For many with long-haul COVID-19, brain fog has become a part of life. Stumbling to find the proper word for something, forgetting details once committed to memory, feeling easily confused, getting lost or being mentally drained have become all too common.
A recent study in the Annals of Clinical and Translational Neurology found that nearly 85% of people with long COVID-19, who weren’t hospitalized, experienced neurological symptoms, including brain fog. This often makes it impossible for them to do tasks they once conquered with ease, like cleaning their house or finishing a work presentation. But what is brain fog? Is there anything to be done about it?
“Brain fog is certainly not an actual diagnostic term,” James C. Jackson, the assistant director of the ICU Recovery Center at Vanderbilt and lead psychologist at the Critical Illness, Brain Dysfunction and Survivorship Center (CIBS), told TODAY. “It isn’t in the formally known nomenclature.”
But that doesn’t mean it’s a complete unknown.
“Brain fog is very common in the ICU survivorship community and the community of cancer survivors,” Jackson said. “It has become common not only in popular culture now, but also certainly in the large and expanding community of COVID long-haulers.”
Explaining brain fog can be tough because it can mean so many things.
“The term is still frustratingly imprecise,” Jackson explained. “It leads to a lot of confusion and it leads to problems in communication. You may tell me you have brain fog … You might be referring by that to problems in memory. I assume that it means problems in attention. It could mean general malaise.”
Still, it remains an incredibly annoying symptom.
“Brain fog very much is one of those one of those things they would list at the top of the pyramid of complaints along with physical fatigue,” Jackson said. “The symptoms usually improve over time, which is not saying necessarily that they go away.”
Tracking symptoms and asking for help
Jackson recommends that people with brain fog talk to their doctors for help. First, they should ask to be screened for mental health conditions, such as depression, anxiety and PTSD. These ailments also can cause people to feel as if they’re not thinking clearly.
“It could be that the brain fog is influenced by the anxiety and depression and if we treat those treatable conditions a natural consequence is that the brain fog could really diminish,” Jackson said. “So that's good news.”
Renee Madathil, a rehabilitation neuropsychologist at the University of Rochester Medical Center, recommends that people record any signs of brain fog.
“Monitor your symptoms by writing them down and keeping a daily journal,” she told TODAY. “See if you notice any patterns.”
Sometimes people might realize that on days they sleep poorly they also have more trouble thinking. That can really help people prioritize healthy behaviors to try to improve their cognition. It also helps direct more specific conversations with doctors.
“You can go to your PCP and say, ‘I’ve been journaling … These are the patterns I have noticed,’” Madathil said. “Your PCP can take it from there and start targeting a plan to manage some of those issues.”
What’s cognitive therapy?
For people who still feel as if medication and behavior changes aren’t improving their thinking, cognitive therapy can help. Cognitive therapists, who are often neuropsychologists, try to determine where the problem starts through a thorough assessment. Often a patient’s goals drive the treatments.
“When we look at memory issues as rehabilitation specialists we have to figure out where the breakdown is occurring,” Madathil said. “I'm going to try to break down the steps to memory formation and take a magnifying glass to each of those steps and see where the breakdown is.”
Memory has several parts, she explained. One first has to pay attention, then encode that information, then store it and finally retrieve it. When Madathil determines where the problem happens, she can provide tailored solutions to help. If it’s attention that’s related to exhaustion, for example, she is going to recommend improved sleep hygiene and stress-reducing measures.
“There is not a pill or a device or a treatment strategy in the world that's going to fix cognitive functioning if you have really poor sleep,” she said. “If we could get sleep under control, if we get anxiety under control and we still continue to see these cognitive issues, we might consider other approaches.”
Cognitive therapists also recommend various tricks to help.
“We're actually working on things like memory strategies,” she said. “Sometimes a medication can come into play depending on what the person’s presenting issues are. But generally speaking for COVID-related brain fog, we're going to start with some of the therapies.”
It might feel “a little bit like school” with people performing tasks with paper and pencil. But the therapists will help people improve their memory, organize their thinking and help the person reach their goals. But it is important to seek professional guidance if brain fog is slowing one down.
“A lot of people who have brain fog were never actually hospitalized and had a mild case. They might not think that they need help,” she said. “Recovery is a process … There are many many specialists that need to be at the table for someone to get back to living the life that they want to after a devastating illness or injury regardless of whether or not you were hospitalized.”