The Role of 'Brain Fog' (cognitive dysfunction) in the Ehlers-Danlos syndromes.

After surveying hundreds of forum topics, articles, and books, it seems to me that almost every patient with Ehlers-Danlos syndrome, at some time, to a varying degree, experiences what many call 'brain fog'.


The average definition of 'brain-fog' can be found within this set of criteria:

• Short-term memory loss. 
• Inability to conjure up old memories - long-term memory loss. 
• Loss of attention.
• Decline in problem-solving skills.
• Loss of organization. 
• Decline in active self-talk.
• Lack of concentration. 
• Fatigue 
• Confusion. 
• Balance issues

These all contribute to form the condition many colloquially refer to as 'brain fog'.  If you think that you're alone, then you're wrong! Millions are affected by cognitive dysfunction, for many different reasons (of which I won't go into great detail here); sarcoidosis, head trauma, encephalitis, certain heart conditions, the list literally goes on, and on, and on; however, whats interesting to me is the prevalence this condition has in the Ehlers-Danlos syndromes.

If your reading this, you probably already know about EDS, so I won't go into explaining that. A myriad of conditions are associated with EDS, the ones that contribute to what we term 'brain-fog', however, form a much smaller, and much more precise list.

1. Postural Orthostatic Tachycardia (POTS) is a condition characterized by: the body's inability to make certain adjustments in order to counteract gravity; an increase of 30bpm (or sinus tachycardia) when changing from a supine to an upright position - returning to a supine position usually returns bp and heart-rate back to normal levels. POTS, very often contributes to the progression and development of cognitive dysfunction to a certain degree. The brain fog itself is postulated to be caused by, in this instance, a poor supply of cranial blood and/or cranial blood volume. A poor supply of cranial blood basically decreases the amount of oxygen available to the brain. 
2. Cervical Spine Instability Is a condition defined by: an inability of the cervical spine to, under normal physiological loads, maintain contact with other vertebrae and prevent nerve damage/ pain. Physiological loads can be defined as the load of your head along with the force of gravity. An example of a physiological load in this instance would not include neck strengthening exercises, or balancing heavy objects atop ones head - which in many instances, do contribute to cervical instability. There are two basic types of cervical instability: chronic instability, and acute. The former is the one most EDS'ers deal with on a regular basis. Due to our lax ligaments and collagen abnormalities, we do not have the tensile and elastic qualities in our spinal column (along with everywhere else in our bodies) to maintain form and resist external/internal forces. Most people with HEDS (hypermobility type) will experience cervical instability - almost always chronic; unless surgically repaired. This instability can impinge nerves and cause undue amounts of pressure on the brain stem, possibly leading to compression of important structures and a build-up of CSF (cerebral spinal fluid). CI can also  aid in the development of Chiari Malformations - which is next on the list. 
3.  Chiari Malformations are functional, structural defects in the cerebellum - the part of the brain that controls balance. The resulting pressure on the cerebellum can block the flow of cerebrospinal fluid and can cause a range of symptoms including dizziness, muscle weakness, numbness, vision problems, headache, and problems with balance and coordination. The most common CM is Type-I; usually found on accident, this type manifests in childhood - or at birth - and causes no serious symptoms: aside from headaches, and facial pressure. [http://en.wikipedia.org/wiki/Arnold%E2%80%93Chiari_malformation]
4. Dysautonomia is described as any condition effecting the autonomic nervous system. The autonomic nervous system, for those of you unfamiliar with the term, is part of the peripheral nervous system that functions below consciousness and controls visceral functions: heart rate, respiration, salivation, digestion etc...for more information about the autonomic nervous system follow this link [http://en.wikipedia.org/wiki/Autonomic_nervous_system]. Dysautonomia includes conditions such POTS (already listed above) vasovagal syncope, neurally mediated hypotension etc...for more information about Dysautonomia follow this link [http://en.wikipedia.org/wiki/Dysautonomia].

These four disorders, along with Chronic fatigue syndrome, depression, and stress all contribute to the formation of cognitive dysfunction.

Although a majority of the EDS population at one time or another experience cognitive dysfunction, that does not mean that everyone experiences cognitive dysfunction; nor does everyones take the same shape, and to the same degree. There is no cure for cognitive dysfunction; however, (and I hate to say this stuff because it does bother me when I read it from others; it definitely sounds like a cop-out) by finding and treating the cause (if their is one), or by eliminating others, symptoms can be relieved. Certain medications used for ADHD have also been found helpful in the maintenance of cognitive dysfunction, as well as life-style and dietary changes. Certain brain exercises have been found to help in leaps and bounds for some patients: color solitaire (not on a computer); for more information on this subject I suggest reading The Brain That Changes Itself by Dr. Norman Doidge - as well as some efficient googling (google scholar works well for finding more scientific notations/ articles). In some cases, cognitive dysfunction has been linked with dysautonomia related syndromes; such as a b12 deficiency. So be sure to have your health-care provider take a full and concise patient history before simply chalking your symptoms up to stress and sending you swiftly on your way!

Also, cognitive dysfunction should not be confused with cognitive decline; the two are completely separate entities with complete separate and unique symptoms and prognosis.


A link covering those things which I did not: [http://www.drlwilson.com/articles/brain_fog.htm].