Important Lifestyle Changes: Cognitive Dysfunction or ‘Brain Fog’ in PoTS

What is brain fog?

Brain fog has been described by PoTS patients as being:

• forgetful
• difficulty thinking or focusing
• a cloudy feeling in the head
• poor memory
• difficulty finding the right words
• mental fatigue
• slow thinking
• mind going blank
• difficulty processing what others say
• easily distracted
• difficulty processing written words
• feeling confused

PoTS patients have been observed to have problems with multi-tasking.

There have been a number of research studies investigating brain fog in PoTS. Many of these have used a range of standard neuropsychological tests to try and identify the specific areas of dysfunction reported by people with PoTS. These tests have found impaired executive function (ability to plan, organise information, and adapt to changes), selective attention, speed of information processing, and working memory problems.

How to combat brain fog

There is no current cure for brain fog in PoTS as research is currently at a very early stage and there may be many factors contributing to it.

Here are a few suggestions which may help to alleviate some of the symptoms based on reports from PoTS patients. Following general advice on treating PoTS may help.

• Stay well hydrated and increase salt intake (using electrolyte solutions may help). A very small study showed that increasing fluid intake reduced heart rate increase and improved brain fog.
• Take regular exercise (where this is possible). Physiotherapists with a specialist knowledge of PoTS may be able to guide patients with an individually tailored programme.
• Avoid unnecessary heat
• Lie down to work if your environment allows or elevate legs – try not to fall asleep!
• Maintain a steady blood sugar level with low proportions of carbohydrates within each meal and exclude refined sugars where possible. Some people find that having small frequent meals helps.
• Some PoTS sufferers report that caffeine helps with brain fog, but others report that it makes the condition worse as it can increase heart rate.
• Patients report that using ‘To Do’ lists or ‘reminder’ phone apps can be helpful.

Additional support for learning

Where children have disabilities that make it harder for them to learn, schools are required to provide appropriate support within the classroom, making any adaptions which are required for the student. SENCOs (Special educational needs co-ordinators) and educational psychologists may administer tests to gain further understanding of the profile of the student.

Students should make their educational establishments aware of the impact of brain fog on their ability to study. The SENCO in schools and disability services in universities can be approached in the first place to find out what learning support is available and how to obtain it.

There are several adjustments which can be made in the classroom and other learning environments to allow students to cope with their brain fog as well as other aspects of PoTS.
For example, students may also need extra time in exams due to brain fog.

Mentors can support students with their studies and so may help students with brain fog and PoTS. Mentoring is an umbrella term and can refer to several types of support. One example of a mentor which might help a student with brain fog is an academic mentor. A mentor might do tasks such as help with time management, motivation or breaking down assignments into achievable goals. Mentors can mediate with staff to provide support interventions.