Cognitive Dysfunction Management

Cognitive dysfunction, also referred to as brain fog, is very common among people with dysautonomia ¹ ².

Some of the most common cognitive dysfunction symptoms are difficulty concentrating for long periods of time, slower cognitive processing time, trouble with finding the right words, and memory impairment ³. 

For those with forms of dysautonomia that involve orthostatic intolerance, cognitive dysfunction is reported as being one of the most disabling symptoms as it can have serious implications on daily activities such as work and school ⁴ ⁵ ⁶ .

Cognitive dysfunction is often associated with fatigue and can be one of the hardest symptoms to control ⁷ ⁸.

However, there are ways to help manage cognitive dysfunction.

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However, there are ways to help manage cognitive dysfunction

Non-pharmacological methods

Improve sleep quality: Reduce blue lights before bed (TV, phone, computer screens, etc.), set up a dark environment, and practice good sleep hygiene. ⁹ 

Dietary Changes: Increase salt and water intake. ¹⁰ ¹¹ Increase B-12, Vitamin D, and Omega 3 fatty acids if prescribed by your healthcare provider. ¹² 

Cognitive strategies: Break up cognitively demanding tasks into segments. ¹³ Limit environmental distractions like background noise. ¹⁴ Avoid reading for long periods of time and instead listen to material. ¹⁵ 

Exercise may cause acute symptoms of brain fog but may help to reduce it over time. ¹⁶

Physical counter maneuvers may be helpful in managing brain fog in those with less severe symptoms. ¹⁷ 

Pharmacological Methods

IV saline, though controversial for a variety of reasons, ¹⁸ may be helpful if the brain fog is caused by hypovolemia (low blood volume). ¹⁹ 

Stimulants may help with vasoconstriction and fatigue/cognitive dysfunction. ²⁰ ²¹ ²² In one recent student, the most commonly prescribed stimulants included ²³ : 

    • Methylphenidate
    • Mixed amphetamine salts
    • Dexmethylphenidate 
    • Lisdexamfetamine

Midodrine ²⁴

B-12 Injections ²⁵ 

Some medications commonly prescribed for dysautonomia can have worsening effects on brain fog including:

Serotonin-norepinephrine reuptake inhibitors (SNRIs) ²⁶ ²⁷

Selective serotonin reuptake inhibitors (SSRIs) ²⁸ 

Beta Blockers- B1 antagonists ²⁹

Fludrocortisone may be contraindicated for cognitive dysfunction ³⁰ .

Reviewed by Medical Content Experts, 2021

Additional Resources

POTS and Brain Fog: Part 1

POTS: How to improve Brain Fog

POTS and Brain Fog: Triggers that make brain fog worse (YouTube)

REFERENCES

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Ross, A. J., Medow, M. S., Rowe, P. C., & Stewart, J. M. (2013). What is brain fog? An evaluation of the symptom in postural tachycardia syndrome. Clinical Autonomic Research, 23(6), 305–311.  {10, 19, 24, 25, 27, 28, 29, 30}

Wells, R., Spurrier, A., Linz, D., Gallagher, C., Mahajan, R., Sanders, P., Page, A., &  Lau, D. (2018). Postural tachycardia syndrome: Current perspectives. Vascular Health and Risk Management, 14, 1-11.  {6, 8}

Wise, S., Ross, A., Brown, A., Evans, M., & Jason, L. (2017).  An assessment of fatigue in patients with postural orthostatic tachycardia syndrome. Journal of Health Psychology, 22(6), 733-742.  {17}

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