Cognitive Dysfunction in Rheumatic Disease
"Brain Fog" and AP (antibiotic protocol)

Patients with rheumatic disease (particularly those with an inflammatory component), often describe what has become known to many of us as "brain fog." It has acquired yet another name in the fibromyalgia community -- "fibro fog." Having brain fog may sound perhaps annoying, but not greatly incapacitating to people who haven't experienced this phenomenon, Some rheumatic patients experience it transiently, and may develop it when they become tired or stressed. However, for other patients, its consequences can be profound.

Many people have posted their comments about brain fog on The Road Back Foundation web site bulletin board (www.roadback.org). One rheumatic patient writes of the condition, "for me this has been the worst symptom of the disease as I could handle all the pain but without mental acuity you just feel like giving up." Another states: "My husband knows when I am starting a herx*/flare-up by an increase in cognitive problems, primarily more difficulty with short-term memory."

People have posted some of their experiences with brain fog on the RBF web site:

1. not being able to retrieve words and to place them into sentences while conducting a conversation
2. disorientation when diving the car and even forgetting where you parked your car
3. forgetting how to spell simple words.
4. forgetting names of people you know while in a conversation with them
5. when I am in a familiar place and become disoriented and unable to recognize my surroundings
6. being utterly unable to add up a column of figures because I get a different answer every time.
7. I am vague, disoriented, and make mistakes about simple things

The good news is that many patients are reporting that their brain fog improves or disappears the longer they are on antibiotic therapy. "My brain fog is manageable now since being on minocycline. And this, of course, makes sense since my arthritis is light years better as well"

Stuart L.Weg, MD, an experienced AP practitioner (with training in anesthesiology) has treated many rheumatic patients with antibiotic therapy. He states:

"I view the mechanism of "brain fog" as related to the infectious model. Infections that are set up in the body produce toxins that cross the blood brain barrier. We recognize the inflammatory response to the microbe in the joints and supporting tissues as an arthritic condition. The inflammatory response to the microbes and their toxins also affect the brain and contribute to the cognitive difficulties experienced by rheumatic patients.

In my practice, patients who are treated with appropriate anti-infective therapies experience significant improvement in their cognitive abilities and may recover completely once all sources of infection are removed."

The return of reliable cognitive function is very important in the healing process, but like so much of the road back -- it could take time. "I no longer have any of the problems but for me it took about just over one year from when I started the AP treatment plan and that year was really bad between the brain fog and the pain," writes a person posting on the bulletin board. However, because patients are optimistic and have hope for recovery, they can cope and find humor in even the most difficult of situations; as one patient wrote "Brain fog is spelling it BRIAN FOG."

*Jarisch Herxheimer reaction, commonly known to people on AP as the "herx." and to some with brain fog who have posted on the bulletin board as "the hex."