Motivation and emotion/Book/2021/Brain fog

Brain fog:
What is brain fog, what causes it, and how can it be managed?

Multimedia presentation (3 min)

Overview

The purpose of this chapter is to help people understand how experiencing brain fog may not impair an individual as much as early research seems to suggest. It is important to understand that, across many studies spanning peer-reviewed articles and longitudinal experiments, the term brain fog is imprecise, and to date the cause of this symptom is unknown. Across the breadth of five studies spanning close to four decades, all articles allude to physical fatigue contributing to mental lapses causing erratic and unbalanced trends in emotion and cognitive ability. They propose that brain fog is prevalent in many mental illnesses. A contemporary study even showcasing brain fog as a major symptom in long COVID (Callan, 2021).

The concept of brain fog is measured to correlate the effect it has on emotion. An overload of stress may bring about brain fog and can become overwhelming for the individual to deal with simple tasks that artificially elevate in difficulty due to an inability to think clearly. Findings suggest that brain fog is a cognitive complaint like mental fatigue (Zung, 1972). Poor posture may even be associated with brain fog (Ocon, 2013). Yet this impairment is not well recognised or thoroughly understood in its depth and capacity. Before brain fog was considered a topic worth developing considerable research, it was mainly characterised as forgetfulness and/or cloudy thoughts. When establishing brain fog as a serious threat to cognition, and more broadly emotion, studies coupled the symptom of brain fog with relevant syndromes and mental illnesses concerned with information collection and interpretation.

A variety of studies linked Chronic Fatigue Syndrome (or CFS) to brain fog as an overflow of information that can’t be mentally processed in ample time, making for lapses in decision-making related to turning information into action. Other studies look toward the framework of Cognitive Load Theory (CLT; Paas, 2003; Sweller, 2011). This theory refers to the used amount of working memory resources and studies have historically focused on CLT have often indicated that brain fog can arise when memory reserves are drained, resulting in an individual becoming easily overwhelmed.

Focus questions What is brain fog? What causes brain fog? How can brain fog be managed?

What is brain fog?

Brain fog can be characterised as difficulty focusing, thinking and communicating, relating to impaired cognition and performance on cognitive tasks. In contrast, the least common descriptors (thoughts moving too quickly, detached, lost, sleepy) were more indicative of general fatigue, anxiety, and depression (Zung, 1972). Individuals subjectively experienced brain fog as mental fatigue, suggesting that the increased change in cerebral perfusion and activation during cognitive tasks was perceived as stressful and exaggerated exhaustion (De Luca et al, 1995). This means that by increasing activity in the brain, the processes in interpreting information become slower as more resources are needed to fuel the brain in this action.

Build on literature

In order to understand how cognitive impairments impact on brain fog in CFS in this case, as well as to guide future research, the goal of this chapter is to analyse the cognitive symptoms which lead to impairment to enhance the quality of research to develop high-end articles that mentions brain fog in focused literature in the future.

Distinctive features of brain fog

Figure 1. An example highlighting the equation of Cognitive Load Theory as it pertains to depleting mental resources.

Brain fog can be informally defined as a temporary state of diminished mental capacity marked by the inability to concentrate or to think or reason clearly.

Mental

• Some individuals who suffer from brain fog could be contributed to a genetic disorder that causes defects in connective tissue (Rowe et.al, 1999)
• Brain fog could be the result of overworked mental capacity with sufficient rest.
• Typically characterised by having trouble concentrating and forgetful thinking.

Physical

• Brain fog is difficult to physically diagnose as individuals often show same signs and symptoms as fatigue.
• Physical difficulties such as lapses in concentration and difficulty in recalling information for it to processed.

Key theory associated with brain fog

Cognitive load theory

Cognitive load theory (Sweller, 2011) is concerned with the design of methods that efficiently use people's limited cognitive processing capacity to apply knowledge and skills to interpret and relate to new situations. Comprised of three schema-based instructional designs in relation to differential between intrinsic, extraneous and germane cognitive load:

• Intrinsic cognitive load is the difficulty in which a single topic in associated with.
• Extraneous cognitive load is created based on the level of difficulty the information is to process.
• German cognitive load is processing the information to be then enacted and stored in autonomic process to the individual.

CLT is based on a cognitive architecture that consists of a limited working memory with partly independent processing units for visual and auditory information, which interacts with an unlimited long-term memory (Paas, 2003). These functions of human cognition have been used to design a variety of novel efficient instructional methods. The associated research has shown that measures of cognitive load can reveal important information for CLT that is not usually the sole focus of research. Particularly, the combination of performance and cognitive load measures have been identified to build a reliable picture of the mental efficiency of the individual.

Cognitive load theory assumes that knowledge can be divided into biologically primary knowledge that we have evolved to acquire and biologically secondary knowledge that is important for cultural reasons. Secondary knowledge, unlike primary knowledge, is the subject of instruction. It is processed in a manner that is analogous to the way biological evolution processes information (Sweller, 2011). When dealing with secondary knowledge that cannot be easily recalled, human cognition becomes far more difficult, requiring a very large information store, the contents of which are acquired largely by obtaining information from other information stores. Novel information is generated by a random generate and test procedure with only very limited amounts of novel information able to be processed at any given time. This contrast can become difficult when brain fog appears as testing information stored may not directly be available, making for foggy patches in recall for the individual. In contrast, very large amounts of organized information stored in the information store can be processed in order to generate a higher-function task.

Quiz

Intrinsic, extraneous and germane cognitive load comprise the schema-based instructional design of cognitive load:

	True
	False

Peer-reviewed study

In linking CFS to brain fog, a study conducted by DeLuca et al. (1995) showed that CFS subjects have intact memory storage, consolidation, and retrieval and “higher order” cognitive function; however, they exhibit decreased speed and efficiency in information processing, especially with auditory material, and subjectively perceive a more generalized cognitive impairment (DeLuca et al., 1995).

Over the past 20 years, research has answered many questions regarding cognitive symptoms in CFS (Ocon, 2013). The experience of “brain fog” in those with CFS appears to be the conscious perception of cognitive impairment and is related to mental fatigue. Interestingly, this perception of generalized cognitive impairment fits the concept of brain fog. Decreased sleep time and sleep quality have been shown to impair performance on various cognitive tasks (Deak, 2010). Individuals with CFS do not exhibit complete cognitive disability or dementia. However, they may experience deficits in working memory, information processing, and attention, which then may translate into a longer reaction time during tasks. It is logical that the perception of such deficits would be described as mental cloudiness and difficulty thinking. Drawing from an overview of the study, cognitive impairment in CFS is exacerbated by stressful stimuli such as a difficult mental task, exercise, and/or orthostatic stress. Physiologically, the cognitive impairments may be associated with impaired cardiovascular ability and altered activation of information recollection during mental tasks. Psychiatric diseases do not seem to be related to cognitive impairment. Importantly, the perception of the symptoms of CFS is often exaggerated and excessive compared to what is measured. Aside from the cognitive impairments, this perception may be disabling. Thus, brain fog is caused by measurable cognitive impairments but also the more subjective perception of mental fatigue and its impact on the individual with CFS (Ocon, 2013). Interactions of multiple factors clearly play a role. One approach is that altered information recollection are exacerbated by a stressor, such as orthostasis or a difficult mental task, that results in the decreased ability to readily process information, which is then perceived as fatiguing and experienced as brain fog.

A more contemporary study examined how long-term symptoms of COVID-19 could possibly play a role in exacerbating brain fog (Callan, 2021). It was found that while the term brain fog was used sparingly among participants, the physical afflictions described matched prior representations of the impairment.

Case study

Case study Sarah is a 40-year old, female teaching aide. She initially presented with feeling sick frequently, ongoing sore throat, reports a high level of tiredness all the time and persistent lapses in concentration. She is married with two children. Her mother has a history of hypertension. Routine testing revealed she had tested positive to a glandular fever antibody test. Sarah experienced conclusive symptoms relevant to brain fog.

What causes brain fog?

Brain fog and emotion

• Brain fog may feel like being lost in a rhetorical maze of sorts.
• Brain fog associated with emotional feelings of anger, sadness and loneliness.
• Being unable to think clearly may make an individual feel helpless, irritable and downcast.

Table 1. Causes of Brain Fog

Causes of Brain Fog

Cause	Description
Stress	Chronic stress can increase blood pressure, weaken the immune system and trigger depressive symptoms. When the brain is exhausted due to stress, it becomes more difficult to complete simple cognitive tasks.
Lack of Sleep	Poor sleep quality can also interfere with how well the brain functions. Sleeping too little can lead to poor concentration and cloudy thoughts.
Medical Conditions	Medical conditions associated with inflammation, fatigue can also cause mental fatigue. Brain fog is a symptom of chronic fatigue syndrome (CFS), which involves persistent fatigue for longer than six months.

Brain fog is a symptom of a number of chronic conditions. It is particularly prevalent in diseases involving inflammation and fatigue. Brain fog most presents itself in chronic fatigue syndrome and fibromyalgia. The most common causes of brain fog is sustained periods of chronic stress and anxiety. The fight-or-flight response gets stuck in hyper-drive and continues to exert more resources than the brain's capacity can handle. The hormone that springs the body into action, cortisol, keeps being produced at a higher-than-expected level. This contributes to prolonged cloudy thinking. During this part of the response, the area of the brain that stores memories is secondary function when the threat of danger is prioritised.

How can brain fog be managed?

Treatment depends on the cause. Some common interventions to improve symptoms in the short-term may involve intravenous therapy, using a saline drip, using stimulant medications. An individual’s doctor may also ask that person make some healthier lifestyle changes. Such as:

• Spend less time on computer and mobile phone – remind oneself to take break.
• Positive thinking and affirmations.
• Get enough sleep – 7-8 hours is key.
• Avoid alcohol, smoking, and drinking coffee.

To date, treatment of CFS has been focused on improving the physical fatigued state rather than the cognitive impairment. Meta-analyses demonstrate that cognitive behavioural therapy and graded exercise therapy effectively treat CFS in many individuals (Edmonds et al., 2004; Price et al., 2008). It would not be surprising if mental fatigue also is improved with such therapies, but future studies are necessary to formally determine this.

In an experiment determining high-fat diets (HFD) on obese mice while utilising the fatty acid amide Palmitoylethanolamide (PEA) on improving depressive-like behaviour (Lama, 2021). It was found that PEA, in fact, provides a benefit to drugs used in brain fog treatment therapy to limit depressive behaviours and memory deficit.

Conclusion

Over a range of theories and studies discussed to find out what brain fog is, what causes it and how it can be efficiently managed it is clear there is more need for research on the subject. In an increasingly uncertain world due to the COVID-19, brain fog appears to be a more salient subject among researchers of clinical psychology more broadly, but also on the effects it has on motivation and emotion. Over the last 20 years, there have been advancements when linking brain fog to other cognitive difficulties and even starting to link them to a major societal roadblock in the form of a global pandemic. There is still much to be discussed including the need for how it relates to motivation as there is extensive reasoning of how it confounds emotion but not motivation. The positive is that the concept of brain fog is still a relatively novel topic of discussion and research where the contributions made to psychology can benefit for many generations in finding out what is brain fog, what the causes are and how we manage it on a day-to-day basis.

See also

• Brain fog (Wikipedia)

References

Callan, C., Ladds, E., Husain, L., Pattinson, K., & Greenhalgh, T. (2021). “I can’t cope with multiple inputs”: Qualitative study of the lived experience of ‘brain fog’ after Covid-19. medRxiv. Retrieved Oct 15 2021 from: https://www.medrxiv.org/content/10.1101/2021.08.07.21261740v1

Deak, M. C., & Stickgold, R. (2010). Sleep and cognition. Wiley Interdisciplinary Reviews: Cognitive Science, 1(4), 491-500. Retrieved Oct 17 2021 from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5831725/

De Lange, F. P., Kalkman, J. S., Bleijenberg, G., Hagoort, P., vd Werf, S. P., Van der Meer, J. W., & Toni, I. (2004). Neural correlates of the chronic fatigue syndrome—an fMRI study. Brain, 127(9), 1948–1957. Retrieved 17 Oct 2021 from: https://pubmed.ncbi.nlm.nih.gov/15240435/

DeLuca, J., Johnson, S. K., Beldowicz, D., & Natelson, B. H. (1995). Neuropsychological impairments in chronic fatigue syndrome, multiple sclerosis, and depression. Journal of Neurology, Neurosurgery & Psychiatry, 58(1), 38-43. Retrieved 13 Oct 2021 from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1073266/

Edmonds, M., McGuire, H., & Price, J. (2004). Exercise therapy for chronic fatigue syndrome. The Cochrane database of systematic reviews. Retrieved Oct 17 2021 from: https://pubmed.ncbi.nlm.nih.gov/15266475/

Lama, A., Pirozzi, C., Annunziata, C., Morgese, M. G., Senzacqua, M., Severi, I., ... & Mattace Raso, G. (2021). Palmitoylethanolamide counteracts brain fog improving depressive‐like behaviour in obese mice: Possible role of synaptic plasticity and neurogenesis. British journal of pharmacology, 178(4), 845-859. Retrieved Sep 29 2021 from: https://pubmed.ncbi.nlm.nih.gov/32346865/

Ocon, A. J. (2013). Caught in the thickness of brain fog: exploring the cognitive symptoms of Chronic Fatigue Syndrome. Frontiers in physiology, 4, 63. Retrieved 4 Sep 2021 from: https://www.frontiersin.org/articles/10.3389/fphys.2013.00063/full

Paas, F., Tuovinen, J. E., Tabbers, H., & Van Gerven, P. W. (2003). Cognitive load measurement as a means to advance cognitive load theory. Educational psychologist, 38(1), 63-71. Retrieved 17 Oct 2021 from: https://www.tandfonline.com/doi/abs/10.1207/S15326985EP3801_8

Price, J. R., Mitchell, E., Tidy, E., & Hunot, V. (2008). Cognitive behaviour therapy for chronic fatigue syndrome in adults. Cochrane Database of Systematic Reviews, (3). Retrieved 10 Oct 2021 from: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD001027.pub2/full

Rowe, P. C., Barron, D. F., Calkins, H., Maumenee, I. H., Tong, P. Y., & Geraghty, M. T. (1999). Orthostatic intolerance and chronic fatigue syndrome associated with Ehlers-Danlos syndrome. The Journal of pediatrics, 135(4), 494-499. Retrieved 15 Oct 2021 from: https://pubmed.ncbi.nlm.nih.gov/10518084/

Sweller, J. (2011). Cognitive load theory. In Psychology of learning and motivation, 55, 37-76. Academic Press. Retrieved 15 Oct 2021 from: https://psycnet.apa.org/record/2011-17503-002

Theoharides, T. C., Weinkauf, C., & Conti, P. (2004). Brain cytokines and neuropsychiatric disorders. Journal of clinical psychopharmacology, 24(6), 577-581. Retrieved October 4 2021 from: https://www.frontiersin.org/articles/10.3389/fnins.2015.00225/full

Zung, W. W. (1972). The depression status inventory: an adjunct to the self-rating depression scale. Journal of Clinical Psychology. Retrieved October 1 2021 from: https://psycnet.apa.org/record/1974-11342-001

External links

• The Mayo clinic q&a podcast: brain fog (YouTube)
• How to fix the exhausted brain (Ted Talk)
• Memory and Brain Fog (PsychologyToday)