What Is Neurofatigue and How Does It Relate to Brain Injury and PTSD?

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Anyone can experience “brain fog,” but it can be exacerbated by TBI and/or PTSD

Although neurofatigue — colloquially known as brain fog — is not a medical diagnosis, for people like William, a retired military cop with TBI and PTSD, neurofatigue can be a daily reality. Some days, he feels like he is swimming through oatmeal. He can’t remember simple steps for a task like making coffee; he has difficulty concentrating or taking in new information; he feels confused, irritable, and most of all, overwhelmed by every large and small thing around him. Even a simple task can take immense effort. At times, William can feel so exhausted he can barely speak.

What is neurofatigue?

Neurofatigue, neurological fatigue, or mental fatigue, is a decrease in concentration, focus, memory, recall, and word retrieval. This fatigue or tiredness is not the same as exhaustion due to physical exertion, insufficient sleep, or overworking. Neurofatigue is common in those with brain injury (TBI), posttraumatic stress disorder (PTSD), and other mental or neurological conditions. Neurofatigue may also be referred to as brain fog — the brain not working as well as it can normally.

Brain fog does not discriminate

Anyone can experience brain fog since, most often, it is catalyzed by stress or poor sleep. It is characterized by confusion, forgetfulness, and a lack of focus and mental clarity. It can come and go — surface one day, disappear another, and some days may feel worse than others.

But for people with TBI and/or PTSD, or people with symptoms of Long-COVID, neurofatigue can be part of everyday existence.  Feeling exhausted and overwhelmed can color everything a person does — from getting dressed, cooking a meal, or socializing with friends.

What does neurofatigue feel like?

Here are just some of the feelings or challenges that can come from neurofatigue:

  • Difficulty thinking clearly
  • Feeling confused, forgetful, or disoriented
  • Difficulty taking in new information
  • Difficulty concentrating or following directions
  • Difficulty recalling words when talking, writing, or thinking
  • Losing train of thoughts mid-sentence
  • Having a short attention span
  • Feeling irritable, exhausted, stressed, or overwhelmed

What can cause neurofatigue?

Everyone is different and experiences the world’s joys and stresses in their own individual ways. Here are some of the most common causes of brain fog:

  • Lack of or irregular sleep
  • Stress, anxiety, depression
  • Blood sugar imbalances
  • Hormone imbalances
  • Reactions to medications or a mix of medications
  • Technology/information overload
  • Gluten intolerance
  • Inflammation
  • Dehydration
  • Brain injury 
  • Neurological illness (multiple sclerosis, Parkinson's, etc.) 

What can I do about my neurofatigue?

Oftentimes, people with neurofatigue function best in the morning, after sleep, because they are recharged and have the most energy. But everyone is different and recognizing your own symptoms of neurofatigue at the onset can be key; powering through rarely works.

Here are some suggestions:

  • Get quality sleep
  • Try to pace yourself
  • Manage your fatigue 
  • Split tasks into chunks
  • Schedule things according to your day’s energy level 
  • Don’t push yourself too far
  • Eat healthy foods
  • Exercise regularly
  • Stay hydrated
  • Practice active relaxation
  • Practice self-care

The extra challenges of TBI and/or PTSD with neurofatigue

Traumatic Brain Injury (TBI)

People with brain injury who are still experiencing symptoms two-months or more post-injury may have post-concussive syndrome, or PCS. Neurofatigue can be one of the most debilitating consequences of TBI as it influences everything a person does both mentally and physically. Realizing how tired you are after an activity — even having coffee with a friend or watching TV — can be depressing and anxious-making. 

Studies show that because some parts of the brain are injured, the brain of a person with TBI works harder and uses more brain cells to process information. More brain areas are involved in performing normal activities than pre-injury, which requires extra bypasses in the brain and consumes more energy to complete a task or a thought. So, reaction time is slower and requires more energy. 

Because your brain is still healing, you need to take things slowly. What is most important is recognizing that you are not where you were before your injury and giving yourself the time, patience, and acceptance to heal is crucial. 

Posttraumatic Stress Disorder (PTSD)

For William, his neurofatigue can worsen if he is triggered. Shopping in a grocery store with loud music or bright lights, seeing suspicious trash on the road that reminds him of patrols, or being in a crowded public place with many activities happening simultaneously can all set him off. If he is feeling overwhelmed or exhausted, he knows that taking the dog on a short walk, chilling with a book, or playing a favorite video game can help him squash — or at least minimize — his symptoms of brain fog. 

William and his family also help mitigate his neurofatigue through planning. For example, they know that it is best to visit places they have been before or that they have heavily researched so there are no surprises, no triggers. Strategies can make all the difference.

Most importantly …

Be kind and patient with yourself. Know what works for you. Know that it is more than okay to take a break and to do what is best to take care of yourself — mentally and physically — in the moment.

Posted on BrainLine June 9, 2022. Reviewed June 9, 2022.

Reviewed by Tamar Rodney, PhD, PMHNP-BC, CNE, Mental Health Nurse Practitioner. 
Dr. Tamar Rodney is an assistant professor at Johns Hopkins School of Nursing. Her research and clinical work focus primarily on improving Post-traumatic stress disorder (PTSD) diagnosis and treatment.