What is Cog Fog (Cognitive or Brain Fog) and How to Deal with This Frequent MS Symptom

Cog fog is a common MS symptom that causes issues with memory, attention, and information processing. Several lifestyle changes, including immediate and long-term strategies, can help make cog fog more manageable.

If you’re living with multiple sclerosis (MS), you’ve probably lost several minutes — if not hours — searching your house for a misplaced item like your keys or wallet, only to find it somewhere random, like the kitchen pantry or medicine cabinet.

You’re not alone. Cog fog, or MS-related brain fog, affects many people living with MS. In fact, it’s estimated that more than half of people living with MS will develop cognitive issues like difficulty understanding conversations, thinking critically, or recalling memories.

What is cog fog?

MSers call this symptom “cog fog,” short for cognitive fog. It’s also referred to as brain fog, changes in cognition, or cognitive impairment.

Losing your train of thought mid-sentence, forgetting why you entered a room, or trying to remember a friend’s name are all possibilities when cog fog strikes.

Krysia Hepatica, an entrepreneur with MS, describes how her brain works differently now. “The information is there. It just takes longer to access it,” she tells Healthline.

“For instance, if someone asks me a question about a particular detail from days or weeks before, I can’t always immediately pull it up. It slowly comes back in chunks. It’s like sifting through an old-school card catalog instead of just Googling it. Analog versus digital. Both work, one is just slower,” Hepatica explains.

Lucie Linder was diagnosed with relapsing-remitting MS in 2007 and says that cog fog has also been a significant issue for her. “The sudden memory loss, disorientation, and mental sluggishness that can strike at any minute are not so fun,” she remarks.

Linder describes times when she’s unable to focus or concentrate on a task because her brain feels like it’s slush in thick mud.

She’s found that cardio exercise helps her blast through that stuck feeling.

For the most part, cognitive changes are typically mild to moderate and will not be so severe that you aren’t able to take care of yourself. But it can make what used to be simple tasks — like shopping for groceries — pretty darn frustrating.

The science behind cog fog

MS is a central nervous system disease affectingTrusted Source the brain and spinal cord. It also causes areas of inflammation and lesions in the brain.

“As a result, [people with MS] can have cognitive issues that typically involve slowness of processing, trouble multitasking, and distractibility,” explains Dr. David Mattson, a neurologist at Indiana University Health.

Some more common areas of life that are affected by cognitive changes include memory, attention and concentration, verbal fluency, and information processing.

Mattson points out that no one MS lesion causes this specifically. However, cog fog seems to be more associated with an increased overall number of lesions in the brain.

On top of that, fatigue is also prevalent in people with MS. This can cause forgetfulness, lack of interest, and low energy.

“Those who experience fatigue may find it more difficult to complete tasks later in the day, have a lower ability to withstand certain environments such as extreme heat, and struggle with sleep disorders or depression,” Mattson adds.

Olivia Djouadi — who has relapsing-remitting MS — says that her cognitive problems seem to occur more with extreme fatigue, which can stop her in her tracks. And as an academic, she says that the brain fog is particularly challenging.

“It means I get forgetful over simple details, yet can still remember complex items,” she explains. “It’s very frustrating because I know I knew the answer, but it won’t come to me.”

There are immediate and long-term strategies for decreasing cog fog or even just making it a bit more manageable.

How to deal with cog fog

Doctors and patients can both feel frustrated at the lack of treatment options for the cognitive issues accompanying MS.

It’s critical for healthcare professionals to offer support and validation to their patients with MS who are experiencing changes in their cognition, says Dr. Victoria M. Leavitt, a clinical neuropsychologist at ColumbiaDoctors and assistant professor of neuropsychology at Columbia University Medical Center.

Leavitt believes that lifestyle factors can make a difference in the absence of treatments. “Modifiable factors that are in our control can help change the way a person with MS lives to best protect their brain,” she tells Healthline.

She says that the classic trio of modifiable lifestyle factors that may help with cognitive function include diet, exercise, and intellectual enrichment.

Diet

Changes to your diet — notably the addition of healthy fats — can helpTrusted Source with cog fog and other MS symptoms. Healthy fats, or foods rich in omega-3s, are known for their role in brain health.

Hepatica has found that eating healthy fats like avocado, coconut oil, and grass-fed butter help her cog fog.

In addition to avocados and coconut oil, consider including some of these in your diet:

• fatty fish like salmon, mackerel, sardines, and cod
• extra-virgin olive oil
• walnuts
• chia seeds
• flaxseeds

Exercise

For years, experts have studied exercise as a way to help people with MS deal with the daily struggles of cog fog. In fact, a small 2022 studyTrusted Source showed that moderate to vigorous physical activity was significantly correlated with improved processing speed in people with MS.

But it’s not just the favorable effect that exercise has on the brain that’s important — engaging in physical activity is also good for your body and mental health.

A small 2019 studyTrusted Source concluded that people with MS who participated in regular physical activity reported fewer problems with fatigue, depression, and impaired memory.

Though any type of exercise is beneficial, aerobic exercise may be especially effective at improving cognitive function in people with MS.

Additionally, a 2022 systematic reviewTrusted Source indicated that exercise likely improves the MSFC score, a measure of both physical and cognitive functioning.

Collectively, these results highlight the wide-ranging and impactful effects exercise can have on the body.

Intellectual enrichment

Intellectual enrichment includes those things you do to challenge your brain.

Participating in daily activities such as word and number games, or thought-challenging exercises like crossword, Sudoku, and jigsaw puzzles, can help keep your brain fresh and engaged. Playing these or other board games with friends or family can also spark more benefits.

To get the biggest brain-boosting benefits, learn a new skill or language, or pick up a new hobby.

Short-term strategies

While implementing long-term solutions for cog fog is important, you’ll also likely benefit from some tips that’ll provide immediate relief.

Hepatica says some additional strategies that work for her when she’s experiencing cog fog are taking good notes, writing everything down on her calendar, and multitasking as little as possible. “It is preferable for me to start and finish tasks before moving on to start something new,” she says.

Mattson agrees with these strategies and says that his patients do best when they make notes, avoid distractions, and do one thing at a time. He also recommends finding the time of day when you’re fresh and energetic and doing your more difficult tasks during that time.

Try in-the-moment strategies like:

• using an organization technique like lists or Post-It notes
• focusing on doing one task at a time in a quiet, distraction-free space
• using the time of day you have the most energy for the most difficult tasks
• asking family and friends to speak more slowly to give you more time to process information
• practicing deep breathing to help reduce the stress and frustration of brain fog

Long-term game plan

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