BRAIN FOG

Managing Functional Neurological Disorder (FND) with Brain Fog

Brain fog is a common and disabling symptom in Functional Neurological Disorder (FND). It affects cognition, memory, attention, and processing speed. While not dangerous, it can deeply impact quality of life and is often misunderstood.

What Is Brain Fog?

Common Descriptions:

• Feeling mentally "cloudy" or "slow"

• Trouble concentrating or finding words

• Memory lapses (short-term or recent events)

• Difficulty multitasking or organizing thoughts

• Delayed speech or response time

Triggers & Patterns:

• Physical or emotional fatigue

• Overstimulation (light, noise, activity)

• Post-exertional malaise

• Anxiety or dissociation

• Poor sleep, illness, hormonal changes

Key Principles of Management

1. Pacing Cognitive Activity

• Schedule breaks before fatigue sets in

• Use the “energy envelope” strategy

• Break tasks into small steps

• Alternate brain-intensive and restful activities

2. Routine & Structure

• Maintain a consistent sleep/wake schedule

• Use calendars and reminders

• Create daily checklists

• Keep environment tidy and familiar to reduce cognitive load

3. Cognitive Tools

• Use timers, alarms, and smart tech

• Voice-to-text apps or digital notes

• Written reminders, sticky notes

• Mental cue cards (e.g., “Pause, Breathe, Refocus”)

4. Speech & Communication Support

• Word-finding issues and delayed speech are common

• Allow time to formulate responses

• Use simple language when needed

• Carry a communication card or app

5. Sensory Regulation

• Limit exposure to loud environments, screens, bright lights

• Use noise-canceling headphones, blue-light filters

• Take sensory breaks in calm settings

6. Mental Health & Grounding

• Practice grounding techniques to reduce dissociation

• Mindfulness, somatic tracking

• Gentle therapy (CBT, ACT, trauma-informed approaches)

• Validate frustration without pushing through symptoms

7. Nutrition & Hydration

• Small, regular meals to prevent energy dips

• Stay hydrated

• Avoid stimulants/sugar crashes

Flare-Up Strategy (Brain Fog Episodes)

• Stop and rest—avoid pushing through

• Re-orient with grounding (name 3 objects, sounds, etc.)

• Use low-effort activity (music, nature sounds, doodling)

• Communicate difficulty using pre-prepared message or card

• Return to normal tasks gradually

Communication During Brain Fog

• Responses may be slow, muted, or jumbled

• Avoid rushing the person or interpreting it as confusion

• Offer alternatives: writing, pointing, yes/no questions

• DO NOT assume intoxication or mental incapacity

When to Escalate

• Brain fog accompanied by new neurological signs

• Sudden loss of ability to communicate or orient

• New severe fatigue preventing basic functioning

• Worsening comorbid symptoms (POTS, migraines, seizures)

Support Team Roles

• Neurologist: Rule out other causes, educate on FND

• Occupational Therapist: Daily functioning and adaptations

• Psychologist/Therapist: Stress management, grounding

• Speech Therapist: Cognitive communication strategies

• Primary Care Provider: Monitor comorbidities, medication side effects

Brain fog in FND is real, frustrating, and manageable. With tools and pacing, clarity and confidence can be rebuilt over time.