81 % subjects reported prolonged concentration to trigger brain fog, 68 % of which agreed that prolonged concentration triggered their brain fog while supine. Īlternatively, brain fog may have a multifactorial etiology with factors not restricted solely to prolonged upright posture. One possible explanation for this is that brain fog could be triggered by excessive reductions in cerebral blood flow that often occurs in POTS subjects when upright. Our finding that brain fog can be triggered by upright posture but not relieved by recumbence is consistent with a carry-over effect from a physiological provocation. Yet, the study did not measure cognition in these patients after returning them to the supine position. showed that POTS patients did not have impaired performance on an N-back memory task while supine but their performance was progressively worsened with incremental orthostatic stress. In contrast to this, subjects did not agree that lying down relieved brain fog and felt that brain fog could be triggered in the supine position. Since orthostatic intolerance is defined by the onset of symptoms with upright posture that are relieved by recumbence, we had previously assumed that brain fog was posturally driven. In this study, 87 % of subjects reported prolonged standing to trigger their brain fog and 81 % recommended lying down to improve brain fog. Subjects with sleep disorders had higher scores on the WMFI than subjects without sleep disorders ( P < 0.01) as shown in Table 2.īrain fog is not limited to the upright posture 1, brain fog severity ratings correlated with WMFI scores (ρ = 0.512, P < 0.0001). The severity of brain fog and mental fatigue varied greatly between subjects. Subjects reported that brain fog impaired their ability to complete schoolwork (86 %), be productive at work (80 %), and participate in social activities (67 %). As shown in Table 2, 96 % of the subjects experienced brain fog and 67 % experienced brain fog on a daily basis. Fifty-one percent of the subjects reported fainting due to OI and 14 % reported that they spent the majority of the day lying down. Subjects had developed POTS symptoms 5.8 ± 4.6 years before study enrollment and were diagnosed with POTS 2.8 ± 2.3 years prior to enrolling in this study. The age of the subjects was 20.4 ± 4.5 years, range 14–29. In all, 138 POTS patients (88 % female) responded by completing a questionnaire. The characteristics of the study group are shown in Table 1. The proposes of this study were to (1) generate a list of descriptors for the term brain fog, (2) evaluate symptoms and triggers of brain fog that could provide insight into the physiological mechanism of the symptom, and (3) assess the perceived effectiveness of treatments to identify targets for further study. Yet, the term “brain fog” is imprecise, and to date the cause of this symptom is unknown. Cognitive impairment is commonly listed among the top complaints of adolescents with POTS and is typically referred to as “brain fog” by patients. Patients with POTS experience a variety of symptoms suggesting central nervous system impairment ranging from prolonged fatigue and lightheadedness to overt neurocognitive deficits. Physiologic studies in those with POTS have identified an excessive reduction in cardiac output and cerebral blood flow in the upright position. Postural tachycardia syndrome (POTS) is a chronic form of orthostatic intolerance (OI) defined by the onset of orthostatic symptoms associated with an increase in heart rate (HR) of at least 40 bpm in adolescents, 30 bpm in adults, or a HR >120 bpm within 5 min of 70° head up tilt (HUT).
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