Brain Fog Vs Cognitive Impairment

[Blasted]

The distinction between these two symptoms is not clear to me...

Brain fog seems to entail a foggy mind due to a disturbance in arousal (wakefulness) while cognitive impairment would be a dementia-like impairment of the mind without an associated disturbance in wakefulness or arousal.

So if during a flare up I feel like I can't think properly yet do not feel like I'm dreaming or half asleep etc... then would that be a mild cognitive impairment rather than brain fog?

Is there a simple way to distinguish between the 2?

 

[adreno]

I don't think there is a clear distinction.

 

[chipmunk1]

i am not sure if there is a distinction between the two.

There is no clear definition of brain fog or cognitive impairment. Brain fog can impair your cognitive function.

You can distinguish between the two if you have a clear objective definition of brain fog and of cognitive impairment.

i am not sure if one exists... i doubt it. it can mean many things to many different people.

if a person says i have brain fog you don't know exactly what they mean because you don't know how they experience it and what symptoms they associate with the word brain fog.

Then instead of consulting a dictionary or a book it would be better to ask the person to describe their symptoms.

If you have brain fog why does it matter how you call it? You could as well say i can't focus at all, my brain is fried.

None of the words give you any information on what is exactly going on in your body or your brain. They are used to describe a subjective mental state or degree of mental functioning. I think cognitive impairment is a more formal term used in medicine and more likely to be associated with more serious and objective neurological impairment. Brain fog is more informal and more likely to be used to describe mild disturbances of cognitive function in absence of serious neurological illness.

 

[alex3619]

There is no clear definition of brain fog or cognitive impairment

I suspect that cognitive impairment is a collection of different things. Some of those are well defined, others less so.

Brain fog is more amorphous. I see it as a description of a collection and overlapping brain issues, which can include brain arousal but is not limited to it or even requiring it.

Cognitive impairment usually refers to specific deficits, but not all deficits are well defined. So for example if you have specific speech impairments, that can be a cognitive impairment. Or you have specific issues with working memory. That is a cognitive impairment. However such impairments can actually be due to a range of different issues. Impairment is about the outcome, not the cause.

Many of us have multiple cognitive impairments. I think these are part of brain fog, but brain fog is possibly more than the simple sum of such impairments.

 

[Blasted]

I think cognitive impairment is a more formal term used in medicine and more likely to be associated with more serious and objective neurological impairment. Brain fog is more informal and more likely to be used to describe mild disturbances of cognitive function in absence of serious neurological illness.

Yes I agree with this.

It seems that the descriptive term 'cognitive impairment' has been appropriated as a defined medical condition (pre-dementia) which kind of precludes us from using it to describe what we're experiencing. However, I really like how you got around this with the phrase 'mild disturbances of cognitive function'. Very well said .

 

[Blasted]

Brain fog is more amorphous. I see it as a description of a collection and overlapping brain issues, which can include brain arousal but is not limited to it or even requiring it.

Ok that makes sense. So I won't exclude myself from the brain fog camp due solely to lack of changes in arousal/wakefulness.

 

[duncan]

Brain fog is a colloquialism, and a vague one at that. It would be a subset of cognitive impairment. You cannot have brain fog without having some degree of cognitive impairment.

But you can have cognitive impairment without having brain fog - although I would argue that is an exception. An example could be found in cognitive testing (which I have lots of experience in unfortunately). You can have complete clarity of thought, but have a memory in shambles, and perform subpar on memory tests.

 

[Gondwanaland]

I can fix my brain fog with electrolytes, and cognitive impairment with T3 hormone.

 

[Hip]

There are two separate Wikipedia articles for (mild) cognitive impairment and for clouding of consciousness (aka: brain fog).

The central symptom in the former appears to be memory impairment, and the central feature of the latter is abnormality in the regulation of the overall level of consciousness.

This is definitely how I experience brain fog: it is a lowering of my conscious awareness of the world, and indeed of myself. If the 1960s counterculture movement was all about consciousness expansion, then the brain fog of ME/CFS may be the diametric opposite: severe consciousness contraction.

Although like most ME/CFS patients I do also have deficits in short-term and working memory (working memory deficits often manifest as difficulties with task switching), word retrieval problems, and some general confusion. I am not sure if you would include these under brain fog or not. My guess is that these may be separate mental symptoms to brain fog.

 

[Jon_Tradicionali]

I can fix my brain fog with electrolytes, and cognitive impairment with T3 hormone.

Please elaborate.

 

[Gondwanaland]

Please elaborate.

I will have to sleep on that before answering... I'm in a low T3 moment

 

[Blasted]

There are two separate Wikipedia articles for (mild) cognitive impairment and for clouding of consciousness (aka: brain fog).

The central symptom in the former appears to be memory impairment, and the central feature of the latter is abnormality in the regulation of the overall level of consciousness.

It was working off of those articles that prompted me to wonder if people on PR who talk about experiencing brain fog were actually referring to a clouding of their consciousness in which case it wouldn't be as fitting a descriptor for me as it would be for you.

I guess it depends if we agree with Wikipedia's more stringent definition or with a wider one as Alex sees it:

Brain fog is more amorphous. I see it as a description of a collection and overlapping brain issues, which can include brain arousal but is not limited to it or even requiring it.

 

[alex3619]

Mild cognitive impairment (MCI, also known as incipient dementia, or isolated memory impairment

This refers to pre-dementia, not cognitive impairment. There are many different types of cognitive impairment. Some arise from brain injury for example. Schizophrenia has cognitive impairment. Speech problems are cognitive impairment. Of course dementia is too.

 

[Hip]

It was working off of those articles that prompted me to wonder if people on PR who talk about experiencing brain fog were actually referring to a clouding of their consciousness in which case it wouldn't be as fitting a descriptor for me as it would be for you.

I guess it depends if we agree with Wikipedia's more stringent definition or with a wider one as Alex sees it:

A couple years ago, Wikipedia had an article on cognitive dysfunction, in which "brain fog" was presented as a synonym for cognitive dysfunction. That article began like this:

Cognitive dysfunction (or brain fog) is defined as unusually poor mental function, associated with confusion, forgetfulness and difficulty concentrating. A number of medical or psychiatric conditions and treatments can cause such symptoms, including heavy metal poisoning (in particular mercury poisoning), menopause, fibromyalgia, ADHD and sleep disorders (including disrupted sleep). The term brain fog is not commonly used to describe people with dementia or other conditions that are known to cause confusion and memory problems, but it can be used as a synonym for sleep inertia or grogginess upon being awakened from deep sleep.

Now this article on cognitive dysfunction has disappeared from Wikipedia, but you can still see the original article on the WayBack Machine.

So this older Wikipedia article on cognitive dysfunction has a slightly different notion of brain fog, defining it in terms of confusion, forgetfulness and difficulty concentrating.

It seems that brain fog has slightly different definitions, depending where or when you look, and Alex's usage of the term, defining in as various overlapping brain issues of ME/CFS, I guess is just as valid (and is similar to the cognitive dysfunction article definition).

It would be nice if there were a widely recognized precise definition of the term brain fog though.

 

[Hip]

Here is another reference to the term "brain fog" in a published study on ME/CFS:

Caught in the thickness of brain fog: exploring the cognitive symptoms of Chronic Fatigue Syndrome

The cognitive symptoms are generally thought to be a mild cognitive impairment, but individuals with CFS subjectively describe them as “brain fog.” The impairment is not fully understood and often is described as slow thinking, difficulty focusing, confusion, lack of concentration, forgetfulness, or a haziness in thought processes.

 

[alex3619]

It would be nice if there were a widely recognized precise definition of the term brain fog though.

Such a basic patient experience, and with 59 years since the Royal Free outbreak we still don't have a strong medical grasp on even symptoms. It says it all.

 

[Woolie]

@alex3619, In neuropsychology, a very clear distinction is made between "Mild cognitive impairment" or MCI which is a specific form of amnesia seen as a possible precursor to Alzheimer's, and cognitive impairment, which can mean anything to speech to high-level vision, to working memory to memory for events, fact, etc, etc. The terms are not very helpful!

When people talk of "brain fog", they seem to be talking about the feeling or experience itself. It may or may not translate into cognitive impairment, as measured on neuropsychological tests. I know some studies have found actual deficits in PWMEs on cognitive tests - especially ones that emphasise working memory. But drawing on wider evidence, there doesn't seem to be a neat correspondence between the experience itself and the presence/extent of cognitive impairment. This is probably because our tools for measuring such things are poor, but is may also be that the condition impacts less on our actual performance than we think. NOT that it isn't horrible and real and debilitating, just that our brains are super resilient and good at compensating in so many ways?

 

[Woolie]

PS I'd like to hear various people describe their own experience of brain fog, see if we have similar or different experiences.

 

[alex3619]

@Woolie, which is kind of what I was trying to say. I agree with you.

There are different forms of brain fog that I experience. Current fog is a combination of things for me, not one thing, and it varies at different times.

What I can say most about it is that during my rare brief interludes of remission, lasting typically about six hours, my brain comes online. Its a very flowers for Algenon moment, as after some hours my cognition fades away and I become as before.

During those interludes my language and math skills climb, my reading speed goes nuts (speed reading instead of struggling), my memory becomes sharp, my capacity to mentally visualize things, including graphs (by inspecting equations) suddenly switches on. When my capacity fades, then its the reverse. It all goes away in a slow slide. Some hours later I am foggy me. Struggling to read, struggling to remember, sometimes unable to even count, or speak, or read at all.

I think that brain fog is essentially the same thing, but maybe with other things added in that vary person by person and over time. It may also be different for fibro compared with ME.

During such times my capacity for exercise also goes into the stratosphere. I can do stuff. This fades with mental capacity.

I think this is important, as it shows that in at least a subset whatever is stuffing us up is dynamic, and if we can figure it out we can shut it down.

 

[Hip]

The clouding of consciousness definition of brain fog appears to be the most common one. If you Google search "clouding of consciousness", it provides a lot of hits.

It's also a very specific definition, referring to abnormalities in the regulation of consciousness, and therefore more scientifically useful, because the brain fog defined in this way might then be pinned down to a specific neurological cause. For example, it is the reticular activating system (RAS) in the brainstem which regulates consciousness, so an abnormality in the regulation of consciousness suggests a problem with the RAS. And we know that there are brainstem abnormalities in ME/CFS.