only will it calm your stomach, it can clear your brain.
Migraines are a direct hit on the mind, and “brain fog is very real for people with migraine,” says Cynthia E. Armand, MD, an attending neurologist at Montefiore Headache Center in New York City.
Migraine brain fog translates into difficulty with concentration and comprehension and moments of “What word am I looking for?!” It can occur before, during, or after headache pain, says Dr. Armand.
Many migraines are handled with medication, which can also help mental acuity. “The usual migraine action plan consists of a medication to use during migraine attacks. A preventive medication is added if individuals experience attacks more frequently,” says Dr. Armand. “Since this is not a one-size-fits-all approach, it is good to speak with your neurologist or headache specialist about any brain fog experienced and your migraine management.”
Thyroid hormone controls your body’s metabolism. When it’s gone awry, you can feel it all over. An underactive thyroid (hypothyroidism) can lead to weight gain, sluggishness, and depression, and thinking can feel like slogging through molasses. Thyroid-related brain fog means trouble concentrating, memory issues, spacing out, and confusion.
Some people may need treatment in the form of synthetic thyroid hormone. Otherwise, make sure you stick to a healthy diet and exercise routine and get enough sleep. Some people say going gluten-free may help with Hashimoto’s disease, a form of underactive thyroid.
After years if not decades of debate, most scientists and lay people now agree that there is such a thing as “menopause brain”–lapses in memory, difficulty concentrating, and trouble paying attention compared to before this mid-life change.
Not every woman experiences brain fog around the end of her period, however, says Pauline Maki, PhD, professor of psychiatry and psychology at the University of Illinois at Chicago. “There are big differences between women in the way they experience this. Nevertheless, it is absolutely measurable and detectable in the best research studies we can conduct.”
But while most people associate these memory slips with the end of menstruation, menopause brain may be most acute earlier on. “It’s actually detectable in early peri-menopause, when menstrual cycles begin to become less regular,” says Maki. “If anything, [the symptoms] get better after menopause.”
We don’t know yet if memory eventually improves or if estrogen–taken by some women in menopause to help with other symptoms, like hot flashes–might help with brain fog too, she says.
Other than hormone therapy, what can you do to jog your brain? Sleep well, limit alcohol, exercise regularly, and follow a Mediterranean diet.
The scientific jury is still out on whether “pregnancy brain” is a real thing, Maki says, but many women who have been pregnant (and probably the people who know them!) will tell you it is.
Pregnancy brain fog is tricky to study, Maki says, for many reasons, including the fact that pregnancy can cause sleep disturbances and anxiety, which themselves could cause brain fog.
Even though the optimal study hasn’t been done, there is research suggesting that periods of hormonal fluctuation–which would certainly include pregnancy–are linked with psychological symptoms like mood and memory.
Speaking of hormonal fluctuations: In the days leading up to a period, women might experience changes in cognitive function.
Research indicates that the female mind works better when estrogen levels are high, which fits well with the idea of “menopause brain,” since estrogen declines after menopause.
In one study of women with premenstrual dysphoric disorder (PMDD), a rare, severe form of PMS, researchers found that women had trouble recalling words in the luteal phase of their cycle. That’s right after ovulation but before bleeding starts and when estrogen levels decline.
Period-related brain fog affects some women and others not at all. Everyone’s symptoms are different, Maki says.
You could argue that depression is the very embodiment of brain fog. Not only do you feel sad and lose interest in your favorite activities, you may find your thinking and speaking slows down or you have difficulty focusing, making decisions, and remembering things.
Other mental health conditions, like anxiety, can also cause brain fog.
There are many effective medications and forms of therapy to treat depression that might help with cognitive symptoms too. As always, getting enough sleep, exercise (even just walking), and healthy foods can keep your brain on a clear path.
Most of us are familiar with the way our mental processes slow after a restless night. It happens!
But people with actual sleep disorders, specifically sleep apnea, may have more severe and more frequent brain fog. Obstructive sleep apnea causes you to stop breathing briefly every so often while you sleep, making your Zzs less restful. Consequently, you might feel extra tired during the day, leading to fuzzy thinking. (Another common sign of sleep apnea is loud snoring; ask your bed partner if you’ve been sawing logs or set up your phone to record yourself.)
If you think you could have sleep apnea, get a formal assessment and, if needed, a CPAP (continuous positive airway pressure) machine to help you sleep. Not only will this clear up fuzzy thinking, it will also reduce your risk of stroke and heart disease, which increase with an apnea diagnosis.
The classic symptoms of the autoimmune disease Sjogren’s syndrome are dry eyes and dry mouth, but brain fog can also be part of the equation, as it is for the autoimmune disease lupus. Again, the fog usually involves memory lapses and poor concentration.
There are medical treatments for Sjogren’s as well as for individual symptoms. Apart from that, the usual lifestyle strategies may provide relief as well: adequate sleep, healthy diet, less caffeine and alcohol, and more exercise.
Some patients with the hallmark pain and fatigue of fibromyalgia say the cognitive issues cause even more distress. Many refer to fibromyalgia-related brain fog as “fibrofog.” Typically, it involves forgetting where you put something and other similar memory lapses, getting distracted easily, and difficulty taking in new information.
While some people with fibromyalgia may also have depression, studies show that fibrofog exists independently of depressive symptoms.
Make sure you get the restorative sleep you need. (Your doctor may recommend a sleep medication.) Exercise and a healthy diet are also key.
Cirrhosis of the liver is a type of chronic liver damage most commonly caused by heavy alcohol use or hepatitis C. People with cirrhosis can develop a condition called hepatic encephalopathy (HE), which can have cognitive effects.
“HE happens when the body builds up ammonia because the liver is not doing a good job metabolizing it,” says Tamar H. Taddei, MD, a member of the American Liver Foundation's National Medical Advisory Committee and an associate professor at Yale School of Medicine. "It can go to the brain and cause what you could call brain fog.” HE is a very serious condition, she adds. It can cause relatively minor symptoms like irritability, but in severe cases it can also lead to a coma.
Fortunately, a drug called lactulose can reduce ammonia and treat HE and liver disease. Sometimes antibiotics are also used for HE.
Because hepatitis C is not only treatable but curable, hepatic encephalopathy is avoidable. Cirrhosis is preventable and treatable as well, not only by taking care of hep C, but also by cutting down on alcohol, eating nutritiously, and being careful with medications (since some can damage the liver).
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Mild cognitive impairment
In some cases, brain fog may be dementia. Mild memory problems could signal what's called mild cognitive impairment or MCI, which puts you at a higher risk for Alzheimer’s and other forms of dementia down the road. These types of cognitive issues are more common in people 65 and older.
MCI symptoms may be noticeable but not get in the way of daily life. They can stay the same or even go away; memory and thinking may return to normal. Alzheimer’s involves progressive worsening of mental acuity. Only a healthcare professional can tell you for sure if this is happening.
Reduce your risk for dementia with regular exercise for your brain and body, and follow a mind-friendly diet.