by Katarina Zulak
You go to the story and forget to buy the main item you went for, even if you have a shopping list. In fact, you’ll forget you even made a shopping list! This is brain fog, one of the most frustrating symptoms you can face. People with fibromyalgia (FM) report a variety of cognitive challenges, including difficulty focusing, difficulty planning, forgetfulness, and slower mental processing. Researchers study brain fog in individuals with FM to find these cognitive changes, which are complex and involve multiple brain regions and functions. I have found it helpful to understand what changes in brain function are happening and how they affect my everyday life. It helps me understand what specific areas I need assistance with, and release the self-blame for even facing these difficulties; it’s your illness, it’s not you. Before we go any further,
About 80-90% of your brain function is automatic, controlling unconscious physical functions such as breathing, heart rate or digestion, and basic or instinctive activities such as walking. Executive function makes up 10-20% of brain function and is mainly mediated by the prefrontal cortex, for the most part. Executive brain function governs control of goal-directed behavior, planning, and self-regulation, involving mental skills such as concentration, prioritization, organization, time management, self-monitoring, task completion, adaptive thinking, and emotional control.  As you have no doubt noticed, many of these skills are negatively affected by FM. You can think of these executive function skills in two broad categories:
Executive function in fibromyalgia
Common brain fog symptoms that can be related to executive dysfunction include:
· Forgetfulness and problems remembering and processing new information
· Difficulty focusing, especially when there are many distractions in the environment
· A feeling of mental effort or exhaustion from concentrating, planning, thinking on the fly
· Has difficulty staying organised, managing time, juggling priorities, changing plans suddenly
· Difficulty, or mental fatigue, from following complex instructions, sequencing tasks to complete a project, multitasking, or putting abstract ideas into words.
You’ll notice that other common brain fog symptoms, such as problems with word recall or visual perception, are not on this list. That’s because they involve other brain regions that aren’t part of executive function.
Most aspects of executive function depend on working memory. Working memory is a complex cognitive system that allows us to hold small amounts of information in our minds (new information or information retrieved from long-term memory) so that we can mentally work on it. Working memory enables us to solve problems, create to-do lists, follow instructions, mentally rearrange priorities and adapt plans based on new information. “For example, if you’re cooking dinner and you want your fried chicken to be cooked at the same time as a side dish, you can pull cooking times from long-term memory and then look at the side dish recipe to see when you need to start them in relation to each other.”[3 ] In this case, you use working memory to follow instructions in a recipe (new information) andto access long-term memory by remembering cooking times (old information), to put together an entire dinner.
Cognitive changes in fibromyalgia that impair executive function and working memory
To study the impact of fibromyalgia on executive brain function, researchers asked a group of fibromyalgia patients and a group of healthy controls to complete a comprehensive series of cognitive tests.
Executive function changes were found in two areas:
Working Memory : You know how your phone will notify you when it’s time to download new updates? A similar process occurs in your brain. In fibro patients, updating was found to be significantly impaired in people with fibromyalgia, suggesting a “glittery” working memory that was slower to update with new information. Brain updating involves monitoring and evaluating new information, and permanently updating old information, which is stored in long-term memory, with new information.
Researchers in a second study found an impairment of working memory in fibromyalgia related to a verbal working memory. The verbal working memory task requires a higher memory load, suggesting that in fibromyalgia, the more you need to remember at once to perform a task, the worse your ability to do it may become.
I nhibition : is defined as self-regulation to overcome distractions and impulses, and control your attention, behavior, thoughts and feelings, to do what is necessary or appropriate. This includes control over attention, so you are able to tune out distracting background sounds or stimuli and focus on a task. Fibromyalgia patients had problems with inhibition related to focus despite distraction; namely, blocking out irrelevant background noise when trying to focus on completing a test. Problems controlling emotional impulses do not appear to be part of executive dysfunction in fibromyalgia.
Causes of executive dysfunction in fibromyalgia
The best predictor of working memory problems, in particular, is sleep disturbance and fatigue (a surprise to no one with FM!). Poor sleep and fatigue were linked to verbal and spatial working memory impairments in one study. In the past, some researchers have suggested that anxiety and depression may contribute to executive dysfunction in fibromyalgia, but most studies have found little evidence to support this.
Taken over by pain management, your brain may have less energy left over for executive function. In fibromyalgia, brain pathways are recruited in certain brain regions, such as the prefrontal cortex and supplementary motor areas, and hippocampal regions to help process the incoming flood of pain symptoms. Neuroimaging studies show hyperactivity in the prefrontal cortex in people with fibromyalgia. The prefrontal cortex, along with other brain regions, is also responsible for executive function. In other words, the brain structures responsible for improved pain management and executive function overlap.
With more energy consumed by pain management networks, there are fewer resources for the brain to use for executive functions, according to some experts, resulting in executive dysfunction. In previous research, the more severe a patient’s pain, the worse their executive dysfunction.  Pain sensitivity was correlated with difficulties in performing demanding working memory tasks, in a separate study.
Other researchers argue that a more likely explanation for the relationship between pain sensitivity and executive function problems is the many brain changes in fibromyalgia, such as brain chemicals (neurotransmitters), such as dopamine, that affect pain levels and cognitive abilities.
Tools to Help Executive Function Brain Fog
Pace Your Planning : Bring the energy it takes to plan, plan and organize at your own pace. For us, it is mentally tiring to do managerial tasks. The energy consumed by going to the store starts with writing the shopping list, not when you get in the car. Try not to take on too much at once, you will only overload your working memory. Don’t commit to plans, new projects or too many tasks. This also applies to your self-care routine. Add only one new habit at a time, not many lifestyle changes.
Limit distractions : Paying attention, starting a task, completing a task, and time management are also drains on your executive functioning skills. It is very difficult to focus and stay on task when there are distractions in your environment. It can help to be aware of visual or auditory distractions in your environment and take steps to limit them. Put your phone away and turn on silent or focus mode! Noise-cancelling headphones, white noise machines, a “do not disturb” sign on your door, or turning off TVs and screens are all possible options to minimize distractions. Don’t focus for too long, max 25 minutes, then rest your mind.
Write it down : For me, out of sight is out of mind. I am a visual learner. If I need to remember a supplement in the morning, I put the bottle next to my kettle so I can see it when I make tea. I need a paper calendar and visual cues, like post-it notes, to stay organized and on top of my schedule. I tried scheduling reminders in my calendar, but found I forgot to schedule the reminder, which defeats the point! You may find a reminder app or calendar feature that is ideal for you. Don’t rely on your memory alone.