How to Handle MS “Brain Fog”

From the WebMD Archives

Have you noticed that simple things you used to do on auto-pilot, like making a pot of coffee, seem more complicated than they used to?

It happens to a lot of people with MS. Often called “brain fog,” it can include forgetfulness, trouble concentrating, and confusion. The disease can affect your thinking as well as your body.

“There are lots of physical issues that people with MS struggle with,” says Bart Rypma, associate professor of behavioral and brain science at the University of Texas, Dallas. “But it’s the cognitive changes -- slowing of thought -- that they experience most immediately.”

You may notice that you:

  • Solve problems more slowly
  • Forget appointments
  • Lose track of conversations
  • Can’t follow directions
  • Need constant reminders about daily tasks

There are ways to get around these problems and make it easier to do what you need, and want, to do.

Why It Happens

The problem, Rypma says, is that communication breaks down between your brain cells and the blood vessels that provide the nutrients that help them work. That makes it harder for your brain to do its job.

Remember that pot of coffee? “Filling up the water, scooping the coffee into the filter, flipping on the switch -- that’s a set of skills that resides in your short-term memory,” Rypma says. “It may seem like you’re doing it by rote, but that’s just the brain working efficiently on its own.”

When you have MS and find that you have to repeatedly talk yourself through each step before going on to the next one, it may be a sign that the guidance systems in your brain have been slowed down by MS. Those brain cells don’t talk to each other as well as they should.

“It’s not that you won’t be able to do all your normal tasks,” Rypma says. “But it could take you longer.”

How to Clear Away the Fog

“Just because cognitive changes are common doesn’t mean there’s nothing you can do about them,” says Sylvia Klineova, MD, of the Corinne Goldsmith Dickinson Center for Multiple Sclerosis at Mount Sinai Hospital in New York. “After all, your brain can be trained.”


Try these five methods:

  1. Tell your doctor. “We try to filter out any related problems that can affect you, like depression, poor sleep, and fatigue,” Klineova says. “When we treat those symptoms, the brain fog may begin to lift.”
  2. Use your strengths to help you manage your weaknesses. If you have trouble remembering where you put the remote control or when you’re supposed to meet your friend for lunch, set up a central command where you keep track of everything happening in your household.

“Keep lots of lists, and have a family calendar where everyone can see what they need to do and where they need to go,” says Rosalind Kalb, PhD, vice president for health care information and resources at the National Multiple Sclerosis Society. “Those organizational strategies can help you feel less foggy. You can learn ways to compensate for the challenges.”

  1. Talk to your boss. Let her know what you need. The law requires employers to make “reasonable accommodations” that make it possible for you to do your job.

“Brain fog is one of those things that you may need help with at work,” Kalb says. “For instance, your manager can’t have a conversation with you in the hallway and assume you’ll remember everything she asked you to do. You may need written instructions. Or if your office is always warm, you might request a fan. With MS, your body is extra sensitive to heat, and you may feel sharper when you can stay cool.”

  1. Give yourself extra time. “Because your brain is communicating more slowly, realize that everything will take a little longer to do,” Rypma says. “Slow down and do things one at a time to help you compensate.” Don’t try to multitask. Go easy on yourself.
  2. Stay active. Do as much as you can physically, and keep your mind challenged, too. Keep up with the hobbies and other interests you enjoy, and try different puzzles and games.

“’Use it or lose it’ holds true for all of us,” Kalb says. “When you stay actively engaged in work and hobbies, it keeps your brain active and stimulated. It’s not a cure, but it definitely makes you feel better.”

WebMD Feature Reviewed by Neil Lava, MD on December 13, 2015



Multiple Sclerosis Australia: “Changes in Memory and Thinking.”

National Multiple Sclerosis Society: “ADA and People with MS.”

Hubbard, N. Neuropsychology, July 6, 2015.

Bart Rypma, associate professor, Center for Brain Health, University of Texas at Dallas.

Sylvia Klineova, MD, assistant professor of neurology, Mount Sinai Hospital, New York; attending physician, Dickinson Center for Multiple Sclerosis, New York.

Rosalind Kalb, PhD, vice president of health care information and resources, National Multiple Sclerosis Society.

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