Like many of the million-plus vaccinated Americans who have contracted breakthrough COVID cases, when I tested positive over the holidays, I wasn’t worried about hospitalization or death. But I was concerned about the risks of long COVID, particularly the lingering effects of “brain fog.” So when I called up clinical neuropsychologist Jacqueline Becker and mixed up our time zones, I wasn’t comfortable joking about it. The fog felt potentially too real.
Becker, who’s also an associate scientist at Icahn School of Medicine at Mount Sinai, was understanding regardless, telling me that “people often don’t know how to describe what they’re feeling. They don’t feel as crisp. And that’s sort of where the term came from. The reason it became a term is because people say they feel a bit cloudy.”
If brain fog seems like an old-timey medical term comparable to “catching the vapors,” that’s because it kinda is. Probably first appearing in a Pennsylvania newspaper in 1853, the colloquial, non-medical phrase has been used to describe symptoms of hypothyroidism, diabetes, lupus and numerous other conditions. No matter the malady, though, brain fog has typically been associated with older individuals — until, that is, COVID hit. “We’re seeing that people of all age groups and different COVID severities are vulnerable to brain fog,” Becker explains, sending me further into a panic spiral.
As for how we’re supposed to tell the difference between a cognitive impairment and a weird afternoon, Becker and other experts offer a few different strategies…
What to Look Out For
Some warning signs of brain fog can be more obvious than others. For instance, “if someone is not oriented to time, place, person, year and situation, you should consult a doctor for further evaluation,” Prashant Rai, an associate professor of neurology at the University of Texas Medical Branch, tells me.
Because brain fog seems to wreak havoc on what’s known as our “executive functioning,” it can start to feel like the “CEO of our brain,” as Becker describes it, is drunk on the job. She uses the analogy of remembering a grocery list to explain: “Let’s say you have chicken, broccoli, bread, oranges, crackers, beef. That’s a lot harder to remember than if you say, ‘Chicken, beef, crackers, bread, oranges, broccoli,’” because the latter list is categorized by food type. Our executive functioning usually employs little hacks like this.
Another example Becker offers is multitasking. If you’re making dinner and you walk away from the kitchen to answer the front door, but forget that you’re cooking in the process, then it might be time to see a doctor (and check the stove).
So You Think You Have Brain Fog
Brain fog isn’t technically a medical term, so you can’t be diagnosed with it. That said, you can undergo neuropsychological testing, including CT and MRI scans of the brain. These tests look at brain functioning as a whole. Even though brain fog mostly hinders memory and executive functioning, other aspects like social cognition also need to be examined because “cognitive domains don’t really work in isolation,” Becker says. In any event, the testing is essential for making any kind of treatment recommendation.
Okay, You Definitely Have Brain Fog. What Do You Do Next?
The treatments certainly aren’t as fancy as the testing. Compensatory strategies include writing things down, using mnemonic devices, not doing more than one task at once, reducing distractions and decreasing demands. They’re generally tailored to the individual and their deficits to get them back to their normal level of functioning (or close to it). It’s not a quick fix by any means, but that’s where the science is at.
Can Brain Fog Be Prevented?
Beyond not getting COVID in the first place, there isn’t a lot people can do to weatherproof their brains from the fog. But it’s worth noting that brain fog can be linked to many other conditions that can occur along with COVID, a la “infections, thyroid adrenal issues and metabolic issues with the liver and kidneys,” as well as the ramifications of taking drugs like “opiates, benzodiazepines and anticholinergics,” Rai explains.
Becker adds that depression, high blood pressure and high cholesterol can also contribute to brain fog. And so, the closest doctors can get to preventing brain fog at this point in time is to address these underlying issues.
How Long Does Brain Fog Last?
Becker stresses that cognitive impairment, like most things, happens on a spectrum. And from what neuroscientists like her can tell so far, brain fog in a COVID context is very different from dementia. And although it can be incredibly disruptive to a person’s day-to-day, the cognitive impairment isn’t as severe or progressive as other conditions like Alzheimer’s. Some patients appear to be rebounding back to their old selves over time, while others have had to adjust to a new level of functioning. Becker admits that more long-term, follow-up studies are required, “but so far, it doesn’t appear that patients are getting worse. So that’s the good news.”
It’s not the sunniest of responses, but when it comes to COVID, there have been much darker forecasts than a bout of brain fog.
Lauren Vinopal
Lauren Vinopal is a writer and stand-up comedian based out of New York City, who writes mostly about health, science and men. She is the host of the Mid Riff Comedy Show in Brooklyn, a frequent podcast guest all over, and lives the life of a teen who looks like they haven’t slept in years.
