Cognitive Dysfunction and Fibromyalgia


Fibromyalgia & CFS

By Adrienne Dellwo, Guide

January 20, 2012 Health’s Disease and Condition content is reviewed by the Medical Review Board

Research Brief

Cognitive dysfunction, often called fibro fog, is a major and debilitating symptom of fibromyalgia1. However, it’s been difficult to measure clinically because the specific dysfunctions common to fibro fog are different from those of established learning disabilities.

However, new research2 puts forth something called the mental-clutter scale that’s was designed specifically to quantify fibro fog. Researchers say it’s consistent and reliable at providing doctors with information about our cognitive function. They also say it can help distinguish fibromyalgia from other illnesses involving memory problems.

The study breaks cognitive problems into 2 categories – cognitive skills and mental clarity – with 8 features in each category:

Cognitive Skills

  1. Concentration
  2. Memory
  3. Staying focused
  4. Multitasking
  5. Expressing yourself
  6. Thinking clearly
  7. Perceptual clarity
  8. Mental speed

Mental Clarity

  1. Spaciness
  2. Looking at life through a haze
  3. Confusion
  4. Cluttered thinking
  5. Fogginess
  6. Rushing thoughts
  7. Fuzzy headedness
  8. Information overlook

You can see the full scale and learn more about it here:

To me, this looks like a good list of common fibro fog symptoms. I think this scale can help bring credibility to our cognitive dysfunction as well as being used to measure changes over time and possibly even to aid diagnosis.

For more information about fibro fog, including possible causes and how to manage this disabling symptom, see:

I’ve had every symptom on the list, to some degree. How many have you experienced? How bad is your fibro fog?

Development of the Mental Clutter Scale.

Leavitt FKatz RS.


Department of Behavioral Sciences, Rush Medical College, USA.


Mental fog is a core symptom of fibromyalgia. Its definition and measurement are central to an understanding of fibromyalgia-related cognitive disability. The Mental Clutter Scale was designed to measure mental fogginess. In an exploratory factor analysis of two different samples (n=128 and n=170), cognitive symptoms of fibromyalgia loaded on 2 dimensions: cognition and mental clarity. The mental clarity factor comprised 8 items with factor loadings greater than .60 and was named the Mental Clutter Scale. The factor stability of the new scale was good, internal consistency was .95, and test-retest reliability over a median of 5 days was .92. The 8-item scale is a quick measure of mental fog that provides clinicians with information about cognitive functioning in fibromyalgia.

Brain Fog/Fibro Fog in Fibromyalgia & Chronic Fatigue Syndrome

What Causes It & What to Do About It

By Adrienne Dellwo, Guide

Updated July 17, 2010 Health’s Disease and Condition content is reviewed by the Medical Review Board

Brain fog (also called fibro fog or cognitive dysfunction) is one of the most common complaints of people with fibromyalgia (FMS) and chronic fatigue syndrome (CFS or ME/CFS). For many, it can be severe and can have just as big an impact on their lives as pain or fatigue. In fact, some people say brain fog is more of a disability than their physical symptoms.

What Causes Brain Fog?

We don’t yet know exactly what causes cognitive dysfunction in these conditions, but we have a lot of theories about possible contributing factors, including:

Lack of restorative sleep

Abnormal cranial blood flow or volume

Brain abnormalities

Premature brain aging

Mental distraction due to pain

In FMS, brain fog generally is worse when pain is worse. In both FMS and ME/CFS, it can be exacerbated when you’re anxious, rushed, or dealing with sensory overload.

Depression, which is common in FMS and ME/CFS, also is associated with cognitive dysfunction. Some studies, however, show that the severity of brain fog is not correlated with depression symptoms.

A lot of common medications for FMS and ME/CFS can contribute to brain fog as well.

Brain Fog Symptoms

Symptoms of brain fog can range from mild to severe. They frequently vary from day to day, and not everyone has all of them. Symptoms include:

Word use & recall: Difficulty recalling known words, use of incorrect words, slow recall of names.

Short-term memory problems: Forgetfulness, inability to remember what’s read or heard.

Directional disorientation: Not recognizing familiar surroundings, easily becoming lost, having trouble recalling where things are.

Multitasking difficulties: Inability to pay attention to more than one thing, forgetfulness of original task when distracted.

Confusion & trouble concentrating Trouble processing information, easily distracted.

Math/number difficulties: Difficulty performing simple math, remembering sequences, transposing numbers, trouble remembering numbers.

Some people may also have other types of cognitive dysfunction.

Brain Fog & Learning Disorders

So far, we don’t have evidence that our brain fog comes from known learning disorders. However, our problems are similar to those associated with disorders such as dyslexia (reading problems), dysphasia (speaking problems) and dyscalculia (math/time/spatial problems).

If you believe you could have a recognized learning disorder, talk to your doctor. A diagnosis could help you get reasonable accommodation at work or strengthen a disability benefits claim.

Treating Brain Fog

For some people, brain fog resolves with effective treatment for pain or sleep problems. (See Treating Fibromyalgia and Treating Chronic Fatigue Syndrome for information on treatment options.)

However, not everyone can find effective treatments, which leaves many of us trying to manage brain fog.

Supplements are a common choice. While we don’t have a lot of evidence to support their effectiveness, some doctors and people with these conditions say they’ve seen supplements help with cognitive function. Common brain-fog supplements include:


B vitamins



Omega-3 (Fish Oil or Flaxseed Oil)


St. John’s Wort



Some doctors recommend dietary changes to include “brain friendly” foods, some of which are natural sources of the supplements listed above. Some of these foods are:

Fish or Flaxseed(Omega-3)

Canola or walnut oil (Omega-3)

Eggs (Choline)

Fruits & vegetables


Some FMS research shows that moderate exercise can help improve cognitive function as well. Exercise is difficult for us, so be sure to read Getting Started With Exercise on

Cognitive Training

Researchers are learning more about the brain and how it works, and new information could help us understand brain fog. Research on aging brains and some degenerative brain conditions shows that cognitive training can slow, stop or sometimes reverse cognitive dysfunction.

Some doctors use cognitive training programs, which often include software that you use at home. Video game companies and websites offer games they claim can improve cognitive function, and while specific games haven’t been evaluated for this ability, some evidence does suggest that virtual reality games improve memory and critical-thinking skills.

Because this is an emerging area of science, we’re likely to learn more about cognition and cognitive training in the next few years.


Attree EA, Dancey CP, Pope AL. Cyberpsychology and Behavior. 2009 Aug;12(4):379-85. An assessment of prospective memory retrieval in woman with chronic fatigue syndrome using a virtual-reality environment; an initial study.


Burgmer M, et al. NeuroImage. 2009 Jan 15;44(2):502-8. Altered brain activity during pain processing in fibromyalgia.


Centers for Disease Control and Prevention. “Symptoms”.


Cook DB, et al. NeuroImage. 2007 May 15;36(1):108-22. Functional neuroimaging correlates of mental fatigue induced by cognition among chronic fatigue syndrome patients and controls.


Emad Y, et al. The Journal of Rheumatology. 2008 Jul;35(7):1371-7. Hippocampus dysfunction may explain symptoms of fibromyalgia syndrome.


Etnier JL, et al. Journal of Physical Activity and Health. 2009 Mar;6(2):239-46. Exercise, fibromyalgia, and fibrofog: a pilot study.


Leavitt F, Katz RS. Journal of Clinical Rheumatology. 2008 Sug;14(4):214-8. Speed of mental operations in fibromyalgia: a selective naming speed deficit.


Luerding R, et al. Brain: A Journal of Neurology. 2008 Dec;131(Pt 12):3222-31.Working memory performance is correlated with local brain morphology in the medial frontal and anterior cingulate cortex in fibromyalgia patients.


Mountz JM, et al. Arthritis and Rheumatism. 1995 Jul;38(7):926-38.Fibromyalgia in women. Abnormalities of regional cerebral blood flow in the thalamus and the caudate nucleus are associated with low pain threshold levels.


Schmidt-Wilcke T, et al. Pain. 2007 Nov;132 Suppl 1:S109-16. Striatal grey matter increase in patients suffering from fibromyalgia–a voxel-based morphometry study.


Devin J. Starlanyl. All rights reserved. “Fibromyalgia and Chronic Myofascial Pain For Doctors and Other Health Care Providers.”