MDPI has published an article that summarises a wide range of research studies relating to Cognitive Dysfunction (also known as brain fog) in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome.
Bansal et al (2025)
Summary
- The relationship between infection, peripheral inflammation, and cognitive dysfunction in ME/CFS is reviewed, including clinical observations.
- Cognitive dysfunction in ME/CFS may result from low-grade, persistent inflammation and elevated pro-inflammatory cytokines.
- Reducing systemic inflammation, managing viral reactivation, and improving mitochondrial energy generation may help improve cognitive dysfunction in ME/CFS.
Abstract
Systemic infection and inflammation impair mental function through a combination of altered attention and cognition. Here, we comprehensively review the relevant literature and report personal clinical observations to discuss the relationship between infection, peripheral inflammation, and cerebral and cognitive dysfunction in patients with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS).
Cognitive dysfunction in ME/CFS could result from low-grade persistent inflammation associated with raised pro-inflammatory cytokines. This may be caused by both infectious and non-infectious stimuli and lead to altered regional cerebral blood flow accompanied by disturbed neuronal function.
Immune dysregulation that manifests as a subtle immunodeficiency or the autoimmunity targeting of one or more neuronal receptors may also be a contributing factor. Efforts to reduce low-grade systemic inflammation and viral reactivation and to improve mitochondrial energy generation in ME/CFS have the potential to improve cognitive dysfunction in this highly disabling condition.
MEA Comment
Cognitive dysfunction, also known as ‘brain fog', is the medical term given to problems with short-term memory, concentration, word finding difficulties and problems with information processing. It is a key diagnostic feature of ME/CFS.
At the moment we don't really know what causes cognitive dysfunction in ME/CFS. However, based on the research evidence to date, which is summarised in this review, there are four possible explanations which may all be linked:
- A continuing over active immune system response to an triggering infection that involves immune system chemicals called pro inflammatory cytokines
- Low level inflammation in the brain – neuroinflammation – resulting from this immune system response
- Changes in the levels of chemical transmitters – neurotransmitters – in the brain that are involved in normal cognitive function
- Reduction in blood flow to parts of the brain involved in cognition
Equally, there is no sound evidence to date to indicate that there any drugs or supplements that are safe and effective treatments when it comes to improving cognitive function in MF/CFS
But there are some drugs and supplements that may be worth assessing in well controlled clinical trials – as also outlined in this review
The ME Association has an information leaflet that covers all aspects of cognitive dysfunction in ME/CFS:
Dr Charles Shepherd,
Trustee and Hon. Medical Adviser to the ME Association,
Member of the 2018-2021 NICE guideline on ME/CFS committee,
Member of the 2002 Chief Medical Officer's Working Group on ME/CFS
