Dr. Sherise Ali addresses the topic of Brain Fog in Sjögren’s.  She is a neuropsychiatrist and has written a chapter on psychiatric care of the rheumatologic patient for the Harvard Medical school and Massachusetts General Hospital textbook of Psychiatry of the Medically Ill.

Brain Fog is defined as “a generalized dysfunction of concentration, short-term memory and cognitive speed which is disruptive to the patient’s lifestyle and not attributable to another cause.”  There is no specific pattern and there can be ripple effects in your life.  Compared to traumatic brain injury, brain fog is mild.  Your IQ is not decreased but you may need to find alternate routes to get to the same endpoint.

Pain also has a deleterious effect on brain fatigue.  So far brain fog is not consistently found to be associated with Anti-Ro or Anti-La antibodies and no one antibody has been isolated that is consistently associated with or specific for CNS (Central Nervous System) symptoms.

In 50% of patients who undergo an MRI for diagnosis the findings are normal, showing the limited role of MRI in this diagnosis.  The most effective way to diagnose brain fog is neuropychological testing.  Dr. Ali says that this symptom has an insidious onset, is non-progressive, not necessarily associated with severity of illness and can occur at any time.  Brain fog is becoming more and more recognized as a symptom of CNS involvement in Sjögren’s.  The most likely mechanism is inflammation of the cerebral vasculature.

Taking control of this symptom is not easy, but it is very possible.  Dr. Ali gives us these conclusions as well as some strategies to support our brains.


  • Play an active role in your medical management – inform your doctor about your Over The Counter (OTC) or herbal remedies and take your agreed-on medications
  • Talk to your doctor and ensure there is no other medical cause
  • Use behavioural strategies to circumvent cognitive issues
  • Keep socially, physically and mentally active
  • Prevent, recognize and manage clinical depression and anxiety
  • Use adaptive coping mechanisms
  • Minimize stress, anxiety
  • Seek positive relationships
  • Join a support group
  • Seek counseling for complicated emotions
  • Seek treatment for suspected depression and other psychiatric conditions
  • Allow yourself to fee sad sometimes; it is a normal emotion


  • Learn a new language
  • Engage in brain training, games, puzzles
  • Physical activity (to increase blood flow to the brain)
  • Pace yourself
  • Engage in creative activity
  • Good sleep is important. Try a pre-bed ritual
  • Seek positive relationships
  • Manage negative emotions
  • Identify your stressors and work on them
  • Seek treatment/professional help and/or a counselor
  • Deep breathing and progressive muscle relaxation can help
  • Acceptance as a method of easing frustration is suggested

“Use it or lose it.  You don’t want to lose synapses.”

*excerpt taken from SjSC “Connections” Newsletter, Volume 8, Issue 3*

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