Brain Fog. What an odd little term. I’d never heard of it as a diagnosis before as a nurse. In fact, had a patient told me they were having “brain fog” I must admit I would have probably cocked one eye brow and looked at them questionably begging for further explanation because that is not an approved medical term or diagnosis. But before you get angry with me over my seemingly superior dismissal of “brain fog” as a symptom, let me tell you that I can attest that brain fog is quite real because I’ve experienced it myself. The phenomenon begs further study by the medical community as it is a patient driven description of a set of common symptoms effecting cognition. Brain fog effects a larger number of people than one might think and it’s not isolated to RA. Many chronic illness patients experience brain fog.
As far as brain fog relates to RA, it is a cloudy feeling in your head as if a literally “fog” has settled over your brain causing you to feel like your mental function has slowed. You can think of it in terms of how much data is being processed by your computer at one time and how the number of processes active at one time can slow down the speed of the computer or even cause it to crash. When I am experiencing brain fog, it feels like the symptoms of rheumatoid disease: the pain, stiffness, mobility impairment, and swelling are all taking up the processing speed that my brain would normally use for data processing. Phone numbers that would normally be on the tip on my tongue are lost the in the fog. I forget what I was going to say in mid-sentence as if there were a glitch in my software. I often cant’ find the right word choice and in my struggle to communicate people fill in the words for me. I also have trouble accepting new information and will look at someone talking to me blankly as they give instruction or are expecting me to follow along with a story they are telling me. It’s quite disturbing for me and those around me. “Huh?” is a common response when the synapses catch and I realize I’ve just missed a part of the information my fogged brain is trying to process. Some might be dismissive and say everyone has a little forgetfulness as they age, but I assure you that the feeling one has with brain fog is different from those sensations. I’m 46 years old and I know that I have normal forgetfulness regarding where I last laid down my keys. This is quite different. When having an episode of brain fog I am quite aware of what is happening, but I can’t fix it.
Brain fog coupled with declining mobility was the reason I left my hospital career as a oncology nurse. I could no longer walk the halls and physically meet the demands of patient care, but I also was having difficulty making quick decisions that nurses are called to make every day in this fast paced setting. I tried to accommodate my illness by changing to a nursing desk job as a case manager and found that although I was not as physically taxed, the brain fog definitely changed my job performance. I could no longer multitask, meaning that answering multiple phone calls, while trying to interact with a coworker at my desk, while retrieving information from the computer system became too overwhelming. I was frustrated and it showed in my voice, on my face, and was mistaken as inability to interact well with coworkers. I simply could not perform at this level while dealing with chronic pain, joint and mobility issues, and being stressed in this way. This was a marked difference in my ability to perform well in the workplace. Prior to being diagnosed with RA, I had many job performance reviews that touted I was a gifted with organizational qualities, that I was a team player, and well liked among my co-workers and held in high regard among my peers as a senior nurse.
Currently, it is not clearly understood by the medical community what causes brain fog in patients with autoimmune diseases such as RA. Never assume that brain fog is just part of symptoms that go with RA because sudden onset of cognitive symptoms could signal a medical emergency. You should always communicate clearly with your physician the symptoms you are having rather than using the term “brain fog” to describe a set of symptoms because the symptoms I associate with brain fog may not be the symptoms you associate with brain fog and key diagnostic information could be missed by your healthcare provider. Impaired cognitive ability could be a side effect of medication, a vitamin or mineral deficiency, or characteristic of other disease processes. Unless your doctor says that the set of cognitive symptoms you are having are related to your autoimmune disorder diagnosis, never make the assumption you are having brain fog . (See: http://rawarrior.com/brain-fog-testing-cognitive-dysfunction-with-rheumatoid-arthritis-disease/)