The Parkinson Society of British Columbia hosted a webinar in mid-September on brain fog in PD. Brain fog has been described as “fuzzy thinking” and “being unable to feel sharp in one’s thoughts.” The speaker addressed the symptoms behind brain fog and how to promote brain health and wellness.
The webinar speaker was Cheryl Daniels, RN, with the Movement Disorder Clinic, UBC Okanagan, in British Columbia. She noted that in Parkinson’s a major contributing symptom to brain fog is fatigue. Other health conditions can be common in PD patients diagnosed with brain fog.
I listened to the webinar and am sharing a summary of the talk. (See below.)
You can find a recording of the webinar on the Parkinson Society of British Columbia’ (PSBC) YouTube channel.
You can find the speaker’s slides on the PSBC website here.
If you have questions about the content of this webinar, please contact PSBC by phone at 604-662-3240 or via their website.
Three topics were prominent in this webinar – fatigue, sleep, and cognition. You can find additional, in-depth resources on these three topics on the Stanford Parkinson’s Community Outreach website:
Your Head in the Clouds: Brain Fog with Parkinson’s Disease
Presented by the Parkinson Society of British Columbia
September 14, 2020
Summary by August Besser, Stanford Parkinson’s Community Outreach
Brain fog is a condition described as “the inability to have a sharp memory or to lack a sharp focus.” In short order, you just really feel like you’re not yourself and you’re unable to think clearly. Brain fog has also been described as “fuzzy thinking” and “unable to feel sharp in one’s thoughts.”
Brain fog is caused by various lifestyle choices and behaviors, as well as medications and other medical conditions. Some lifestyle choices that contribute to brain fog are poor diet, sleep disorders, infections, altered mood, inactivity, and chronic stress. Medical conditions that contribute to brain fog are diabetes, a thyroid condition, low iron, heart disease, and excess weight.
A major contributing symptom to brain fog is fatigue. Half of Parkinson’s Disease (PD) patients report fatigue with a third stating fatigue as the most debilitating symptom. Fatigue is exhaustion and a lack of energy. It is not improved by rest. Fatigue is a physical symptom characterized as being unable to do things or having no energy (being deeply tired/weary). Fatigue is mental: it causes a person difficulty in thinking, focusing, or concentrating. It overlaps with many other symptoms. Fatigue is caused by medications, sleep issues, mood alterations, cognitive deficits, deconditioning, and other health conditions.
Sleep issues are very common in PD patients diagnosed with brain fog. The issues can occur at any time, and are often discovered before an official diagnosis by many years. Sleep issues can include a REM sleep behavior disorder, difficulty falling asleep, difficulty staying asleep (insomnia), and sleeping too much. The latter is often in more advanced situations.
The cognitive symptoms related with sleep issues are sun-downing, feeling agitated, wandering around, and hallucinating.
The circadian rhythm that controls and regulates sleep is changed due to brain fog. The primary sleep-wake cycle is dysregulated, which leads to fragmented sleep patterns. Melatonin production is disrupted, leading to less time in the deepest REM sleep. The result of brain fog disrupting one’s circadian rhythm is daytime sleepiness and fatigue, as well as reduced mental clarity.
Other disrupters to the circadian rhythm are: difficulty turning in bed, the return of PD symptoms (e.g., tremors, rigidity, restlessness, dystonia, thermoregulatory symptoms, dysregulated mood), a need to go to the bathroom frequently, sleep apnea, and stress.
Some ways that patients experiencing brain fog can improve their sleep are as follows: taking medications (such as melatonin, clonazepam, or antidepressants); maximizing the management of PD symptoms by adjusting one’s medication(s); practicing good sleep hygiene; using satin sheets and pajamas, as well as bed rails; exercising, getting sunlight, avoiding late naps and stimulation; and avoiding psychological stressors.
Mood changes are another symptom of brain fog. Depression, anxiety, and apathy are all a part of this category. Other feelings associated with mood changes are no joy in life, feeling tired, constant worry, panic attacks, a loss of interest in things one used to enjoy, and difficulty focusing/concentrating on things. These mood changes affect 30 to 60% of patients. These mood changes can also occur any time during the course of the disease as well as before PD motor symptoms appear. Mood changes are due to the body and mind adjusting to the diagnosis, but are also due to overall changes in brain functioning.
There are ways for patients experiencing brain fog to improve their mood. The first method is through medication: either the regular PD medications a patient is taking, and/or mood stabilizers. Another method could be meeting with a counselor or a psychiatrist. Patients can also take steps on their own by meditating, using a biofeedback machine, practicing yoga, and going to cognitive behavioral therapy. Furthermore, people can participate in social activities, provide support to others, and volunteer. Exercise, sunlight, fresh air, and healthy eating also boost the mood. One of the more common causes of cognitive complaints relate to altered moods.
Brain fog can result in cognitive changes; specifically, brain fog changes the ability to maintain attention, think clearly, remember things, and thoughts are slowed. These changes increase with age and the duration of the disease (mid- to late-stages). Someone can either experience memory/thinking problems (such as dementia) or hallucinations/delusions. Cognitive changes also fluctuate with the medication “on/off” cycle. However, cognitive changes are exacerbated by some PD treatments and even levodopa. There can be other underlying pathology contributing to cognitive dysfunction, such as head injuries, strokes, or vascular damage.
Cognitive changes can be a cause for concern and monitoring. Of people over 65 years of age, 40% experience memory loss in one form or another. There is a considerable variation in the specific cognitive functions over time, as well as per the individual. It is important to consider other contributing factors to cognitive changes. In general, cognitive changes that are concerning interfere with day to day function and independence are a concern of others around you and less apparent to the individual themselves. A patient needs to ask themselves: “How are you functioning in relation to your per group? Is your safety a concern?”
To manage cognitive problems, patients need to manage a variety of other problems. Specifically, cognitive changes can be managed by managing PD symptoms (particularly the sleep and mood issues). Treatment specific medications like rivastigmine and donepezil can benefit patients, in addition to adjusting other PD medication levels. Performing cognitive exercises can also give a boost to preventing cognitive changes. Furthermore, picking certain times for the activities and events performed can aid in limiting cognitive changes. Above all, utilizing practical strategies and support from caregivers are key ways to manage cognitive problems.
Decreased activity levels are a major contributor to cognitive change. Increased difficulties or challenges in walking or moving, and reduced activity levels (both with and without apathy), lead to greater changes in cognitive activity. Furthermore, caregivers and other people in relationship with the patient can experience greater stress when activity levels decrease. Deconditioning of the body, meaning a lack of muscle coordination and strength, can lead to reduced brain perfusion (i.e., less blood flow to the brain) and decreased stimulation. Deconditioning also leads to increased fatigue and slowed cognitive function. It’s imperative for PD patients to exercise, participate, encourage people to visit them, and elicit help when they need it.
Other health conditions can be common in PD patients diagnosed with brain fog. Conditions like chronic disease, hypertension, and cholesterol are commonly diagnosed after age 60, and the chance of diagnosis increases with increasing age. Other conditions like vascular disease, diabetes, thyroid problems, and low iron are linked to developing brain fog. Medication side effects, orthostatic hypotension, chronic pain, and sleep apnea are also all linked to cognitive changes.
To manage and prevent brain fog, PD patients need to manage other underlying medical conditions. Maintaining healthy blood pressure and blood sugar, getting consistent exercise, eating healthy, and drinking adequate water all assist with managing those medical conditions. Furthermore, patients that review their medication (and substitute prescriptions, alter the times when medications are taken, and simplify the number of medications being taken), can reduce the chances of experiencing brain fog.
Brain wellness is a key component of reducing the likelihood of the onset of brain fog. In order to promote brain wellness, patients should:
- control their blood pressure
- not smoke
- consume alcohol in moderation
- eat healthy
- get adequate sleep
- stay organized
- plan ahead
- above all, be kind to yourself and others
In summary, brain fog is a common symptom in patients with Parkinson’s disease. There are many other factors that can contribute to brain fog. However, there are many medical and practical solutions to aid in preventing brain fog. Those solutions can fluctuate with the cycle of medication a PD patient may be on. Finally, exercise is important, and sticking to a consistent schedule helps with brain fog.