Supplemental Science: Lifting the Fog | Psychology Today Singapore

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</div> </div> </div> </header> <div class="outer-layout-container"> <main class="layout-content layout-container" > <div class="layout-content-full"> <div> <div data-drupal-messages-fallback class="hidden"></div> </div> </div> <div class="layout-container--grid layout-container--has-left-rail layout-container--has-right-rail retain-ltr-area-order"> <div class="layout-content-main"> <div> <div id="block-pt-content" class="block"> <article data-history-node-id="5016825" role="article"> <h1 class="blog-entry__title--full"> Supplemental Science: Lifting the Fog </h1> <h2 class="blog-entry__subtitle--full"> A new self-report measure promises to bring some clarity to the diagnosis and eventual treatment of brain fog. </h2> <p class="blog-entry__date--full fine-print"> By Hara Estroff Marano published March 5, 2024 - last reviewed on March 5, 2024 </p> <div class="pt-social-media blog-entry-divider"> <ul class="share-buttons"> <li> <a title="Share on Facebook" class="facebook-share-button 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href="mailto:?subject=Psychology%20Today%3A%20Supplemental%20Science%3A%20Lifting%20the%20Fog&body=Hi%2C%0D%0A%0D%0AI%20thought%20you%27d%20be%20interested%20in%20this%20article%20on%20Psychology%20Today%3A%0D%0A%0D%0A%20Supplemental%20Science%3A%20Lifting%20the%20Fog%0D%0Ahttps%3A//www.psychologytoday.com/sg/articles/202403/supplemental-science-lifting-the-fog%3Feml%0D%0A%0D%0A%0D%0A---%0D%0AFind%20Counselling%3A%20https%3A//www.psychologytoday.com/sg&destination=node/5016825"> <div><img border="0" src="https://cdn2.psychologytoday.com/theme-assets/icons/icon-share-round-email-md.svg" alt="Share via Email" width="37" height="37" /><span class="visually-hidden">Email</span></div> </a> </div> </li> </ul> </div> <div class="field-name-body"> <div class="insertArea"> <div class="image-article_inline_full"> <div class="insert-inner"> <div class="insert-image"><img alt="Sergei / Adobe Stock, Shacil / Adobe Stock, Photo Illustration / Edward Levine" class="image-article_inline_full_caption" height="595" src="https://cdn2.psychologytoday.com/assets/styles/article_inline_full_caption/public/articles/2024-02/AdobeStock_259914560_web.jpg?itok=cZ-Eo2fx" title="Sergei / Adobe Stock, Shacil / Adobe Stock, Photo Illustration / Edward Levine" width="639"></div> <div class="caption"> </div> <div class="insertArea--origin subtext">Sergei / Adobe Stock, Shacil / Adobe Stock, Photo Illustration / Edward Levine</div> </div> </div> </div> <p>The cognitive cloud known as brain fog didn’t originate with COVID-19. It has long been identified in the wake of other viral infections, notably Lyme disease and myalgic encephalitis/chronic fatigue syndrome. But the pandemic put it on the medical map with force and urgency, considering that millions were suddenly affected and many remain affected several years after onset.</p> <div class="markup-replacement-slot markup-replacement-slot-0" data-slot-position="0"></div> <p>A colloquial term for persistent cognitive difficulties, <em>brain</em> fog is marked by impairments in <a href="https://www.psychologytoday.com/sg/basics/executive-function" title="Psychology Today looks at executive functions" class="basics-link" hreflang="en-SG">executive functions</a>, <a href="https://www.psychologytoday.com/sg/basics/memory" title="Psychology Today looks at memory" class="basics-link" hreflang="en-SG">memory</a>, <a href="https://www.psychologytoday.com/sg/basics/attention" title="Psychology Today looks at attention" class="basics-link" hreflang="en-SG">attention</a> regulation, and <a href="https://www.psychologytoday.com/sg/basics/motivation" title="Psychology Today looks at motivation" class="basics-link" hreflang="en-SG">motivation</a>. People report problems finding words and other memory lapses. They have difficulty making decisions. They lack mental energy. They find themselves easily confused, experiencing a loss of mental sharpness. They have trouble concentrating and processing information. Some, but not all, suffer headaches.</p> <div class="markup-replacement-slot markup-replacement-slot-1" data-slot-position="1"></div> <p>In their own words, people describe “slow and sluggish thinking,” “fuzziness,” “blur,” being “not their usual self.” Many healthy people have experienced such symptoms briefly, during a bout of the flu, say, or after a night of heavy celebrating. But those who experience brain fog find themselves seriously disabled, unable to resume roles they once mastered.</p> <div class="markup-replacement-slot markup-replacement-slot-2" data-slot-position="2"></div> <p>Patients can lose a significant chunk of cognitive power compared to before infection. In a study conducted at Kings College London, subjects suffering from long COVID exhibited an average 28 percent decrease in memory, attention, and reasoning. Those who reported being the sickest demonstrated a whopping 57 percent decline in cognitive function compared to their pre-illness state.</p> <div class="markup-replacement-slot markup-replacement-slot-3" data-slot-position="3"></div> <p>No one knows what causes post-COVID brain fog, but many ideas have been put forth and are under active investigation. It is possible that the <a href="https://www.psychologytoday.com/sg/basics/coronavirus-disease-2019" title="Psychology Today looks at coronavirus" class="basics-link" hreflang="en-SG">coronavirus</a> directly targets neuronal cells, causing dysfunction of the <a href="https://www.psychologytoday.com/sg/basics/metabolism" title="Psychology Today looks at mitochondria" class="basics-link" hreflang="en-SG">mitochondria</a>, the power plants in all cells. Recent research shows that the SARS virus can block the expression of core mitochondrial <a href="https://www.psychologytoday.com/sg/basics/genetics" title="Psychology Today looks at genes" class="basics-link" hreflang="en-SG">genes</a> in animals; that process is visible in autopsy tissue from patients who had had COVID.</p> <div class="markup-replacement-slot markup-replacement-slot-4" data-slot-position="4"></div> <p>Its high energy requirements—the adult brain weighs three pounds, representing 2 percent of body weight, but consumes 20 percent of the body’s fuel—mean that cerebral tissues have a high metabolic demand. A reduction in energy output due to compromised mitochondrial function would have its most disruptive effect on the most energy-demanding brain operations, such as executive function.</p> <div class="markup-replacement-slot markup-replacement-slot-5" data-slot-position="5"></div> <p><a href="https://www.psychologytoday.com/sg/basics/neuroscience" title="Psychology Today looks at Neural" class="basics-link" hreflang="en-SG">Neural</a> inflammation may be another cause of brain fog. As with chemotherapy, long associated with “<a href="https://www.psychologytoday.com/sg/basics/brain-fog" title="Psychology Today looks at chemo brain" class="basics-link" hreflang="en-SG">chemo brain</a>,” the cognitive dulling many cancer patients experience during treatment, COVID-19 causes neural inflammation. The viral attack activates glial cells, the brain’s immune responders, with downstream effects on cognitive function.</p> <div class="markup-replacement-slot markup-replacement-slot-6" data-slot-position="6"></div> <p>The rampant release of inflammatory molecules such as cytokines can reduce neurogenesis, dendritic sprouting, and other mediators of cognitive <a href="https://www.psychologytoday.com/sg/basics/resilience" title="Psychology Today looks at resilience" class="basics-link" hreflang="en-SG">resilience</a>, hampering the brain’s ability to remain cognitively normal in the face of insults to it.</p> <p>Further, virus particles lingering in the body may set off an ongoing or overactive immune response, causing collateral damage. The response may include production of auto-antibodies, proteins misdirecting their protective power against the body. Although the last word has yet to be written on the subject, at least one major study has eliminated neural inflammation as a cause of COVID-induced brain fog.</p> <div class="markup-replacement-slot markup-replacement-slot-7" data-slot-position="7"></div> <p>There’s also evidence that blood clots can cause the brain fog linked to COVID. Early in the pandemic, researchers and clinicians noted a tendency for patients hospitalized with severe COVID to experience organ damage due to blood clots. More recently, a team following patients who had been hospitalized for COVID in 2020 and 2021 identified elevated levels of two clot-inducing proteins (fibrinogen and D-dimer) in the blood of those who later had cognitive difficulties.</p> <div class="markup-replacement-slot markup-replacement-slot-8" data-slot-position="8"></div> <p>Patients who had higher than average levels of fibrinogen and D-dimer in their blood at the time of hospitalization later rated their general cognitive abilities as poorer in questionnaires than did low-fibrinogen patients. The high-fibrinogen group also tended to score worse on objective measures of memory and attention. The study, reported in <em>Nature Medicine</em>, supports the possibility that blood clots triggered during the acute stages of viral infection led to lingering symptoms, such as brain fog.</p> <div class="markup-replacement-slot markup-replacement-slot-9" data-slot-position="9"></div> <p>Researchers recently proposed a surprising additional pathway to brain fog—the gut. Persistent viral RNA, often found in the gut of patients with long COVID, triggers the immune system to release inflammatory molecules that, in their attempt to fight infection, do collateral damage, preventing the absorption of the amino acid tryptophan from food. Tryptophan is the precursor to serotonin. The resulting dearth of serotonin—most of the body’s supply of the neurotransmitter is produced in the gut—impedes communication between the gut and the brain, normally conducted via the <a href="https://www.psychologytoday.com/sg/basics/vagus-nerve" title="Psychology Today looks at vagus nerve" class="basics-link" hreflang="en-SG">vagus nerve</a>. Most affected may be the hippocampus, resulting in memory difficulty.</p> <div class="markup-replacement-slot markup-replacement-slot-10" data-slot-position="10"></div> <p>Research on the cognitive consequences of COVID, however, suffers from one glaring problem—there’s no agreed-on definition of brain fog and no standardized way to assess it, hampering comparison of the results of studies. Nor is there clarity about the neuropsychological processes involved.</p> <p>Into this diagnostic nebula has stepped a team of Polish psychologists. In the <em>Journal <a href="https://www.psychologytoday.com/sg/basics/personality" title="Psychology Today looks at Personality" class="basics-link" hreflang="en-SG">Personality</a> and Individual Differences</em>, Agata Debowska and colleagues report the development of a brain fog scale to provide a common method of assessment.</p> <div class="markup-replacement-slot markup-replacement-slot-11" data-slot-position="11"></div> <p>Not only does it set out to capture all the symptoms but it finds they sort themselves into three distinct domains<br> —mental fatigue, impaired cognitive acuity, and confusion. Because the instrument is a self-report measure, individuals can test themselves.</p> <p>Although scientists can’t say for sure yet what causes brain fog, and there are no specific remedies, <a href="https://www.psychologytoday.com/sg/basics/antioxidant" title="Psychology Today looks at antioxidant" class="basics-link" hreflang="en-SG">antioxidant</a> supplements may help maintain the brain’s oxygen supply. A Yale team studying brain fog has found that a small group of patients given the antioxidant N-acetylcysteine (NAC) had improved memory, organizational skills, and ability to multitask. Patients took a dose of 600 milligrams of NAC once a day; in some, brain fog resolved so completely they were able to return to their jobs.</p> <div class="markup-replacement-slot markup-replacement-slot-12" data-slot-position="12"></div> <p>NAC is currently available without a prescription. The researchers are also formally testing NAC as a treatment for <a href="https://www.psychologytoday.com/sg/basics/traumatic-brain-injury" title="Psychology Today looks at traumatic brain injury" class="basics-link" hreflang="en-SG">traumatic brain injury</a>.</p> <h2>The Brain Fog Scale</h2> <p>These statements capture the components of brain fog. The full scale includes 23 items.</p> <p><strong>Factor 1: Mental Fatigue</strong></p> <ul><li>My thinking has been slow.</li> <li>I have felt mentally exhausted.</li> </ul> <div class="markup-replacement-slot markup-replacement-slot-13" data-slot-position="13"></div> <p><strong>Factor 2: Impaired Cognitive Acuity</strong></p> <ul><li>I have felt it difficult to remember and understand new information.</li> <li>I have found myself forgetting certain words, such as the names of objects.</li> </ul> <p><strong>Factor 3: Confusion</strong></p> <ul><li>I have had a hard time understanding what others say.</li> <li>I have felt spacey.</li> </ul> <div class="markup-replacement-slot markup-replacement-slot-last" data-slot-position="last"></div> </div> </article> </div> </div> </div> <aside class="layout-content-left-rail" role="complementary"> <div class="magazine-issue magazine-cover-feature-date"> <div class="magazine-cover-feature-date__cover"> <a 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