Skip to main content

What is brain fog? An evaluation of the symptom in postural tachycardia syndrome

Abstract

Purpose

Adolescents with postural tachycardia syndrome (POTS) often experience ill-defined cognitive impairment referred to by patients as “brain fog.” The objective of this study was to evaluate the symptom of brain fog as a means of gaining further insight into its etiology and potential palliative interventions.

Methods

Eligible subjects who reported having been diagnosed with POTS were recruited from social media web sites. Subjects were asked to complete a 38-item questionnaire designed for this study, and the Wood mental fatigue inventory (WMFI).

Results

Responses were received from 138 subjects with POTS (88 % female), ranging in age from 14 to 29 years; 132 subjects reported brain fog. WMFI scores correlated with brain fog frequency and severity (P < 0.001). The top ranked descriptors of brain fog were “forgetful,” “cloudy,” and “difficulty focusing, thinking and communicating.” The most frequently reported brain fog triggers were fatigue (91 %), lack of sleep (90 %), prolonged standing (87 %), dehydration (86 %), and feeling faint (85 %). Although aggravated by upright posture, brain fog was reported to persist after assuming a recumbent posture. The most frequently reported interventions for the treatment of brain fog were intravenous saline (77 %), stimulant medications (67 %), salt tablets (54 %), intra-muscular vitamin B-12 injections (48 %), and midodrine (45 %).

Conclusions

Descriptors for “brain fog” are most consistent with it being a cognitive complaint. Factors other than upright posture may play a role in the persistence of this symptom. Subjects reported a number of therapeutic interventions for brain fog not typically used in the treatment of POTS that may warrant further investigation.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3

References

  1. Singer W, Sletten DM, Opfer-Gehrking TL, Brands CK, Fischer PR, Low PA (2012) Postural tachycardia in children and adolescents: what is abnormal? J Pediatr 160:222–226

    PubMed  Article  Google Scholar 

  2. Stewart JM (2012) Update on the theory and management of orthostatic intolerance and related syndromes in adolescents and children. Expert Rev Cardiovasc Ther 10:1387–1399

    PubMed  Article  CAS  Google Scholar 

  3. Ocon AJ, Medow MS, Taneja I, Clarke D, Stewart JM (2009) Decreased upright cerebral blood flow and cerebral autoregulation in normocapnic postural tachycardia syndrome. Am J Physiol Heart Circ Physiol 297:H664–H673

    PubMed  Article  CAS  Google Scholar 

  4. Ocon AJ, Messer ZR, Medow MS, Stewart JM (2012) Increasing orthostatic stress impairs functioning in chronic fatigue syndrome with postural tachycardia syndrome. orthostasis impairs neurocognition in POTS. Clin Sci 122:227–238

    PubMed  Article  Google Scholar 

  5. Arnold AC, Haman K, Garland EM, Paranjape SY, Shibao CA, Biaggioni I, Robertson D, Raj SR (2012) Origins of cognitive dysfunction in postural tachycardiasyndrome. Clin Auton Res 22:207–258

    Article  Google Scholar 

  6. Karas B, Grubb BP, Boehm K, Kip K (2000) The postural orthostatic tachycardia syndrome: a potentially treatable cause of chronic fatigue, exercise intolerance, and cognitive impairment in adolescents. Pac Clin Electrophysiol 23:344–351

    Article  CAS  Google Scholar 

  7. Plash WB, Diedrich A, Biaggioni I, Garland EM, Paranjape SY, Black BK, Dupont WD, Raj SR (2013) Diagnosing postural tachycardia syndrome: comparison of tilt testing compared with standing haemodynamics. Clin Sci (Lond) 124:109–114

    Article  Google Scholar 

  8. Muth ER, Stern RM, Thayer JF, Koch KL (1996) Assessment of the multiple dimensions of nausea: the Nausea Profile (NP). Psychosom Res 40:511–520

    Article  CAS  Google Scholar 

  9. Bentall RP, Wood GC, Marrinam T, Dears C, Edwards RHT (1993) A brief mental fatigue questionnaire. Br J Clin Psychol 32:375–379

    PubMed  Article  Google Scholar 

  10. Bou-Holaigah I, Rowe PC, Kan J, Calkins H (1995) The relationship between neurally mediated hypotension and the chronic fatigue syndrome. JAMA 274:961–967

    PubMed  Article  CAS  Google Scholar 

  11. Zung WWK (1972) The depression status inventory: an adjunct to the self-rating depression scale. J Clin Psychol 28:539–554

    PubMed  Article  CAS  Google Scholar 

  12. Manyari DE, Rose S, Tyberg JV, Sheldon RS (1996) Abnormal reflex venous function in patients with neuromediated syncope. JACC 27:1730–1735

    PubMed  Article  CAS  Google Scholar 

  13. Ohayon MM, Roberts RE, Zulley J, Smirne S, Priest RG (2000) Prevalence and patterns of problematic sleep among older adolescents. J Am Acad Child adolsec Psychiatry 39:1549–1556

    Article  CAS  Google Scholar 

  14. Bagai K, Wakwe CI, Beth Malow B, Black BK, Biaggioni I, Paranjape SY, Orozco C, Raj SR (2013) Estimation of sleep disturbances using wrist actigraphy in patients withpostural tachycardia syndrome. Auton Neurosci. doi:10.1016/j.autneu.2013.02.021

    PubMed  Google Scholar 

  15. Bagai K, Song Y, Ling JF, Malow B, Black BK, Biaggioni I, Robertson D, Raj SR (2011) Sleep disturbances and diminished quality of life in postural tachycardia syndrome. J Clin Sleep Med 7:204–210

    PubMed  Google Scholar 

  16. Deak MC, Stickgold R (2010) Sleep and Cognition. WIREs Cognitive Sci 1:491–500

    Google Scholar 

  17. Claydon VE, Hainsworth R (2004) Salt supplementation improves orthostatic cerebral and peripheral vascular control in patients with syncope. Hypertension 43(4):809–813

    PubMed  Article  CAS  Google Scholar 

  18. Jarvis MJ (1992) Does caffeine intake enhance absolute levels of cognitive performance? Psychopharmacology 110:45–52

    Article  Google Scholar 

  19. Jacob G, Shannon JR, Black B, Biaggioni I, Mosqueda-Garcia R, Robertson RM, Robertson D (1997) Effects of volume loading and pressor agents in idiopathic orthostatic tachycardia. Circulation 96(2):575–580

    PubMed  Article  CAS  Google Scholar 

  20. Gordon VM, Opfer-Gehrking TL, Novak V, Low PA (2000) Hemodynamic and symptomatic effects of acute interventions on tilt in patients with postural tachycardia syndrome. Clin Auton Res 10(1):29–33

    PubMed  Article  CAS  Google Scholar 

  21. Raj SR, Black BK, Biaggioni I, Sachin PY, Ramirez M, Dupont WD, Robertson D (2009) Propranolol decreases tachycardia and improves symptoms in the postural tachycardia syndrome (pots): less is more. Circulation 120:725–734

    PubMed  Article  CAS  Google Scholar 

  22. Biringer E, Rongvel A, Lund A (2009) A review of modern antidepressants’ effects on neurocognitive function. Curr Psychiatry Rev 5:1–11

    Article  Google Scholar 

  23. Joyner MJ, Masuki S (2008) POTS versus deconditioning: the same or different? Clin Auton Res 18:300–307

    PubMed  Article  Google Scholar 

  24. Fu Q, VanGundy TB, Shibata S, Auchus RJ, Williams GH, Levine BD (2011) Exercise training versus propanolol in the treatment of the postural tachycardia syndrome. Hypertension 58:167–175

    PubMed  Article  CAS  Google Scholar 

  25. Hillman CH, Erickson KI, Kramer AF (2008) Be smart, exercise your heart: exercise effects on brain and cognition. Nat Rev Neurosci 9:58–65

    PubMed  Article  CAS  Google Scholar 

  26. Benarroch EE (2012) Postural tachycardia syndrome: a heterogeneous and multifactorial disorder. Mayo Clin Proc 87:1214–1215

    PubMed  Article  Google Scholar 

Download references

Acknowledgments

The authors would like to thank the research subjects for their participation and Dysautonomia International for their help with recruitment. The authors would also like to acknowledge Dr. Leonard Jason and Lindzi Shanks for their assistance designing the study questionnaire. This work was supported by the National Heart, Lung, and Blood Institute Grants RO1-HL074873 and RO1-HL087803 and by a grant from the CFIDS Association.

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Julian M. Stewart.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Ross, A.J., Medow, M.S., Rowe, P.C. et al. What is brain fog? An evaluation of the symptom in postural tachycardia syndrome. Clin Auton Res 23, 305–311 (2013). https://doi.org/10.1007/s10286-013-0212-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10286-013-0212-z

Keywords

  • Postural tachycardia syndrome
  • Orthostatic intolerance
  • Cognition