Brain Foggy Day

The following is a transcript of a lecture by Kenneth Erickson, M.D., at a VEDA conference held in Portland, Oregon. 

'Patients and families, of course, have known for a long time that vestibular disorders bring about cognitive difficulties.  Some psychologists and neurologists here in Portland for at least five years, crystallizing in the last two or three years, have now begun to recognize and study a number of cognitive disturbances associated with vestibular disorders.

Cognitive disturbances involve a difficulty in basic mental operations such as memory, paying attention or focusing attention on something, and in prolonged concentration. They also involve shifting attention from one subject or idea to another.  People with cognitive disturbances have trouble in perceiving accurate spatial relationships between objects, in comprehending or expressing language, and performing calculations, and in a number of other areas.  These are areas that psychologists routinely test when they are doing so-called neuro-psychological exams.

A brief run-through of the kind of cognitive dysfunctions that we know of in vestibular disorders would have to include the following areas: 

First of all, vestibular patients exhibit a decreased ability to track two processes at once, something we usually take for granted.  This ability requires a rapid shifting of attention.  A good example is when you are driving and you have one person approaching unexpectedly coming out of a left-hand lane and another car coming behind you unexpectedly on your right side.  Suddenly there are two things that you need to monitor and pay attention to at the same time.  This might have come easily to you at one time, but if you now have vestibular difficulties, it's very hard.

Another example is when you have conflicting emotions inside of you, if, for example, there are two different things you want to do at the same time.  The sensation you feel is confusion.  Because of your cognitive problems, you may find it very difficult to express that confusion.

These are only two concrete examples of a pervasive problem.

The second area of cognitive problems vestibular patients exhibit is difficulty in handling sequences.  This includes a wide range of sequences.  It pertains to the mixing up of words and syllables when you're speaking, to the transposing or reversing of letters or numbers, to having trouble tracking the flow of a normal conversation or the sequence of events in a story or article.   All of those have been very frequent complaints of the vestibular patients that we see.

A third area would be decreased mental stamina.  That speaks for itself.  For a vestibular patient an hour or two of concentration is a special blessing, and most days 15 minutes of intellectual concentration is very fatiguing.

The fourth area involves decreased memory retrieval ability, the ability to pull out information from your long-term memory store reliably.  You might hit it most of the time, but you do not have a reliable rate.

Number five is a decreased sense of internal certainty.  This is a peculiar way to state it, but it is exceedingly accurate.  Vestibular patients with on-going physical problems have a frustrating lack of closure. They lack that "ah-ha; I've got it now; I see the big picture."  Or "that's what I was trying to remember; I know it's that."  They lack that kind of certainty which measures an idea or a conversation or a social situation up against some internal "gold standard."  Vestibular patients often lack internal certainty. 

Finally, people with vestibular disorders experience a decreased ability to grasp the large whole concept.  The ability to see the big picture or the forest for the trees is very elusive for someone with vestibular disorders.'

That was only part of a much larger talk, but I felt it was worth putting up that slice of the whole transcript.

I guess this is the 'brainfog' we're all pretty familiar with.  It's nice to see the condition acknowledged by a medical expert, because literally no medical expert I have spoken to was aware that such a thing came with the whole MD package.  Come to that, none were aware it caused physical fatigue, let alone mental exhaustion.  So many of them focus on the triumvate of vertigo, tinnitus and hearing loss trees that they cannot see the sub-symptoms woods; the symptoms that come about as a consequence of the condition in its entirety.