Brain Fog

Many of those infected with hepatitis C list brain fog as a common and disruptive symptom. What is brain fog? Brain fog is a term some maybe unfamiliar with, but refers to feelings of mental confusion that may include forgetfulness, lack of concentration and focus, and disorganized thinking. Research indicated that about 50% of those infected with hep C experience neuropsychiatric symptoms including brain fog and often co-symptoms of irritability, weakness, and fatigue that interfere with performing the tasks of daily life irrespective of the severity of the disease.¹

How common is hepatitis C brain fog?

According to the results of the 2020 Hepatitis C In America survey, 59% of cured patients and 55% of not cured patients said that they experience cognitive difficulties. After completing treatment, 28% still experienced cognitive difficulties (such as brain fog, confusion, or memory loss) for up to one year, and 63% were still experiencing cognitive difficulties upon taking the survey.

What causes brain fog?

The actual biological mechanism that leads brain fog is not understood.² Some theorize that brain fog results from the reduced functional condition of the liver that cleanses the blood of harmful substances and when this is not operating correctly it can affect many part of the body including the brain.

Brain fog seems to occur more in those with advanced chronic hep C and those who develop cirrhosis. It can also result from some treatments including DAA’s, but was more prevalent in the older regimes of medications using interferons that are now generally not used in the US.³

Alan Franciscus, former Editor-in-Chief of HCV Advocate notes, “The exact cause of brain fog in people with hepatitis C is poorly understood but there have been some recent studies that may explain the higher incidence of brain fog in the hepatitis C population. One study found that since the hepatitis C virus crosses the blood-brain barrier there is some low level inflammation in the brain that would affect cognitive function”.⁴

Brain fog symptoms

As noted above, fatigue (often resulting from insomnia or from ribavirin, a treatment medication) is a common cause for brain fog. Ribavirin can cause memory loss and difficulty in concentration, resulting in brain fog.⁵ Other symptoms that cause a chronic discomfort, muscle and stomach aches, fever, and loss of appetite have also been associated with brain fog.

More severe quality of life problems consistent with brain fog are developed by hepatic encephalopathy (HE), a condition where the brain function is more severely affected by ammonia and toxins in the blood stream the liver is unable to cleanse. HE occurs in those with advanced hepatitis, cirrhosis, or another chronic liver disease.⁶ Symptoms include more intensive brain fog, musty or sweet breadth, and difficulty with small hand movements. As the condition gets worse, shaking of the arms or hands, personality changes, and slurred speak may appear.

Coping with brain fog

For those affected by brain fog during treatments, it often dissipates once the body adjusts to the medication. Dosage adjustments can also diminish the affects and ease the brain fog. While the symptoms of brain fog seem to be common for those with HVC, “successful antiviral therapy does improve them. Many people who have successfully had the virus treated find that their concentration and memory return to normal.”⁷ The use of complementary therapies yoga, meditation and breathing exercises, and changes in diet, sleep patterns, and physical exercise, may also ease the symptoms and side effects of brain fog.