Cognitive Rehabilitation For Brain Fog

[summer]

Cognitive rehab (brain exercise) was brought up in a recent post. After a cognitive assessment, it was recommended by the psychologist that I begin cognitive rehab to improve my brain fog. Is this likely to be helpful? Can we do any harm to our brain by increasing cognitive demands when blood flow is already insufficient?

I'm also wondering if any of you ever had your diagnosing ANS specialist recommend this. I know when I was diagnosed, the recommendations were very detailed including exercise, meals, fluid and salt intake, medications, even when I should take my bath! But no mention of cognitive rehab for my brain fog which has always been signifigant.

I guess I am concerned that this might only exhaust me more and make things worse instead of better. Anyone have any experience with this?

Thanks,

Summer

[firewatcher]

Thinking too hard or too long is often a trigger for me, not a help. If I have to think really hard on something, I'll often get rapid eyestrain and a severe headache, it also makes me more tachy. There have been studies done on how mental stress is almost as bad as physical stress. The only way that I can think that it would improve your brain-fog is by desensitizing your brain to the increased stimulation. Try tangrams or something that you enjoy that would require you to use your mind, but not stress you out and maybe work up from there. When I have a bad bout of fog, not much helps other than lying down.

[summer]

Thinking too hard or too long is often a trigger for me, not a help.

Yes, I know this is true for me too. I would say it is even more of a trigger for me than physical exercise (well... light exercise). I'm thinking, again, this is advice from someone who does not truely understand POTS. There must be a reason why our autonomic docs are not adding this to their list of recommendations.

I agree that when brain fog is at it's worst, the best thing I can do is lie down. I can't imagine adding to the brain strain by doing mental exercise.... Well... actually I can, and it scares me.

Thanks for your reply.

[ramakentesh]

Im sorry but in my opinion it would be useless. You cant retrain a brain to receive more blood flow through thinking harder.

[summer]

Im sorry but in my opinion it would be useless. You cant retrain a brain to receive more blood flow through thinking harder.

This makes total sense. This is not a brain injury or organic brain disease were I need to create new pathways. In fact, when I'm feeling "well perfused" I seem to have all the pathways I need - they just get really fuzzy at times! The plan being suggested is not an at home "do-it-yourself" program. It would be like rehab for stroke patients - with memory drills and learning to tolerate interference while concentrating, etc.

Has anyone else been asked to try this?

[Guest tearose]

Well, I agree that the rehab doesn't change the way we loose O2 to the brain or stop our fog...

However, maybe this cognitive program is going to teach Summer "how to manage" with the loss of some brain function. Maybe this will help.

Some people need to learn to use decision trees. To take tasks and break them down in small manageable parts.

For example:

After a relapse, I had trouble signing checks, making grocery lists... I did four or five sessions of occupational therapy. It helped me to access and use my coping skills. It may take me two hours to make a grocery list but at least I can do it. I can sign checks again in the right place. I never regained my basic math skills but I can do other functions alright.

It may be worth a try for summer depending on what is lost and what is needed.

tearose

[summer]

However, maybe this cognitive program is going to teach Summer "how to manage" with the loss of some brain function. Maybe this will help.

Tearose,

Thank you for your post. This is a really good point that I had not thought of. You are right. I'm sure there are ways of compensating for these weaknesses that I am not aware of. It maybe about more than regaining my previous "brain power". I'm really glad you mentioned this - It certainly is something else to consider. Also, encouraging that you found some work with OT helpful.

Thanks,

Summer

[lissy]

Sorry to intrude I was wondering if this Cognitive problem goes away with treatment (what ever they prescribe for blood flow to the brain) and exactly what test determines lack of blood flow to brain? And lack of blood flow is causing slow damage right or is that just temporary?

Lissy

[Guest tearose]

lissy, I hope others will answer you to..(this is from my experience and only my opinion)

Do you get brain fog? Have you lost some cognitive ability?

Does everything come back to you or have you lost some skills? These are personal questions that are different for all of us depending on our POTS symptoms and course of our symptom development. Some people have "Lost" skills.

From what I understand: You only can "capture" on paper the lack of blood to the brain if you are hooked up to the machine at the time of the event. There is a sonogram type machine that visualizes the arteries in your neck. But as Rama discovered in an article on the vascular system to the brain, we still do not have the appropriate tools to measure what is actually happening accurately.

I believe small occurrences of lack of blood flow go undetected because they are small and very fast to occur. After effects in some people will be a headache or migraine, some will get tired.

We all hope any damage we sustain will repair itself however in my opinion, there are far reaching long term effects that lead to decline down the line. I am still a realistic,and an optimistic person and feel that we can and do heal a lot with good intervention.

In this case of cognitive training, it does not repair damage sustained but rather teach the person new ways of circumventing the problem and managing a better quality of life.

best regards,

tearose

[summer]

Sorry to intrude I was wondering if this Cognitive problem goes away with treatment (what ever they prescribe for blood flow to the brain) and exactly what test determines lack of blood flow to brain? And lack of blood flow is causing slow damage right or is that just temporary?

Lissy

Hi Lissy,

I agree with Tearose... and will add my two cents as well.

So far, I have not found any type of treatment to consistantly improve my brainfog. For me it happens in episodes- sometimes for several hours, sometimes all day. It varies in severity, but happens to me to some degree everyday. It can be quite severe- to the point that I have difficulty understanding what people are saying to me. Then other times I feel very close to my "original" self. Because of that, I do not believe I have any permanent damage to my brain. Lying down when I feel this way helps.

When I had my tilt table test done to diagnose POTS, I also wore a "transcranial doppler" which was strapped around my head, and measured blood flow in the middle cerebral artery during the test. The doctor was able to show me a graph which recorded the decrease in blood flow to my brain while I was standing. The drop was signifigant and he told me this was the reason for my fogginess.

I do not know of any medication that increases the blood flow to the brain, but I'd love to find out about it if there is one!

Take care,

Summer

[lissy]

TearRose,

I do have Brainfog if that is the word that describes whats happening to me everyday. It feels like my thinking ability is always clouded and delayed and I have noticed it is alot worse the more I stand or the later it gets during the day. If I lay down most of the day I can think clearer but then my body has a harder time regulating everything else and its more sensitive. I really feel like a learning disabled person I forget words or what I just did minutes prior , not long ago I was washing dishes and walked back to sit down in the living room and I had my trusty fan going like always so I couldn't hear the water running but my 3 year old came in the room an said something but I was not paying attention and she yelled Mommy the water is all over the floor...I jumped up and it had flooded the kitchen floor and just was pouring down the countertop like a waterfall. I do alot of things now that cause more work for myself . I wish I could do something about this symptom, it really makes me feel stupid and embarrassed. I use to be a very quick thinker and learner.....

Lissy

[Guest tearose]

I really understand Lissy.

May I suggest you do all you can to preserve as much as you can by avoiding all triggers you know of. For example, get yourself a tall bar type stool to sit on while you do dishes. I don't know your treatment plan but do you wear compression hose? Also, take rests during the day and sit or lay down. Throughout the day elevate your legs or lay on the floor for a few minutes and you will FEEL the blood returning better to your head! "Take a load off" so to speak. Your kids will find it amusing I am sure!

Hang in there dear,

tearose

[ramakentesh]

According to MAYO the best most patients feel on current medications in best case scenarios is 60% better.

That is why Vandy are currently trying to find better medications in their current studies which are looking at over 20 new ones.

As others have said, the cerebral reductions in blood flow can be found fairly easily in many ways in most cases - transcranial dopplers, some bodies just use an ultrasound of blood flow through the carotids during tilt (which is what I had with a 44% reduction on a good day).

the study I recently posted by Ocon et al found a subgroup of POTS patients where the blood flow abnormality was found to be ONLY in the head, where the blood pressure regulation was totally messed up so the speed of blood into the brain was slowed and reduced in frequency, causing symptons. These were normal flow patients.

Currently the only successful way to keep normal amounts of blood to our brains is lying down. its unclear why its reduced - if its from vasoconstriction taking peripheral vasoconstrictors might not actually be totally helpful, and florinef and volume loading is just filling up the system with more liquid so that more stays up LOL.