“It’s Not Just All In Your Head”: Post Covid Brain Fog: What We Know So Far And Strategies To Help Lift The Cloud

by | Jul 24, 2022 | Issue 152, Issues | 0 comments

Ever experienced mental fogginess, slowness during recuperation from illness? Simply put, you may be suffering from ‘Brain fog’. Though not a medical term, it’s not such a simple medical condition....

Ever experienced mental fogginess, slowness during recuperation from illness? Simply put, you may be suffering from ‘Brain fog’. Though not a medical term, it’s not such a simple medical condition. More recently, brought to the fore by the onslaught of COVID -19. Brain fog is a common, yet troublesome cognitive impairment phenomenon experienced by many patients weeks to months after suffering from COVID-19, to describe feeling mentally slow or feeling not as sharp a thought process as before. This is part of the CDC’s umbrella term ‘Long COVID-19’ or Post-Acute Sequelae of SARS-CoV-2 infection (PASC), which includes the various symptoms someone can experience during or even after being infected with COVID-19. 

 PASC occurs when patients experience persistent, new or recurring symptoms four or more weeks after the initial COVID-19 infection. Even weeks after being infected with COVID-19, some people will continue to experience symptoms, including brain fog, which can stick around for many weeks after you’ve recovered from the disease. 


Symptoms of Brain Fog

Brain fog is a broad term that encompasses a variety of symptoms. The commonality through these symptoms is some impaired mental function that can make it harder to think clearly, hence the term ‘fog.’ For example, individuals may have a hard time finding the right word or remembering the names of things. They may also find it hard to focus or multitask. 

Brain fog impairs more than one’s ability to focus; it can also slow or impair brain function. Normally, the brain controls and accesses information by encoding and retrieving, meaning the brain encodes information into its memory to remember it, and the brain retrieves it from where it was encoded to access that information. 

However, brain fog slows this process, making it harder to learn, encode or retrieve the information you already know. This process also makes decision-making more difficult by reducing the brain’s processing speed and creating mental fatigue. 

The most severe symptom of COVID-19 brain fog affects middle-aged adults and is called dysexecutive syndrome. It occurs when someone has a hard time organizing information with impairments in speed processing, memory encoding, recall and category fluency, implying an impact on frontoparietal and frontostriatal brain networks. Basically, the brain has a reduced ability to function, indicating that the brain networks responsible for motor, behavioral and mental functions may be affected.

Researchers agree that COVID-19 may be behind this syndrome. According to a research letter published in October 2021 in JAMA Network Open, researchers tested 740 COVID-19 patients in New York with a mean age of 49. Even months after being infected with COVID-19, individuals manifested a dysexecutive syndrome. Researchers also noted that the subjects tested positive for COVID-19 or its antibodies and had no history of dementia. Therefore, their symptoms were caused by COVID-19’s effects on their brains, not underlying dementia. 

 “Not just in your head”: Causes of Brain Fog


Our learning of the SARS-CoV-2 virus is occurring in real time, but one thing is clear: brain fog is not entirely a psychological phenomenon. Instead, brain fog has been found to have a biologic basis and can affect anyone who was infected with COVID-19, not limited to those that were extremely sick, hospitalized or on a ventilator. The exact cause of brain fog is difficult to determine, but some of the most common factors are: 


  1. Poor brain oxygenation caused by brain injury, lung/multi-organ damage or ventilator use;
  2. Inflammation of the coverings of the brain (i.e., viral encephalitis) or blood vessels (i.e., microvascular injury);
  3. Cytokine storm (i.e., heightened immune response to the virus or its remnants in the body) leading to a post-infectious autoimmune response;
  4. Autonomic and small fiber neuropathy from complex viral mechanisms could potentially lead to dizziness and lightheadedness.


These factors can affect the brain’s surrounding tissue or the amount of oxygen the brain receives, resulting in impaired function and the brain fog associated with COVID-19. 

Other medical conditions can contribute to COVID-19 brain fog as well. According to a study of non-hospitalized post-COVID-19 patients’ cerebrospinal fluid (i.e., the fluid which bathes and surrounds the brain), even COVID-19 patients without severe conditions still experienced brain inflammation. This implies that the body’s inflammatory response to COVID was still present even months after the initial infection and that the body’s inflammatory systems, which are activated during the infection, were still active even after the infection had passed. The researchers also found that patients with brain fog were also likely to have conditions such as hypertension, diabetes, sleep apnea, depression, anxiety, heavy alcohol and stimulant use, and learning disabilities.

Management of Post-COVID-19 Brain Fog

Make a diary of your symptoms and seek advice from a doctor through medical examination, lab tests, imaging and neuropsychological studies as deemed appropriate. There are myriad situations which could cause or potentiate brain fog symptoms. Unhealthy diet, poor sleep quality, chronic stress, hormonal changes, may be contributory, as have been the use of certain medications and medical conditions such as anemia, post chemotherapy, and depression, to name a few.


Strategies for Beating COVID-19 Brain Fog

Once your doctor is sure that there is no other explanation for cognitive difficulties, certain lifestyle strategies may be of help.


Mindful Planning

Plan, prioritize and pace your daily schedule with time for rest, rotating between mental and physical tasks. Write down on sticky notes, planners and calendars to place on your refrigerator, laptop or door for easy access and repetition. This strategy can help you avoid forgetting important things because of your brain fog.

You should also maintain a symptom diary to find triggers and helpful avoidance strategies. Such a diary will help you better understand your brain fog, what makes it worse and what helps. 

Ask for assistance when overwhelmed. In some instances, professional cognitive therapy may be helpful to your recovery process. 


Mindful Sleep

According to The Sleep Foundation, adults (18-64 years) need an average of 7-9 hours of rest every night. Sleep helps the brain and body recharge appropriately for optimal functioning and healing. It is especially important when you’re struggling with brain fog impairing your brain function. So make sure you get extra sleep to give your brain all the energy it can to push through brain fog. 

To help you sleep better at night, try to avoid coffee after 2 p.m., create a relaxing ritual like a warm bath before bedtime, turn off the TV, block blue light on digital devices at least a few hours prior and use the bedroom only for sleep and intimacy.


Mindful Diet

The brain-healthy Mediterranean or a plant-predominant diet consisting of whole grains, beans, olive oil, fruits, nuts, vegetables and fish has been shown to have anti-inflammatory properties. Avoid processed foods that are inflammatory. Remember to drink water throughout the day and avoid tobacco, alcohol and drugs.


Mindful Exercise 

Exercise can be very beneficial even when you’re battling brain fog. However, start slow, with gentle movements, stretching from a few minutes a few times a day, and build up in a graduated manner toward working out 30 minutes a day, five days a week. Remember to warm up and cool down before and after workouts to get the best out of your session.


Socialize Mindfully!

Be intentional when socializing. Surround yourself with mindful, mood-enhancing people and activities. You can also pursue reading, listening to music, breathwork, practicing mindfulness, meditation and maintaining a grateful and positive attitude.


Be Mindful of Other Conditions 

Make sure that you keep an eye out for other conditions as well. Seek medical help for conditions such as refractory headache, numbness, hypertension, diabetes, depression, substance abuse and liver, kidney, heart, lung or other multi-organ involvements.

Luckily, brain fog is unlikely to become a permanent condition. An optimistic study shed some light at the end of the tunnel that this fog may not be permanent. The latest research published in Brain Communications suggested that COVID-19 survivors showed a substantial reduction in attention retention on demanding tasks up to nine months after COVID-19 and an even worse memory for up to six months. The researchers found that previous COVID-19 patients had brain functions that were not significantly different from normal after 6-9 months.

Remember, our brain functions best with a balance of rest and repetition for rewiring and eventually getting back on track. The same is true with dealing with brain fog. The best way to overcome it is simply giving your brain enough rest. 


A Parting Reminder

Brain fog and other persistent symptoms of COVID-19 may seem challenging to those experiencing them. After all, dealing with symptoms of an illness you think you’ve gotten over is discouraging. Optimistic research with newer/ repurposed medicines is on the horizon. But, with these strategies, tips, and a tincture of time, you should be able to weather the fog.

 **This article  is a compilation from different medical sources and the author’s views and opinions are her own. This is to raise awareness on medical issues, not personal medical advice. Please ask your doctor about any questions/ concerns. Life is precious***

Dr. Ayushi Chugh M.D

Dr. Ayushi Chugh M.D

MD, Consultant Neurologist, Phoenix, Arizona