“Brain fog” usually describes short-term difficulties with attention, processing speed and working memory from reversible causes — sleep problems (including sleep apnoea), menopause/perimenopause, mood and stress, pain/fatigue, medication side-effects, or post-viral states such as long COVID. Dementia involves a progressive decline that disrupts day-to-day independence (money, navigation, medication management). If symptoms are new, worsening or affecting daily function, arrange a medical review. Objective testing can separate benign fog from mild cognitive impairment (MCI) or dementia and point to practical treatment and rehabilitation (NICE, 2024; Hampshire et al., 2024; Marchi et al., 2024; Taylor-Rowan et al., 2021).
1) Is my brain fog early dementia? A clinician’s quick answer
Short answer: usually not — but we take it seriously. Fog tends to fluctuate (better on rested, low-stress days), improves when root causes are treated (sleep, mood, hormones, medications), and rarely causes sustained loss of independence. Dementia, by contrast, progresses over months/years and often shows a pattern of forgetting recent events, repeating questions, getting lost in familiar places, or struggling with bills/medications. If you recognise those red flags, especially when family notice change, seek assessment.
Did you know?
Memory vs attention. Many “memory lapses” in fog are actually attention problems — the information never encoded properly — which is why poor sleep, stress and interruptions make them worse.
Quick self-check (decision aid):
- Are your worst days linked to poor sleep, pain flares, hot flushes, stress or busy multitasking? → Fog likely; investigate causes.
- Is someone close noticing gradual decline over ≥6–12 months? → Consider medical review for MCI/dementia screen.
- Do problems chiefly involve losing track mid-task, word-finding and slowed thinking, but you manage bills/medications? → Fog more likely.
- Are there new navigation problems, repeating questions, or difficulty learning new information? → Escalate assessment.
- On several meds (bladder, nausea, allergy, mood, pain)? → Ask for anticholinergic burden review.
- Snoring/daytime sleepiness or waking unrefreshed? → Screen for sleep apnoea (Marchi et al., 2024; Taylor-Rowan et al., 2021).
2) How “brain fog” works (in plain English)
Brain fog isn’t a diagnosis; it’s a shorthand for feeling slowed down: harder to focus, juggle tasks, find words, or hold things in mind. The most common domains involved are attention and processing speed, with knock-ons to working memory and executive function (planning, multi-tasking).
Frequent reversible drivers:
- Sleep problems & obstructive sleep apnoea (OSA): fragmented sleep and nocturnal oxygen dips blunt attention/working memory; CPAP and sleep optimisation can restore clarity (Marchi et al., 2024).
- Mood & anxiety: low mood/worry drain attentional bandwidth and heighten the feeling of cognitive failure; treatment often normalises performance.
- Hormonal shifts (menopause/perimenopause): many experience word-finding issues and slowed processing; managing symptoms can lift cognition indirectly (NICE, 2024).
- Medication effects & anticholinergic burden: the cumulative anticholinergic load across common drugs can cloud thinking (Taylor-Rowan et al., 2021).
- Post-viral states (e.g., long COVID): small but measurable changes in memory/reasoning/executive tasks can persist for some and usually improve with pacing-based rehab (Hampshire et al., 2024).
Also check thyroid function and vitamin B12 if symptoms persist; treatables here can make a decisive difference.
3) Menopause & midlife hormones: when fog peaks, when it passes
During the menopause transition, many report word-finding glitches, slower thinking and patchy focus. This is common, real, and varies day-to-day. Treatment choices include HRT (hormone replacement therapy) and non-hormonal strategies; the aim is to improve sleep, vasomotor symptoms and mood, which often lifts cognition indirectly (NICE, 2024). If you’re navigating this stage and want joined-up support for mood, sleep and cognition, our guide explains options and how we work alongside your GP or gynaecologist: Menopause & Mental Health: https://strongerminds.co.uk/menopause-mental-health/
Did you know?
Processing speed vs memory. In hormonal transitions we often see slower processing speed rather than true storage failure. Slower “input speed” makes recall feel unreliable even when the information is stored.
4) Post-COVID brain fog: what we now know, and what helps
Large UK research shows measurable changes in memory, reasoning and executive tasks after COVID-19, particularly with persistent symptoms; many improve over time, though pacing and rehabilitation often help (Hampshire et al., 2024). Practical steps: energy management, graded activity, sleep optimisation, mood treatment and careful return-to-work planning. If symptoms limit daily life beyond a few months, objective testing can identify which cognitive systems are affected and guide a targeted rehab plan.
5) Mood, anxiety & “pseudodementia”: why feelings distort thinking
Low mood, anxiety, trauma and chronic stress narrow attentional focus (towards threat/rumination), flatten motivation and reduce working-memory bandwidth. In clinic we treat both tracks: evidence-based therapy for mood/anxiety and practical cognitive strategies (externalising memory with lists/reminders, focus blocks, phone alarms, environmental tweaks). When pain or fatigue co-exist, pacing prevents boom-and-bust cycles that worsen clarity.
If chronic pain is part of the picture, and you’ve noticed flares worsen concentration or sleep, here’s how we approach pain management in a way that supports both mood and cognition: Therapy for Chronic Pain & Pain Management: https://strongerminds.co.uk/therapy-for-chronic-pain-and-pain-management/
6) Sleep & breathing (OSA), pain and fatigue: the hidden culprits
If your partner notices snoring, breathing pauses or gasping, or you wake unrefreshed with daytime sleepiness, screen for OSA. The typical cognitive pattern is difficulty with attention, working memory and processing speed. Treatment (e.g., CPAP) plus sleep-hygiene changes often lifts fog significantly (Marchi et al., 2024).
Chronic pain and insomnia form a loop with mood and attention; addressing them pays double dividends for thinking clarity. Where needed we coordinate with sleep or respiratory services and your GP in Birmingham/West Midlands and online across the UK.
7) Medicines & anticholinergic burden: a quiet thief of focus
Some medicines with anticholinergic properties subtly reduce attention and processing speed; the total burden across multiple drugs is what counts (Taylor-Rowan et al., 2021). Examples that may contribute include certain bladder antimuscarinics, some antihistamines for allergy, some anti-nausea, vertigo and mood/pain medicines. Don’t stop anything suddenly; instead, ask your GP or pharmacist for an anticholinergic burden (ACB) review and discuss safer alternatives.
If you take or are considering medicines known to influence mood/cognition (for example, isotretinoin for acne), ensure there’s psychological monitoring alongside dermatology care; we offer in-depth assessments where this is relevant to safe prescribing: In-Depth Psychological Assessment for Isotretinoin (Roaccutane/Accutane): https://strongerminds.co.uk/in-depth-psychological-assessment-for-roaccutane-isotretinoin-accutane/
8) ADHD vs MCI in midlife/older adults: how clinicians tell them apart
Symptoms can look similar (distractibility, forgetfulness, losing track), and both ADHD and MCI can coexist with anxiety or depression. Clues we look for:
- Lifelong pattern (school reports, longstanding disorganisation) points to ADHD.
- Clear decline from prior baseline over months/years suggests MCI/dementia.
- ADHD often shows fluctuating attention that improves with structure/sleep; MCI shows progressive difficulty with new learning that affects daily independence.
- Objective profiles overlap, so history and collateral (partner/family view) matter; neuropsychological testing helps separate attention/working-memory vs new-learning deficits and guide treatment/referral (Mendonça et al., 2021).
When mood swings and energy changes are prominent, bipolar disorder may be part of the picture — even when mood seems “settled,” cognitive efficiency can be affected. If that resonates, this overview explains our assessment and treatment approach: Bipolar Disorder — Assessment & Treatment: https://strongerminds.co.uk/bipolar-disorder-assessment-and-treatment/
9) When to worry: red flags for dementia and what happens at assessment
Arrange a GP review if you or others notice: worsening forgetfulness for recent events, getting lost in familiar places, difficulty managing money/medications, marked word-finding problems in conversation, personality/behaviour change, or new confusion — especially if onset is subacute after illness. Typical pathway: history, brief cognitive screening, key blood tests (thyroid, B12, etc.), medication review, and, where indicated, referral to a memory clinic. If you prefer a faster private route, we coordinate with your GP so nothing is missed.
For a plain-English overview of symptoms and options: What Is Dementia? Guide to Symptoms, Causes, Diagnosis & Treatment: https://strongerminds.co.uk/what-is-dementia-guide-symptoms-causes-diagnosis-treatment/
10) What an objective neuropsychological assessment gives you (plus a mini-vignette)
What we test: attention, processing speed, working and long-term memory, language, visuospatial skills and executive functions.
What you get: a clear map of strengths/weaknesses, practical compensatory strategies, and evidence-based signposting (sleep clinic, medication review, HRT discussion, mood/PTSD treatment, OSA testing, neurology/memory clinic, etc.).
Mini-vignette (composite):
“Sarah,” 52, noticed word-finding glitches and losing her train of thought at work. Sleep was poor; periods irregular; on two meds with anticholinergic effects. Testing showed slowed processing speed and weak sustained attention; memory storage was intact. With a sleep/OSA screen, medication adjustments via her GP, targeted attention strategies and menopause-informed care, her confidence and performance improved over three months.
If you’d value that level of clarity, our Neuropsychological Assessment (Birmingham) page explains the process and how we work: Neuropsychological Assessment (Birmingham) (StrongerMinds): https://strongerminds.co.uk/neuropsychological-assessment-birmingham-2/
11) Small steps that improve cognition now
- Protect sleep: consistent bed/wake times; screen for OSA if snoring/daytime sleepiness.
- Move daily: even 20–30 minutes of brisk walking can lift processing speed and mood over time.
- Lower anticholinergic load: ask for an ACB review if you’re on several meds (Taylor-Rowan et al., 2021).
- Lighten the cognitive load: externalise memory (lists/phone reminders/whiteboards), reduce multitasking, use chunking and brief “single-task sprints.”
- Treat mood/anxiety/trauma: therapy widens attentional bandwidth and restores confidence. If you’re living with chronic stress or emotional abuse, cognitive symptoms are common; confidential support is available. Find out more about Domestic Violence & Emotional Abuse: https://strongerminds.co.uk/domestic-violence-and-emotional-abuse/
Did you know?
Subjective vs objective cognition. How foggy you feel and how you test don’t always match. Mood, sleep and stress can magnify the feeling of impairment even when scores are fine. Both matter.
12) Bipolar & cognition across the lifespan (if relevant to you)
Even when mood is “stable,” many people with bipolar disorder experience slower processing speed or executive-function glitches that feel like fog. Therapy helps pace tasks, plan workdays and build routines that protect cognitive energy; medication plans can be reviewed to balance mood stability and clarity (contextualised to your prescriber).
13) Quiet risks at home: chronic stress/abuse and cognition
Living in a high-threat environment (including coercive control) keeps the nervous system on alert, narrowing attention and exhausting sleep. If that resonates, you’re not overreacting — impacts on thinking are real and often reversible with safety, support and trauma-informed care. If it’s safe to do so, use the Domestic Abuse link above or speak with a trusted professional.
Key takeaways
- Brain fog is common and usually driven by reversible factors.
- Red flags (progression, daily-life impact) need assessment.
- Treatable drivers include sleep/OSA, mood, menopause, pain/fatigue, medications and post-viral states.
- Objective testing clarifies what’s going on and points to practical changes.
- Support available in Birmingham/West Midlands and online across the UK.
Most brain fog is treatable once the drivers are identified. Red flags (progressive decline affecting daily independence) warrant assessment. If you’re worried, we can help you get clarity and a plan in Birmingham/West Midlands or online across the UK.
Clinical disclaimer & urgent help
This article is general information and not a medical diagnosis. If someone has sudden confusion, stroke symptoms, new severe headache, or rapid deterioration, call 999 or attend A&E. For persistent or progressive symptoms, see your GP or speak with a qualified clinician.
Author: Dr Nick, Consultant Clinical Psychologist, HCPC-registered
Publish date: 17 September 2025
Last reviewed: 17 September 2025
References
Hampshire, A., Azor, A., Atchison, C., et al. (2024). Cognition and memory after COVID-19 in a large community sample. New England Journal of Medicine, 390(9), 806–818. https://doi.org/10.1056/NEJMoa2311330
Marchi, N. A., Allali, G., & Heinzer, R. (2024). Obstructive sleep apnoea, cognitive impairment, and dementia: Is sleep microstructure an important feature? Sleep, 47(12), zsae161. https://doi.org/10.1093/sleep/zsae161
Mendonça, F., Sudo, F. K., Santiago-Bravo, G., et al. (2021). Mild cognitive impairment or attention-deficit/hyperactivity disorder in older adults? A cross-sectional study. Frontiers in Psychiatry, 12, 737357. https://doi.org/10.3389/fpsyt.2021.737357
NICE. (2024). Menopause: Identification and management (NG23). National Institute for Health and Care Excellence. https://www.nice.org.uk/guidance/ng23
Taylor-Rowan, M., Edwards, S., Noel-Storr, A. H., et al. (2021). Anticholinergic burden for prediction of cognitive decline in older adults with no known cognitive syndrome. Cochrane Database of Systematic Reviews, 2021(5), CD013540. https://doi.org/10.1002/14651858.CD013540.pub2
