From Linda M. Rio – mental and emotional health author and PWN contributor – A common complaint for many dealing with a pituitary tumor or other endocrine disorder is what is often referred to as “brain fog.” Because patients so frequently bring this up, it might be important to delve into what this is and what can be done about it.
Brain fog is not an official diagnosis. Physicians, especially endocrinologists, have heard patients use this term to describe disturbing concerns about their mental capacity, primarily if this represents a sudden or recent change. This term is a descriptor for a host of cognitive impairments. It is a neuropsychological sign usually used by scientists to explain the loss of intellectual functions, such as thinking, remembering, and reasoning, sufficiently severe to interfere with daily functioning (Nouraeinejad, 2022). Patients may describe this as anything from mental sluggishness and forgetfulness to feeling easily distracted or overwhelmed by mundane tasks. Brain fog may also include deficits in spatial planning, working memory and executive functioning, difficulty with word retrieval and fluency, poor attention, difficulty multitasking, paying attention, understanding conversations, and recalling memories. There is a range of intensity ranging from relatively mild and temporary to a more intense and persistent experience that may accompany a serious or chronic illness. Anyone can experience mild brain. Most experience mental and physical sluggishness after eating a sizeable carbohydrate-enriched meal or as part of a jet lag experience. Some medications, even over-the-counter medications like antihistamines, can make cognitive functions challenging shortly after taking them. However, pituitary disorder brain fog is not typically in this mild and transient range, and this is often among the many pre-diagnosis symptoms patients don’t realize is a part of their illness until long down the road of discovering what is causing a whole array of their difficulties.
Many illnesses have a brain-fog description among the symptoms described. David Duncan, M.D., director of the Multiple Sclerosis Center at Jersey Shore University Medical Center, works with multiple sclerosis patients, for example. He states that “cognitive impairment is estimated to affect more than half of multiple sclerosis patients during their illness. Other conditions such as cancer, Lyme disease, lupus, menopause, and pregnancy can present with cognitive fog (Knvul, 2022). Cognitive symptoms, commonly referred to as brain fog, are among the most common persistent or new symptoms after COVID-19 in both people who have been hospitalized and those who have not. In long COVID cases, 20 to 30 percent of patients report cognitive impairment or “brain fog” three months after their initial infection. Increasing data indicate that people infected with COVID-19 are at high risk for developing long-term neurological complications, such as “brain fog” or cognitive impairment. (Nouraeinjad, 2022).
So how does brain fog affect those with pituitary or other neuroendocrine challenges? The answer is, of course, it depends. Factors affecting how much or little brain fog people experience depend on each patient. Garni Barkhoudarian, M.D, Pacific Neuroscience Institute, states that 25% of pituitary patients will experience some form of brain fog, including cognitive delay, fatigue, depression, and more. One pituitary patient describes brain fog in the following way. “It was very frustrating to lose the one thing I was good at (intellectual capacity)…but when I got the diagnosis, it helped because it gave me validation…I had thought I was going crazy, or it was all in my head”. For this particular person, the loss of any mental capacity was one of the most debilitating symptoms because their career depended on attention to sharp detail and a high level of cognitive skills. For such a person, the loss of any level of cognitive functioning might be akin to losing a limb. For others whose job doesn’t rely on the importance of computational or other skills requiring fine attention to detail, the disruption may not be as noticed. For others, it can be disheartening to rely on a spouse or partner to do even basic things that once came easily. The brain, pituitary, and hypothalamus can all be affected by disruptions in healthy hormonal levels, resulting in processing errors. “It just hits you- all you can do is breathe, rest…it felt like I was going crazy”, described a patient. Paying routine bills can become impossible for some. Essential tasks like remembering to pay taxes can cause significant problems if left unattended.
Another concern patients express is the uncertainty about if or when their brains will function normally again. Even the best physicians cannot provide guarantees for this. The inability to have hope for a return to full functioning can cause additional worry and anxiety for some and even lead to depression. In addition, patients may wonder about their self-image and self-worth if they cannot contribute to running a household or job.
The good news is that often surgery or medical interventions will, for many, improve or even restore levels of cognitive functioning. The most important reason to seek medical treatment only from those with a high degree of special training and expertise in pituitary medicine is to affect the most favorable outcome. It is also crucial to communicate with the physician about all symptoms as well as the levels of severity of such symptoms; for example, a rating of 1 to 10 can help the doctor know if a symptom is mild or extreme. Rating a symptom such as brain fog can also be a short, quick way to describe something often hard to describe with words, especially if language skills are impaired. Words often just don’t come as quickly or accurately, particularly when in an anxiety-producing situation such as at a medical clinic. Most people become anxious when seeing their doctor. Anyone having a medical visit for anything to do with their “head” is bound to cause additional stress. And we know brains don’t function at optimum levels when stressed. So, other tools might be helpful:
- Make lists
- Do regular deep, meditative breathing
- Do as much physical exercise as your doctor, and you agree upon
- Get regular and consistent sleep.
- Keep to a routine
- Eat a healthy diet
- Avoiding screen time at least an hour before bedtime
- Do challenging mental activities such as memory games, playing Jeopardy, puzzles, and reading (if possible)
- Set alarms to avoid forgetting appointments.
- Use your phone to help with reminders.
- Use your phone’s audio note-taking capacity.
- Don’t beat yourself up.
- Discuss your mental impairments with those important in your life and give them information about your pituitary diagnosis to help them better understand your experience.
- Seek psychological/relationship counseling or therapy.
Often patients desperately hold hope that surgery to remove the adenoma or other dysfunction will “fix” everything, only to experience significant disappointment once the swelling goes down and obvious signs post-surgery are over. This is why it is vital to discuss with the surgeon and pituitary endocrinologist what REASONABLE expectations are. It can take weeks or months for such signs as brain fog to dissipate. Sometimes several post-surgery adjustments in medications and hormone replacements are necessary, but eventually, brain functioning will return to normal or near normal. During the pre-surgery or pre-optimal medication phase, it can be helpful to consult a mental health professional to assist in any signs of depression, anxiety, or other signs of stress that can be present. A therapist can also help family members talk about the challenges and emotions that are bound to occur with any significant illness. Read more articles on emotional and mental health by Linda.
References
Knvul Sheikh, K. (2022). Brain fog, what it is, and how can I treat it? Published Sept. 13, 2022. Retrieved April 10, from https://www.nytimes.com/2022/09/13/well/mind/brain-fog-treatment.html
Nouraeinejad A.(2022). Brain fog as a Long-term Sequela of COVID-19. SN Compr Clin Med. Retrieved March 2023 from ;5(1):9. doi: 10.1007/s42399-022-01352-5. Epub 2022 Nov 24. PMID: 36466122; PMCID: PMC9685075.
Nouraeinejad A. (2022). A proposal to apply brain injury recovery treatments for cognitive impairment in COVID-19 survivors. IntNeurosci. RetrievedMarch2023from 2022;5:1–2. doi: 10.1080/00207454.2022.2084091
Linda M. Rio, M.A., LMFT (805) 619-0950 www.Lindamrio.com
The book The Hormone Factor in Mental Health is available through Amazon.com and other major booksellers.
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