Brain Fog: Testing Cognitive Dysfunction with Rheumatoid Arthritis / Disease | Rheumatoid Arthritis Warrior

Brain Fog: Testing Cognitive Dysfunction with Rheumatoid Arthritis / Disease

The last few weeks I’ve been rereading abstracts from the ACR scientific meeting we attended in November. There were many fascinating studies presented, like the tendons investigation on the blog a couple days ago. This one on testing cognitive function jumps out at me:

The Relationship Between Perceived Cognitive Dysfunction and Objective Neuropsychological Performance in Persons with Rheumatoid Arthritis

Doctors at the University of California tested 120 people diagnosed with Rheumatoid Arthritis to compare two cognitive measures: First, each patient took a “Perceived Deficit Questionnaire” to assess the level of subjective cognitive impairment (did they feel impaired?). Second, each person completed a “battery of 12 standardized neuropsychological measures” to test the level to which they were actually impaired. The results showed no significant relationship between perceived cognitive dysfunction and performance on the objective neuropsychological test.

However, the researchers did find depression and fatigue associated significantly with perceived cognitive dysfunction.

Brain fog in rheumatoid arthritisAs with most studies, we not only learn something from these results, but also have new questions.

1) Perhaps people with RA experience cognitive dysfunction or notice mental fog on some days and so rate themselves lower, but still perform well on other days. The patients in the study were tested in a single clinic visit.

2) Perhaps fatigue and depression independently increase cognitive dysfunction. There is likely separate evidence of that, outside of rheumatology. For fun, try typing: “Does depression cause cognitive dysfunction?” into a Google search, or “Does fatigue cause brain fog?” You’ll see that Google reads cognitive dysfunction as a synonym for brain fog… and that there are lots of NIH studies and other articles relating fatigue and depression to cognitive dysfunction.

3) Perhaps something else plays a role, such as medications or pain levels. In addition to depression and fatigue, the study controlled for “gender, race, marital status, income, education, disease duration, and disease severity.” It would be good to have more information, and to have it from the patient point of view. I’d be curious what was used to rate “disease severity” since that measure often differs between RA patients and clinicians (more from an interesting abstract on that topic soon).

Medications are often blamed for any brain fog associated with Rheumatoid Arthritis.

And that makes sense too. Several medications make obvious suspects. This study didn’t separate patients based on medications, so it’s not possible to say whether methotrexate, pain medications, prednisone, nerve meds, sleep meds, or disease modifying treatments play a part.

What do you think? Can you tell whether you have brain fog or what causes it?

Postblog: What is brain fog anyway?

What is brain fog to you? I like that someone is investigating how people diagnosed with RA function mentally – and that they performed well! Severely low thyroid levels once made it impossible for me to even read. Obviously, I recovered with medication. With RA, I’ve only experienced mild short-term memory problems. For me, it does not associate with fatigue, depression, or medication so I still suspect the inflammation itself. We’d love to hear about your experience.

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Kelly O'Neill

Kelly O'Neill (formerly Kelly Young) has worked about 12 years as an advocate helping patients to be better informed and have a greater voice in their healthcare. She is the author of the best-selling book Rheumatoid Arthritis Unmasked: 10 Dangers of Rheumatoid Disease. Kelly received national acknowledgement with the 2011 WebMD Health Hero award. She is the president of the Rheumatoid Patient Foundation. Through her writing and speaking, she builds a more accurate awareness of rheumatoid disease (RD) aka rheumatoid arthritis (RA) geared toward the public and medical community; creates ways to empower patients to advocate for improved diagnosis and treatment; and brings recognition and visibility to the RA patient journey. In addition to RA Warrior, she writes periodically for newsletters, magazines, and websites. There are over 60,000 connections of her highly interactive Facebook page. You can also connect with Kelly on Twitter or YouTube, or LinkedIn. She created the hashtag: #rheum. Kelly is a mother of five, longtime home-schooler, NASA enthusiast, and NFL fan. She has lived over fourteen years with unrelenting RD. See also https:/

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92 thoughts on “Brain Fog: Testing Cognitive Dysfunction with Rheumatoid Arthritis / Disease

  • April 21, 2014 at 11:51 pm

    I know this is an old post but I am so relieved to have found it. I’ve been getting worsening brain fog to the point I am worried about my competence at work. When I mentioned it to my Rheumy she she really didn’t seem to listen and said it was more likely to be a medication side effect.

    I’m so grateful that I have found this site.

  • April 25, 2014 at 4:30 pm

    Hi! I’m new to this website, but already feel like I’m not alone out there! 20 years ago I started to have “problems” and it took about another 7 to 10 yrs. before I was diagnosed with RA. I have episodes where I’m totally exhausted, very achy and barely can function. These can last several month and often there is an underlying cause and once that cause is addressed I start to feel better (for a while). My new “episode” started over a month ago, my lab work looks great (wished I would feel great, too!!) It started out with extreme exhaustion, throbbing body aches & weakness. For a week now I also feel drowsy and my brain feels “overwhelmed” (can’t really describe it), also I started having this tightness in temple area which comes & goes, at times it’s scary!! Thank you for letting me share!

  • August 15, 2014 at 11:51 pm

    I have brain fog. Now there are some days I have it the entire day. I found it got really bad and I could not concentrate after the rheumatologist put me on Gabapentin and increased my cymbalta to 90 mg. I weaned off the Gabapentin and went back to 60 mg of cymbalta and I do feel better. I
    feel the best when I can get alot of sleep.

  • October 22, 2014 at 5:54 pm

    My symptoms started out with foot pain that got worse. Shortly after my RA diagnosis, I spiraled down into a tornado of symptoms including TMJ that caused muffled hearing. I had also started Sulfasalazine. During that time, I had horrible foggy brain. I would completely lose my train of thought in the middle of a sentence and not be able to pick the next word all the time. At the time, I assumed it was a side effect of the med. Now, over a year later, my symptoms are much better controlled. I’m still on Sulfasalazine, as well as Humira (after trying Enbrel) and I’m not having regular brain fog or trouble finding words. However, every once in a while, I will experience it again, even if I’m not fatigued and doing pretty well. I also have periods of time when my TMJ is flaring and my hearing is funny again. Since the medication hasn’t changed, and the disease is the variable, I’m inclined to believe that my occasional foggy brain is associated with the disease activity itself. My Rheumatologist is the one who identified TMJ inflammation and acknowledged that it affects my hearing, but I haven’t mentioned the brain fog theory.

  • February 6, 2015 at 2:04 pm

    I can’t tell you how comforting it is to read all these comments because I thought I was going crazy! I a smart, accomplished individual who has lost her ability to speak in public now. I can never seem to find the right words, I stumble iver my sent neves, forget what I was trying to say… I sound like a bumbling idiot! Not that I’m glad to have this attributed to RA, I am glad to know it’s “normal” and that I’m not alone in this. I really thought I was losin my mind (ok maybe I am but at least i know why!) do folks think it’s RA or medication related. I’ve been off MEX for 6 months but still have cognition issues. Any treatment for it?

    • December 6, 2015 at 4:57 pm

      After 6 months, I”d wonder whether the mtx is to blame. It could be the inflammation. Or another medicine. No way to be sure except to experiment by changing one thing at a time. I hope it gets better.

  • August 31, 2015 at 2:09 am

    I had major brain fog associated with my flare and associated it mostly with the extreme fatigue I was suffering. I started on MTX 3 weeks ago and my dose is being gradually increased every fortnight (started on 10mg and will be on 20mg a week ongoing). The only side effect I have noticed is major brain fog and general body fatigue for first 24 hours and improving over the following day (less fatigue and vagueness but headachy). Generally by 3 days after I’m feeling almost normal again although still tire easily.

  • February 3, 2016 at 4:09 pm

    i am 63 and was diagnosed with R.A. 2 years ago.I have been taking Hydroxychloquorine and prednisolone since diagnosis ( i have reduced the latters dosage and am now on 10mg. daily- and i need it). I have also started Enbril injections (weekly) 4 months ago.
    With regard to this article I feel very attatched.I honestly thought i was entering the early stages of dementure.My memory which was i thought very good was getting progressively worse.In most cases if i was reminded of an event the day before,it might as well never happened.i did not remember anything about it.It causes arguements,i have been accused of inattentiveness and being rude and ignorant but for me some events as far as my memory was concerned never existed.
    I live in Manchester (UK) and my concern made me visit my GP.The dementure test here is a laugh,repeat or remember a name and address for a few minutes – Thats it.That is not what concerns me-its events,people,recognition,statements and allsorts of other things.I know I have a problem i just,because of a lot of other health related problems,do not know where to take this a step further.

  • September 2, 2016 at 6:16 pm

    Has anyone ever had extreme brain fog when taking biologics?
    I’ve had RA for 20 years, but when taking Enbrel,Orencia,remicade,Actemra, I get a generally drunken sensation.
    I describe it as 2 beers, 6 beers, 10 beers depending on how drunk I feel. I stop the medicine and after 1-2 months go back to normal but the RA reflares again.I’ve lost a few joints over the years and recently had to quit a heavy labor power plant job. These are the only drugs that give me brain fog sensation, and I know I am not as intelligent as I was prior to their use. Similar for anyone?

  • September 16, 2016 at 4:46 am

    This is the first time I have heard this topic associated with RD. What a great relief. I have experienced a diminished and foggy brain. Before I was diagnosed, I feel as though I was much worse. Currently, I am taking Prednisone, Methotrexate, and Humira. After adding Humira 6 weeks ago, I think that I am having more ‘good’ brain days. It has shaken my confidence at work. I am 50 and have been told that this brain issue was related to my age and gender. I worry about this problem as much as being able to walk to the printer at work or being able to hold the steering wheel to drive. I hope the Humira (or combination) is really helping. Thank you all for the emotional boost! It helps to read the comments and know that someone understands.

  • December 4, 2016 at 6:11 pm

    I’m so glad to find this site. When I mentioned cognitive and fatigue issues , my rheumatologist smiled and looked sympathetic .. and increased my methotrexate but split the weekly dose over 2 days. .. this only prolonged my post- metho brain fog from one day to two days 🙂

    It’s infuriating that the cognitive and emotional impact of RD don’t get more attention .. but not surprising. I think it’s true for many chronic diseases.

    Has anyone switched from methotrexate to a biological and experienced less brain fog ? My observation is that inflammation itself makes me “stupid ” .. but I do improve with more sleep, healther diet , Excersize. And I’ve been taking methotrexate for 6 mo
    I Feel almost back to normal some days.

    Methotrexate is an additional weekly whammy. I am Exhausted and lightheaded for 24 hours
    I’d like to switch but worried it could be worse

  • July 26, 2019 at 1:24 pm

    I am concerned not only with brain fog but also neurological all together. I have brought up these concerns with a neurologist but he doesn’t seem to find them important, he just wants to concentrate on the RA issue, me taking my meds the rheumatologist put me on, losing weight and I gotta quit smoking. I know all of these are important but I have issues thinking, speaking, balance, nerve pain and burning sensations. I have vision problems (optical nerve atrophy), hearing problems, etc…I will be going to get a second opinion.

    Why don’t doctors/specialists address the CNS issues that a patient like myself has with RA/RD?

  • March 4, 2020 at 4:47 pm

    I began suffering with symptoms of rheumatoid arthritis when I was 3 years old, shortly after my father died. My mother took me to the hospital with a high fever thinking I was going to die (She just lost my father, poor woman) It took about a week for the doctors to diagnose me. they wrapped my legs in casts I stayed for a total of three weeks. When I went home I crawled, had to relearn walking. I dont remember but I was told my joints were swollen and sort of bent. I had bad bouts of pain, crying myself to sleep a lot of nights, my mother wouldnt give me strong pain killers. Childrens aspirin was all I could have. They were pink. And like many mention no one could understand what I was going through. I often felt alone which made it even harder. Looking back I had depression and brain fog, I frustrated my mother,8 she didnt understand. It was a hard time.

    All in all though I am now 45 and have been in remission for more then 40 years. sometimes when it rains I get an little ache but thats it. The more I read the more I realize how lucky I am.


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