More on Brain Fog

My post yesterday about a foggy brain elicited this response from a reader:

"I, too, find myself frustrated when I experience foggy episodes, even though I know that they are due to the ongoing joys of a whacky immune system.
I was wondering if you have any information on why we experience these "brain clouds" - what is the mechanism in our bodies that causes this symptom.  If you do, could you please write about it sometime when you have the time?"

I'd be happy to oblige by reposting excerpts of an entry about brain fog that I wrote back in July 2010.

In addition to presenting the information in my July 2010 post, I wish I could specifically answer the reader's question about WHY brain fog occurs. But I can't. Obviously the brain and central nervous system has to be affected in some way, but as of yet, researchers haven't learned what happens at a basic cellular level that causes this very frustrating and frightening symptom. Brain fog isn't diagnostic or specific to Sjogren's syndrome. There's lots of other diseases that unfortunately can cause this same symptom.

It's not surprising to note that even though I wrote this two years ago, my feelings about dumb stupid brain fog remain the same:

THIS is my Sjogren's Brain

Remember those anti-drug public service announcements from awhile back? The ones that showed an egg dropped into a sizzling hot frying pan while the announcer said, "THIS is your brain on drugs!"



I thought they were pretty effective. Well, dramatic anyway. I think they should do a similar PSA for Sjoggies: THIS is your brain on Sjogren's syndrome: Splat! Sizzle....pop.....

So, I have had a week where the ol' grey matter just isn't functioning at it's peak. This used to freak me out considerably early on in my experience with autoimmune disease. You know the feeling - it's as if any thought process is in sloooooooow mooooooootion. Retrieval of items in my memory feels like rummaging around blindly for my size in a mile high stack of clearance sweaters at JC Penny. It's possible to find what you need. But it takes forever.

For example, the other night I was in a conversation which involved the brand name Kenworth. It's a brand of semi tractors. Don't ask why. It was a typical conversation with friends which means that all kind of silliness ensues. So when my brain is mush, I just can't get stuff to stick in my short term memory. I kept calling this truck a Kenmore, and we all got sidetracked into envisioning a truck that also functioned as a washing machine......hoo boy. Actually it was all pretty entertaining.

As an aside, I want to point out here that my friends no longer respectfully cease and desist teasing me about my gaffes when I remind them that I have Sjogren's syndrome. (With a dramatic sigh for effect). I think that I may have played the S card one too many times. Dang. Use this excuse with restraint, people, for the maximum sympathy benefit. Just a tip.

My point here, and actually there is one, is that several years back, this experience would have led me to frantically google the early signs of Alzheimer's disease with the certainty that I was indeed afflicted. But now, I know that this is just another one of those sjoggie "things". It's one of those symptoms that are hard to describe and vaguely come and go, but without a doubt indicate a significant change in my body and brain that came with the arrival of autoimmune disease.

If I try to describe this sensation to a non-sjoggie, invariably they respond with something like this: "Oh, yes. I know the feeling. Sometimes it's so hard to concentrate on things...." Not that there's anything wrong with that response - it's what I would have said in my pre autoimmune days to someone else.

But a sjoggie knows - this is different. She/he knows that what she is experiencing isn't the forgetfulness or distractibility that she used to know. She knows that her brain has been fundamentally changed. At least, that's the way that this sjoggie feels.

It's important to note here that not all sjoggies experience severe neurological changes. However, a significant majority of sjoggies do experience brain fog, which is indeed a symptom which arises from the brain and central nervous system. There is an enormous need to continue to study this area of autoimmune disease.

I think that one article in particular summarizes effectively the potential for change in the central nervous system in Sjogren's syndrome. It was written by Stewart J. Tepper, M.D., Clinical Assistant Professor of Medicine, University of Washington, Department of Medicine, Department of Neurology. It can be read in it's entirety on the Sjogren's world website.  Here's a sampling:

The first question that we all want answered is, "how often can nervous system involvement occur in Sjögren's? "We don't really have good studies to tell us. The nervous system may be involved in as many as 20-30% of patients with primary Sjögren's, and involvement can occur in brain, spinal cord and nerves. There may be a slightly higher rate of development of nervous system involvement in patients who have the SS-A antibody (anti-Ro). Having an SS-A antibody present can increase the frequency of involvement of a variety of target organs in Sjögren's. It appears that neurologic involvement can occur at almost any place in the nervous system. The central nervous system is defined as the brain and spinal cord, and Sjögren's can involve the brain and spinal cord. It can also involve the spinal fluid around the brain and spinal cord, and it can involve the nerves which leave the brain or which leave the spinal cord and go out into the rest of the body.

Here's another excellent explanation of central nervous system involvement in Sjogren's Syndrome, found here. This information was taken from a transcript of a presentation made by Dr. Susan McDermott, M.D. at a Sjogren's Syndrome Foundation 2003 national meeting. I have chosen just a few paragraphs from her speech, so please read it in it's entirety.

In Sjögren’s syndrome the whole nervous system can be affected, but here we will focus primarily on the Central Nervous System (CNS)...........Another way the CNS can be affected is by brain fog. This is a condition that most people are familiar with, and yet there is no medical term for it and it cannot be researched by putting ‘brain fog’ into an Internet search engine. The closest term would be ‘mild cognitive dysfunction,’ but this encompasses a wide spectrum of often subtle changes.

Brain fog is often experienced as problems with memory or difficulty focusing or problems with processing information or numbers or with paying attention. It is an experience of feeling not quite ‘all there’ mentally. While some people may feel they are becoming demented or developing Alzheimer’s disease, this generally is not the case, in that this is a different type of ‘dementia’ that is not likely to land a person in a nursing home for chronic care. In fact, brain fog is a relatively common condition that can be brought on by a variety of factors.

It is possible that patients with Sjögren’s syndrome might experience any one of these CNS symptoms during the course of their disease process. However, there are many other conditions that can cause these problems, some of which may be more serious and some of which may not. Therefore, it is important not to dismiss these things as being ‘just part of my Sjögren’s syndrome.’ Instead, it is worth checking with your doctor to determine how concerned to be about any problem you are experiencing and what treatment to embark on for it.

For most patients with Sjögren’s syndrome, is the brain fog going to be related to the Sjögren’s? The answer is yes, it is likely the case as it is consistent with the Sjögren’s picture. Is it diagnostic of Sjögren’s? No, as it is seen in most of the rheumatologic diseases as well as many of the conditions discussed above. Particularly, multiple sclerosis can be confused with Sjögren’s syndrome, as they have very similar symptom pictures. So the best course of action is to talk to your doctor, and if you don’t have a doctor who will listen to you and take you seriously, then find another doctor who will. Your doctor may not always agree with you as to what types of tests or treatments you may think you need, but he or she should at least be open to communicating about it. (Bolding mine).

The Sjogren's Syndrome Foundation has an excellent patient fact sheet entitled Brain Fog, which offers this definition and some suggestions for coping with brain fog:

What is Brain Fog? Brain Fog is a lay term to describe fluctuating mild memory loss that is inappropriate for a person’s age. It may include forgetfulness, spaciness, confusion, decreased ability to pay attention, an inability to focus, and difficulty in processing information. Remember that gradual cognitive decline from early adulthood is a fact of life. Brain Fog can occur in Sjögren’s syndrome (SS), but other factors might cause these symptoms and should be considered by you and your doctor.

What YOU can do about Brain Fog:

Manage your lifestyle to optimize your health and sense of well being.

Develop a close working relationship with your doctor(s):

• Always report changes in cognition/memory and mood (depression, anxiety).
• Make sure your physician knows about all the prescription and OTC medications you are taking. Especially in patients over 65-70 years of age, a major cause of cognitive dysfunction can be side effects of drugs and drug interactions.
• Inquire about your hormonal status, thyroid function, and blood pressure.

Additional actions:

• Rejuvenate with sufficient sleep. If after 8-9 hours of sleep you are still tired, tell your doctor. 

• Minimize stress and anxiety:
• Set realistic expectations 

• Plan ahead 

• Take breaks throughout the day 

• Learn relaxation exercises and practice them at regular intervals 

• Balance work and leisure 

• Let yourself laugh 

• Talk about feelings 

• Limit multi-tasking and focus on one task at a time
• Reduce caffeine and alcohol.
• Manage effectively musculoskeletal and joint pain.
• Exercise regularly. Adequate physical exercise enhances cognition/memory.
• Train the Brain! “If you don’t use it, you will lose it.”
• Boost your brain power: Continue to work into retirement (part time), learn new skills, volunteer, engage in social and mentally stimulating activities and establish new friendships and relationships.
• Take your body to the gym and don’t forget to visit the “BRAIN SPA” – both will improve brain function. 

• Recent scientific data show that longevity is associated with the successful management of chronic diseases, such as Sjögren’s syndrome, not the absence of any disease!

Well, putting together this info certainly has exercised MY brain for the day. Think I'll take a nap. Now which way......do I go......to find my favorite couch......?