Health Essentials from Cleveland Clinic

By: Howard Smith, MD

Monday morning finds many of us feeling foggy, but 20 to 50 percent of people who struggle with lupus have a unique feeling of mental fogginess, including:

• Depression
• Memory problems
• Headaches
• Fatigue
• Confusion
• Other neurologic symptoms

This set of symptoms, often called “brain fog” or “lupus fog,” is important to identify if you or a loved one has lupus. Knowing what to expect and having coping mechanisms in place can help with these issues.

What causes confusion? Patients with lupus can be confused because of cognitive defects, short- or long-term memory problems, psychosis, severe depression or anxiety, dementia or because of an infection or fever.

If brain fog occurs, it usually happens within the first year or two after diagnosis.

Treatments may target lupus itself or symptoms

There are treatments available, but it might take some time for you and your doctor to find a treatment that will work for you because not all treatments work the same way on every patient with lupus.

Physicians try to identify what could be causing the patient’s confusion. Depending upon the patient, we’ll try various medications, including those aimed at treating the underlying lupus itself and those that target an associated problem, such as depression, anxiety or psychosis.

Steroids are commonly used to treat lupus, but they can sometimes worsen confusion or cause mood changes, so patients need to be monitored closely while taking them.

5 lupus coping strategies

Medications are just one part of the puzzle when it comes to treating lupus and brain fog. It’s important to look at your overall health by working to:

1. Foster a good emotional environment. Having a warm, supportive environment and being surrounded by positive people at home and at work are important in helping lupus patients manage symptoms.
2. Partner up with your doctor. The number one thing is to get the disease under control. Having a good rapport with all your physicians and a supportive environment at home, taking your medications, and following your doctors’ instructions will help with that.
3. Take care of your body. To help with their symptoms, people with lupus should eat a healthy diet and exercise regularly. Avoid alcohol, tobacco and illegal substances.
4. Challenge your mind. Give yourself cognitive challenges. Do whatever you can to keep your physical and mental health at its peak.
5. Consider therapy. Cognitive-behavioral therapy (CBT) can be helpful in teaching people to cope with their illness and its symptoms (more on this below).

Counseling is to help patients regain control

Counselors can play a big role in helping manage brain fog. The goal of counseling is to help patients identify any anxiety or depression that could contribute to feelings of confusion and to strategize about how patients can regain control. One strategy to consider is list-making, which is helpful in easing anxiety for many patients.

If you have memory problems, CBT won’t cure that, but it might make it easier to deal with.

In general, make sure your doctor knows about any mental or emotional issues you’re having, so the two of you can work out a treatment plan that clears the fog.