Woman lying on bed deep in thought

How to Manage MS Brain Fog

By Lisa Marie Basile
Reviewed by Dana Cooper, M.D.
December 11, 2023

If you’re living with multiple sclerosis (MS) and having issues focusing, recalling details of what you did yesterday, or remembering where you put your keys, you’re not alone. According to the National Multiple Sclerosis Society (NMSS), this symptom, known as brain fog or cog fog, affects more than half of people who have MS.

“Brain fog usually affects the ability to concentrate—as well as clarity and speed of thinking,” says Achillefs Ntranos, M.D., a board-certified neurologist at Treat MS in Scarsdale, New York. “You can think of cog fog as fatigue of the brain, similar to muscles getting tired after exercise.”

Anyone with MS can experience this elusive symptom. For most people who have it, brain fog comes and goes. It may be even more challenging for those with progressive forms of MS.

What Are the Causes of MS Brain Fog?

Even someone without MS is likely to experience cognitive decline as they get older. According to an article published in the journal Seminars in Hearing, cognitive changes come naturally with aging. For some people, there may be even greater cognitive decline due to neurodegenerative diseases such as Alzheimer’s disease. But MS-related brain fog is different in that it’s often due to the brain lesions or brain atrophy that happen when one has MS.

Brain inflammation is a major culprit, says Ntranos. In MS, cells in the brain called microglia are responsible for inflammation, leading to cognitive issues.

In addition to structural changes in the brain, there may be other variables that affect cognition for people with MS, explains Andrew Sylvester, M.D., a board-certified neurologist specializing in MS at Cooperman Barnabas Medical Center, in Livingston, New Jersey.

“[MS] brain fog [could come from] the disease itself,” Sylvester explains. “Or medications, depression or anxiety, not getting adequate sleep, suffering from heat exposure, or vitamin deficiencies.” Of course, other health conditions can contribute, as well, like high blood pressure or hormonal issues.

5 Ways to Manage MS Brain Fog

There is good news: Cognitive health can be managed with proper treatment and cognition-boosting activities or therapies, Sylvester explains. Work with your doctor to create a treatment plan for your MS, and consider trying a few of the following tactics to help promote cognitive health.

1. Get a Cognitive Evaluation

If you’re concerned about your brain function, ask your healthcare provider for a short screening test or a more comprehensive cognitive evaluation, suggests Lauren B. Krupp, M.D., neurologist and director of the Multiple Sclerosis Comprehensive Care Center at NYU Langone in New York City.

“People with MS complain of cognitive problems, but this is a poor predictor of how they would [actually] perform on a neuropsychological test,” Krupp says. In other words, you could be dealing with issues that make you feel foggy and still do well on a cognitive evaluation.

The earlier you start with cognitive screenings and evaluations, the better. Knowing your baseline is important, explains Krupp, as it can help your doctor pinpoint worsening symptoms and determine what’s causing the cognitive impairment (for example, if it’s due to fatigue or lesions in the brain related to MS), how severe it is, and how to overcome it.

2. Practice Good Sleep Hygiene

Sleep problems—often linked to lack of exercise, medication side effects, mood issues, or as a direct result of the illness—are common in people who have MS. Poor sleep is notorious for causing or worsening brain fog.

Talking to your doctor openly about any sleep struggles can help you get to the root of the problem and find treatment, if needed. Meanwhile, try to adopt a nighttime ritual to help get you ready for rest. The NMSS suggests implementing these strategies:

  • Go to bed and wake up at the same time each day.
  • Create a bedtime ritual to do each night to help you relax (for example, write your worries down in a journal, read a book, and dim the lights).
  • Avoid exercising or having food, alcohol, or caffeine within two hours before your bedtime.

Research suggests that cognitive behavioral therapy for insomnia (CBT-I) may also help with sleep and fatigue in people with MS. CBT-I works by helping people reframe their thoughts and change their behaviors relating to sleep, according to the International Journal of MS Care. You can seek CBT-I in a group setting or get one-on-one treatment with a therapist. There are also CBT workbooks and online videos for self-guided learning.

3. Stay Active

Research suggests that exercise can help both the body and the mind of people living with MS. Regular movement can support everything from heart health to muscle strength, and it can also improve energy levels and mental alertness.

Another win? Exercise boosts mood, which can also help improve cognition, Krupp says.

4. Eat a Balanced Diet

While there’s no official MS diet, eating well can help keep your energy levels from tanking, which may worsen fatigue and brain fog.

A good starting place? Avoid inflammatory dishes like fried foods, refined carbs, and foods with added sugars. Another general rule of thumb is to prepare your own meals at home using fresh, colorful foods rich in nutrients.

There is some evidence that filling up on omega-3 fatty acids can reduce relapse rate, inflammation, and improve the quality of life for people with MS, according to Nutritional Neuroscience, so it’s a good idea to incorporate seafood such as mackerel, salmon, sardines, oysters, and anchovies into your diet. If you don't like fish, chia seeds, walnuts, and soybeans have omega-3s, as well. Aim for about 3 grams per day.

You can get some healthy meal ideas by visiting MyPlate.gov.

5. Stay Social

Having social support—from friends, family, and/or a support group—is key. A review in Current Opinion in Psychiatry suggested there were better health outcomes for people who had someone to lean on. Plus, socializing with others may help keep your mind sharp. In a 2021 study, people with MS who had social support self-reported better cognitive function.

It may be even better if the social interactions include activities that make you think, such as games. One study suggests that engaging in community games, like mahjong, chess, or cards, may help increase cognitive function.

The good news? Connecting with online communities like ours and other groups related to your interests, as well as texting and making phone calls to catch up with friends and loved ones, all counts as social engagement.

Asking for Help at Work, If You Need It

If MS brain fog is making it challenging to do your job, you might ask for accommodations so you can be more productive. According to the Americans with Disabilities Act (ADA), many people with MS have the right to reasonable work accommodations. This might include changing the type of work you do, flexible scheduling, telecommuting, or modifying your role, according to the NMSS.

Even though MS brain fog might be a part of your life, it doesn’t have to run it. Know that you’re not alone—and there are ways to get a handle on it.

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