Category: Rheumatology

Getting Lost in the Brain Fog

Lupus can affect many parts of the body, but one common complaint is the fog that overtakes people’s brains.

Memory problems are a common issue in lupus patients. Otherwise highly functioning individuals have a hard time with the easiest of tasks, like making coffee or remembering their hairstylist’s name. This happens even when our lupus patients’ disease is under control. To understand this phenomenon further, We reached out to our colleague and world expert in lupus care, Dr. Daniel Wallace, MD to share his insights on this problem.

Dr. Wallace explains:

“Many lupus patients complain of a mental fog, or difficulty thinking clearly. This can occur even if the disease appears to be under control with minimal inflammatory parameters. One way to sort it out is to divide the nervous system into three parts:

  1. The central nervous system (brain and spinal column)
  2. The peripheral nervous system (allows one to move their arms and legs and feel things)
  3. The autonomic nervous system (sympathetic and parasympathetic).


The sympathetic nervous system controls our pulse and blood pressure by opening and closing blood vessels. When it’s cold outside, some lupus patients develop Raynaud’s, which is where the vessels over constrict and turn blue. If it’s warm, they can over dilate and turn red. The same phenomenon can occur in the brain. Over dilation can cause a headache and over constriction can produce a mental fog. I like to call it ‘Raynaud’s of the brain’.

Although some patients with SLE have mental status changes from inflammation, the overwhelming majority have a ‘lupus fog’ as a result of a dysfunctional autonomic nervous system. This so-called hypo-perfusion can be visualized on certain types of brain imaging, such as a SPECT scan or a functional MRI.”

Armed with this understanding of the process, the next question naturally is what can be done.

Attune Health’s Dr. Venuturupalli says, “While no definitive answers are available, the medical literature suggests that guided meditation, mindfulness and chanting might be helpful in restoring some balance to the autonomic nervous system by emphasizing the parasympathetic nervous system (calming) versus the sympathetic (fight or flight response) nervous system. Similarly, exercise might trigger a similar response. Does nutrition have something to do with it? While there’s no definitive research to prove it, diets might play a significant role in balance of the immune system. One of the areas of research in autoimmune diseases has to do with the effects of the microbiome (the gut bacteria) on neurological signaling. This area is being hotly researched and we await further scientific insights from this field.

I believe that keeping the mind stimulated and engaging in activities such as crossword puzzles and memory games is also important in maintaining important brain connections.”