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Brain Fog and Multiple Sclerosis

Updated on February 10, 2021
Medically reviewed by
Amit M. Shelat, D.O.
Article written by
Sarah Winfrey

Brain fog — also referred to as “cog fog” — is a name for the cognitive issues sometimes associated with multiple sclerosis (MS). About 50 percent of people diagnosed with multiple sclerosis experience cognitive issues with memory, concentration, problem-solving, information processing, and visual or spatial abilities.

Although the brain-fog symptoms are generally mild in most people with MS, they can fluctuate. For example, they’ve been found to worsen or improve depending on factors like a person’s exhaustion levels, medications, and stress. Around 5 percent to 10 percent of people diagnosed with multiple sclerosis have severe brain fog that can interfere with normal activities and daily life.

Cognitive Symptoms of Brain Fog

Cognitive function — or higher brain functions — include reasoning, memory, and problem-solving. Because MS can affect any area of the brain, the condition can impact almost any cognitive function.

These impacts can be mild, affecting only one or two aspects of cognitive function. In some cases, however, they prevent you from being able to work, go to school, and attend to other responsibilities.

Brain fog commonly affects several aspects of a person’s cognition.

Memory

People with brain fog may find that their memory isn’t as sharp as before. In most cases, these memory problems involve having difficulty remembering specific information, recent events, or preplanned tasks. If brain fog impacts your memory, you may find yourself frequently misplacing objects or missing appointments if you don’t set reminders.

Concentration

Brain fog can cause difficulty in concentrating, particularly when distractions are nearby. Your mind may wander if you are with multiple people talking at once. You may even experience an overwhelming information overload — an inability to process what’s going on in front of you — while trying to focus on one person or task in a noisy or visually distracting setting.

Remembering Words

We all struggle to find the right word from time to time. However, if brain fog is among your MS symptoms, you may have particular difficulty recalling words. You may, for instance, find yourself unable to come up with the word “restaurant,” instead describing it as “a place where you order food.”

Information Processing

MS can impact your ability to process information — that is, to follow a series of complex instructions. This can be particularly difficult if you’re provided with a great deal of information very quickly.

Executive Skills

Brain fog from MS can impair your executive skills, which include your abilities to plan and problem-solve. This can make it difficult for you to predict the future impacts of your actions or decisions.

If a person with MS experiences changes to their executive skills, a loved one will often notice this first. They may, for example, notice you’re making rash or unsound decisions, which can be difficult to recognize on your own.

Visuospatial Abilities

Your visuospatial abilities help you relate to and interpret visual and spatial information. Throughout the day, you’re constantly picking up on different cues to determine your place in relation to the world around you. Brain fog can impair this ability, causing you to become lost in familiar places, unintentionally bump into objects, or have trouble accurately judging your speed and distances while driving.

Depression, Anxiety, and Fatigue

People diagnosed with multiple sclerosis often experience feelings of depression, anxiety, and fatigue, all of which can impair their cognitive abilities.

Self-Esteem

Brain fog can affect your self-esteem. “Cognitive problems are a big downer for my self-esteem, and sometimes I really just want to quit life over it,” wrote one MyMSTeam member.

It’s common to feel frustrated or ashamed for not being able to function the way you did before your MS diagnosis. However, it’s important to remind yourself that cognitive problems are not your fault.

What Does Brain Fog Feel Like?

Brain fog often causes people to become forgetful, confused, or generally “out of it.” As one MyMSTeam member put it, “I’ve noticed that I can zone out.”

For some people, this means misplacing objects. “I took out a simple bagel this morning, and I thought I set it down somewhere on the counter,” one MyMSTeam member shared. “I went to retrieve it after it was thawed, and it had vanished. I thought one of my dogs took it because they enjoy taking things off the counter, but that was not the case.”

Brain fog may also affect speech or cause difficulty recalling words. “I get my words mixed up, and pronunciation sometimes can be a struggle,” a MyMSTeam member wrote.

Another member noted, “I slur and stutter when I speak.”

Brain fog can occur anywhere, and for many people with MS, the symptom is particularly concerning on the job. “I work, and sometimes I'm just not ‘all there,’” a MyMSTeam member shared. “I still have to plow through it, both because I want to and because work demands it.”

People may feel embarrassed about their brain fog. In some cases, it may cause them to isolate and avoid social gatherings. However, one MyMSTeam member noted the importance of spending time with others: “Let your spouse or friends talk you into going out into a social setting when your other symptoms are in a good place, and your only reason to say 'no' is because you're embarrassed.”

What Causes Brain Fog in Multiple Sclerosis?

MS impacts the body and brain in several ways, resulting in brain fog. In some cases, medications used to treat MS can contribute to cognitive changes.

Cell Damage

Multiple sclerosis damages the brain’s nerve cells and myelin (the coating that protects nerve cells). MRI scans have tied the severity of brain fog to the extent of demyelination (myelin damage) within the brain.

The location of the damage in the brain can dictate the specific symptoms you may experience. For example, damage to the part of the brain responsible for speech can impair your verbal abilities.

Brain Lesions

Brain fog has also been associated with lesions in the brain resulting from multiple sclerosis. Neither the type of lesions you may have nor their locations have a discernible tie to a person’s brain fog. The overall number of lesions, however, does matter: The more lesions a person has, the more severe their brain fog will likely be.

Relapse

Relapses of multiple sclerosis may worsen brain fog. One study followed people with stable MS, people with MS who were relapsing, and people with no MS diagnosis. Researchers found that the people undergoing relapses scored lower on cognitive tests.

Certain Medications

Some medications commonly prescribed for multiple sclerosis can contribute to brain fog. If you’re experiencing new or worsened cognitive problems, you should ask your doctor whether any of your prescriptions could be the cause.

Managing Brain Fog in Multiple Sclerosis

Fortunately, there are techniques for managing and living productively with brain fog. Here are some tips from researchers and MyMSTeam members.

Exercise

Doctors used to advise against exercise for people with multiple sclerosis, believing physical activity could worsen symptoms or cause the condition to progress.

Today, we understand that exercise can have tremendous wellness benefits for people with MS. Although there is no evidence physical activity can slow the condition’s progression, it has been found to help improve mood.

People with MS have found water exercises, pilates, tai chi, stretching, and yoga to be great forms of physical activity. Ultimately, the right exercise routine to support your physical and emotional wellness will depend on your specific diagnosis and symptoms, your mobility, and your treatment plan.

However, your doctor is your best resource for determining which exercises will be safest and most beneficial for your well-being. Always talk to your doctor before beginning a new exercise routine.

Find Ways To Relax and Rest

Brain fog can feel worse if you’re feeling especially tired or stressed. Meditation has demonstrated significant benefit for people with MS. Resting, deep breathing, and positive affirmations may also help.

“My symptoms get a lot worse when I'm exhausted. I need to lie down frequently. It's the only way I know to relax at all,” advised a MyMSTeam member. “If you can't lie down, sit down and focus on your breath. Deep, rhythmic breathing relaxes the brain. Pace yourself, use calming self-talk (i.e., 'This will pass. It's going to be OK.'). It helps.”

Build Associations

Memory loss can be a frustrating symptom of the brain fog that comes with MS. Building connections or associations can help. For example, you might try connecting two activities, such as taking your medication with your first glass of water in the morning. Doing so can help build the habit of doing them together: If you do one, you’ll be more likely to think of the other and do it, too.

If you have trouble remembering names when meeting new people, associate them with someone you know who has the same name, or with a word that sounds like the name.

Use a Calendar and Set Reminders

Brain fog can force you to forget appointments, special occasions, and daily responsibilities. Calendars, alarms, and to-do lists can help ensure you stay on top of your tasks.

I have a calendar on my computer and keep a calendar that tells me birthdays, anniversaries, appointments, and any other things I have to remember. I check it each day. It's on my phone, too,” one MyMSTeam member wrote. “I [also] put alarms on my phone to remind me to do things, like call my brother for his birthday, go to a doctor’s appointment at 4, give my dog his flea meds, remember to buy bread, etc. It may seem stupid to some, but they don't have MS.”

Experts also recommend this as part of your cognitive rehabilitation plan.

Try Learning Something New

Sometimes, training one part of your brain can help you strengthen your overall mental health. One MyMSTeam member found that her brain fog improved after she started learning a new language. “I've started learning Welsh, as I had heard that learning another language keeps the grey matter [of the brain] healthy,” she wrote. “Sure enough, after five weeks, I'm actually remembering what I learned — plus remembering a whole sentence both in Welsh and English. Try something new. It's working for me, and I’m so pleased that I have typed all this!”

Talk To Your Doctor

Your doctor should be able to connect you with experts who can help you compensate for your brain fog or restore some of your lost cognitive function.

Get Support

MyMSTeam is the social network and online support group for those living with multiple sclerosis and their loved ones. Members talk about a range of personal experiences and struggles. Brain fog is one of the top 10 most frequently discussed topics.

Have you experienced brain fog with your MS? Do you have any tricks for improving thinking and memory? Start the conversation by commenting below or posting on your Activities page.

A MyMSTeam Member said:

I think nuvigil helps a bit

posted 22 days ago

hug

Amit M. Shelat, D.O. is a fellow of the American Academy of Neurology and the American College of Physicians. Review provided by VeriMed Healthcare Network. Learn more about him here.
Sarah Winfrey is a writer at MyHealthTeams. Learn more about her here.

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