Brain fog and affecting factors in health care workers

Year 2025, Volume: 4 Issue: 3, 184 - 192, 31.12.2025

Kübranur Yılmaz , Şule Ecevit Alpar , Derya Emre Yavuz

https://doi.org/10.55971/EJLS.1779965

Abstract

Brain fog was first described in the 1850s as a form of mental fatigue, particularly observed among individuals engaged in occupations requiring intensive cognitive effort. The present study aims to examine the occurrence of brain fog among healthcare professionals—who are required to perform multiple tasks simultaneously and make critical decisions—and to identify contributing factors through a review of the current literature. Accordingly, a traditional literature review was conducted by retrieving articles published between 2019 and 2025 from the PubMed database using the keywords “brain fog”, “cognitive impairment” and “mental fatigue”. Brain fog is characterized by forgetfulness, difficulty concentrating, impaired multitasking ability, and diminished cognitive functioning. Healthcare professionals constitute one of the occupational groups most frequently exposed to brain fog. Physicians, nurses, and other healthcare personnel are subjected to various stressors and adverse working conditions that may precipitate brain fog, including time pressure, uncertainty in patient treatment and care processes, extended working hours and insufficient nutrition. Given that healthcare professionals are responsible for improving and maintaining individual health and quality of life, the experience of brain fog within this group poses risks to patient safety due to the cognitive symptoms it entails. Examining brain fog and its associated factors among healthcare professionals is essential for implementing preventive strategies, enhancing the quality of patient care, minimizing errors during clinical practice, and improving job satisfaction and quality of life among healthcare personnel. Furthermore, investigations may provide a foundation for developing evidence-based strategies to mitigate brain fog in healthcare settings.

Keywords

Mental fatigue , Confusion , Healthcare workers , Factors That Affect Brain Fog

Ethical Statement

Not applicable, because this article does not contain any studies with human or animal subjects.

Supporting Institution

--

Thanks

--

References

• Woo MS, Malsy J, Pöttgen J, Seddiq Zai S, Ufer F, Hadjilaou A, Schmiedel S, Addo MM, Gerloff C, Heesen C, Schulze Zur Wiesch J, Friese MA. Frequent neurocognitive deficits after recovery from mild COVID-19. Brain Communications. (2020);2(2):fcaa205. https://doi.org/10.1093/braincomms/fcaa205
• Van der Feltz-Cornelis C, Turk F, Sweetman J, Khunti K, Gabbay M, Shepherd J, Montgomery H, Strain WD, Lip GYH, Wootton D, Watkins CL, Cuthbertson DJ, Williams N, Banerjee A. Prevalence of mental health conditions and brain fog in people with long COVID: a systematic review and meta-analysis. Gen Hosp Psychiatry. (2024);88:10–22. https://doi.org/10.1016/j.genhosppsych.2024.02.009
• Denno P, Zhao S, Husain M, Hampshire A. Defining brain fog across medical conditions. Trends Neurosci. (2025);48(5):330–348. https://doi.org/10.1016/j.tins.2025.01.003
• Gorenshtein A, Liba T, Leibovitch L, Stern S, Stern Y. Intervention modalities for brain fog caused by long-COVID: systematic review of the literature. Neurol Sci. (2024);45(7):2951–2968. https://doi.org/10.1007/s10072-024-07566-w
• Premraj L, Kannapadi NV, Briggs J, Seal SM, Battaglini D, Fanning J, Suen J, Robba C, Fraser J, Cho SM. Mid and long-term neurological and neuropsychiatric manifestations of post-COVID-19 syndrome: a meta-analysis. J Neurol Sci. (2022);434:120162. https://doi.org/10.1016/j.jns.2022.120162
• Elboraay T, Ebada MA, Elsayed M, Aboeldahab HA, Salamah HM, Rageh O, Elmallahy M, AboElfarh HE, Mansour LS, Nabil Y, Eltawab AKA, Atwan H, Alkanj S. Long-term neurological and cognitive impact of COVID-19: a systematic review and meta-analysis in over 4 million patients. BMC Neurol. (2025);25(1):250. https://doi.org/10.1186/s12883-025-04174-9
• Sowers KL, Gayda-Chelder CA, Galantino ML. Self-reported cognitive impairment in individuals with primary immunodeficiency disease. Brain Behav Immun Health. (2020);9:100170. https://doi.org/10.1016/j.bbih.2020.100170
• Uğurlu ÖY. Covid-19 pandemisinin sağlık çalışanlarının beslenme alışkanlıkları üzerine etkisi [Yüksek Lisans Tezi]. Karabük: Karabük Üniversitesi; (2022).
• Lin K, Gao Y, Ji W, Li Y, Wang W, Du M, Liu J, Hong Z, Jiang T, Wang Y. Attentional impairment and altered brain activity in healthcare workers after mild COVID-19. Brain Imaging Behav. (2024);18(3):566–575. https://doi.org/10.1007/s11682-024-00851-4
• Atik D, İnel Manav A. A scale development study: Brain Fog Scale. Psychiatria Danubina. (2023);35(1):73–79. https://doi.org/10.24869/psyd.2023.73
• Avittan H, Kustovs D. Cognition and mental health in pediatric patients following COVID-19. International Journal of Environmental Research and Public Health. (2023);20(6):5061. https://doi.org/10.3390/ijerph20065061
• Reinfeld S. Can bupropion treat COVID-19-induced brain fog? A case series. Int Clin Psychopharmacol.(2023);38(3):189-191. https://doi.org/10.1097/YIC.0000000000000436
• Beas R, Godoy A, Norwood DA, Ascencio YO, Izquierdo-Veraza D, Montalvan-Sanchez EE, Ramirez M, Kurada S. Cognitive impairment and insomnia in celiac disease: a systematic review and meta-analysis. Gut Liver. (2024);18(6):1080–1084. https://doi.org/10.5009/gnl240063
• Pinzon RT, Wijaya VO, Jody AA, Nunsio PN, Buana RB. Persistent neurological manifestations in long COVID-19 syndrome: a systematic review and meta-analysis. J Infect Public Health. (2022);15(8):856–869. https://doi.org/10.1016/j.jiph.2022.06.013
• Hassani M, Fathi Jouzdani A, Motarjem S, Ranjbar A, Khansari N. How COVID-19 can cause autonomic dysfunctions and postural orthostatic syndrome? A review of mechanisms and evidence. Neurol Clin Neurosci. (2021);9(6):434–442. https://doi.org/10.1111/ncn3.12548
• Dani M, Dirksen A, Taraborrelli P, Torocastro M, Panagopoulos D, Sutton R, Lim PB. Autonomic dysfunction in long COVID: rationale, physiology and management strategies. Clin Med (Lond). (2021);21(1):e63–e67. https://doi.org/10.7861/clinmed.2020-0896
• Flynn MJ, Abolhosseini S, Gamboa J, Campbell TS, Carlson LE. Persistent benefits and medical approaches in cancer survivors: a systematic review and meta-analysis. Psychosocial Oncology Research and Practice. (2023);5(1):e00079. https://doi.org/10.1097/OR9.0000000000000094
• Ishikura T, Nakano T, Kitano T, Tokuda T, Sumi-Akamaru H, Naka T. Serum ferritin level during hospitalization is associated with brain fog after COVID-19. Sci Rep. (2023);13(1):13095. https://doi.org/10.1038/s41598-023-40011-0
• Jiang S, Sun Y, Yu L, Hu X, Li J. Effects of mindfulness-based interventions on cognitive impairment in patients with cancer: a systematic review and meta-analysis. Int J Clin Health Psychol. (2025);25(2):100576. https://doi.org/10.1016/j.ijchp.2025.100576
• Kent CA, Holch P, Gough B, Wyld L, Jones GL. Experiences of women who self-report Breast Implant Illness (BII): a qualitative evidence synthesis. Health Psychol Rev. (2025);19(3):659–688. https://doi.org/10.1080/17437199.2025.2503743
• Maki PM, Jaff NG. Menopause and brain fog: how to counsel and treat midlife women. Menopause. (2024);31(7):647–649. https://doi.org/10.1097/GME.0000000000002382
• Nouraeinejad A. Brain fog as a long-term sequela of COVID-19. SN Compr Clin Med. (2023);5(1):9. https://doi.org/10.1007/s42399-022-01352-5
• Núñez-Cortés R, Suso-Martí L, Almonacid-Lleida J, Salazar-Méndez J, López-Bueno R, Cruz-Montecinos C, Andersen LL, Ramírez-Vélez R, Calatayud J. Optimal dose of aerobic exercise programs to reduce pain intensity and improve health status in patients with fibromyalgia: a dose-response meta-analysis. Phys Ther. (2025);105(6):pzaf057. https://doi.org/10.1093/ptj/pzaf057
• Mallick D, Goyal L, Chourasia P, Zapata MR, Yashi K, Surani S. COVID-19 induced postural orthostatic tachycardia syndrome (POTS): a review. Cureus. (2023);15(3):e36955. https://doi.org/10.7759/cureus.36955
• Elliott TR, Hsiao YY, Randolph K, Urban RJ, Sheffield-Moore M, Pyles RB, Masel BE, Wexler T, Wright TJ. Efficient assessment of brain fog and fatigue: development of the fatigue and altered cognition scale (FACs). PLoS One. (2023);18(12):e0295593. https://doi.org/10.1371/journal.pone.0295593
• Omar AKAE, Dahesh SMA, Ellakwa DES, Elhadd TA, Tamimi MA, Cooper K, Zhang J, Singh B. Cognitive impairment in health care workers recovering from COVID-19 infection: a cross-sectional comparative study. Middle East Curr Psychiatry. (2022);29:79. https://doi.org/10.1186/s43045-022-00245-6
• Peláez I, Martínez-Íñigo D, Fernandes-Magalhaes R, De Lahoz ME, Del Pino AB, Pérez-Aranda S, García-Romero A, Soldic D, Mercado F. One year after mild COVID-19: emotional distress but preserved cognition in healthcare workers. J Clin Med. (2025);14(17):6007. https://doi.org/10.3390/jcm14176007
• Zhang L, Wen J, Yuan L, Yan Y, Zhang Z, Li K, Tang Z. Anxiety and depression in healthcare workers 2 years after COVID-19 infection and scale validation. Sci Rep. (2025);15(1):13893. https://doi.org/10.1038/s41598-025-98515-w
• Amer SAAM, Fouad AM, El-Samahy M, Anan M, Saati AA, Sarhan AA, Alalfy SA, Tawfik MY. Cognitive function and work resilience of healthcare professionals: a comparative cross-sectional study. J Family Community Med. (2024);31(2):153–159. https://doi.org/10.4103/jfcm.jfcm_304_23
• Moussa S, Malaeb D, Achkouty I, Hallit S, Ghosn A, Obeid S. Association between work fatigue and cognitive function among Lebanese health-care professionals: the moderating effect of emotional intelligence. Int J Environ Health Res. (2024);34(3):1487–1498. https://doi.org/10.1080/09603123.2023.2222270
• de Souza-Talarico JN, Suemoto CK, Santos IS, Griep RH, Yamaguti STF, Lotufo PA, Bensenõr IJM. Work-related stress and cognitive performance among middle-aged adults: the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). Stress Health. (2020);36(1):19–30. https://doi.org/10.1002/smi.2906
• Farahat SA, Amin OR, Hamdy HS, Fouad MM. The impact of work-related stress on the cognition domain of executive functioning of health care workers during the COVID-19 pandemic. Int Arch Occup Environ Health. (2022);95(5):1079–1090. https://doi.org/10.1007/s00420-021-01745-0
• Ma L. Depression, Anxiety, and Apathy in Mild Cognitive Impairment: Current Perspectives. Front Aging Neurosci. 2020 Jan 30;12:9. https://doi.org/10.3389/fnagi.2020.00009
• Ganesan S, Magee M, Stone JE, Mulhall MD, Collins A, Howard ME, Lockley SW, Rajaratnam SMW, Sletten TL. The impact of shift work on sleep, alertness and performance in healthcare workers. Sci Rep. (2019);9(1):4635. https://doi.org/10.1038/s41598-019-40914-x
• Teng NIMF, Ngelayang E, Said NM, Juliana N, Mohd Azmi NAS, Chen LW, Loy SL. A qualitative study on nutrition and well-being of healthcare shift workers. Sci Rep. (2025);15(1):30512. https://doi.org/10.1038/s41598-025-11534-5
• Chasco EE, Dukes K, Jones D, Comellas AP, Hoffman RM, Garg A. Brain fog and fatigue following COVID-19 infection: an exploratory study of patient experiences of long COVID. Int J Environ Res Public Health. (2022);19(23):15499. https://doi.org/10.3390/ijerph192315499
• Jia H, Lin CJ, Wang EM. Effects of mental fatigue on risk preference and feedback processing in risk decision-making. Scientific Reports. (2022);12(1):10695. https://doi.org/10.1038/s41598-022-14682-0
• Kunasegaran K, Ismail AMH, Ramasamy S, Gnanou JV, Caszo BA, Chen PL. Understanding mental fatigue and its detection: a comparative analysis of assessments and tools. PeerJ. (2023);11:e15744. https://doi.org/10.7717/peerj.15744
• Güven B, İbrahimoğlu Ö. Ameliyathane hemşirelerinde zihinsel yorgunluk ile klinik karar verme arasındaki ilişkinin incelenmesi. Sağlık Bilimleri Üniversitesi Hemşirelik Dergisi. (2023);5(3):237–244. https://doi.org/10.48071/sbuhemsirelik.1330883
• Herlambang MB, Cnossen F, Taatgen NA. The effects of intrinsic motivation on mental fatigue. PLoS One. (2021);16(1):e0243754. https://doi.org/10.1371/journal.pone.0243754
• Chmielewski J, Łoś K, Łuczyński W. Mindfulness in healthcare professionals and medical education. Int J Occup Med Environ Health. (2021);34(1):1–14. https://doi.org/10.13075/ijomeh.1896.01542
• Türkili S, Aslan E, Tot Ş. Türkiye’de sağlık çalışanları arasında koronavirüs salgını nedeniyle yaşanılan zorluklar, kaygı, depresyon ve tükenmişlik sendromunun incelenmesi. Mersin Üniversitesi Sağlık Bilimleri Dergisi. (2022);15(1):74–87. https://doi.org/10.26559/mersinsbd.949616
• Arora T, Grey I, Östlundh L, Alamoodi A, Omar OM, Hubert Lam KB, Grandner M. A systematic review and meta-analysis to assess the relationship between sleep duration/quality, mental toughness and resilience amongst healthy individuals. Sleep Med Rev. (2022);62:101593. https://doi.org/10.1016/j.smrv.2022.101593
• Kulak AY, Yeşil E. The relationship between nutritional status and cognitive functions of shift health workers. J Turk Sleep Med. (2022);9(3):269–277. https://doi.org/10.4274/jtsm.galenos.2022.48278
• Martland RN, Ma R, Paleri V, Valmaggia L, Riches S, Firth J, Stubbs B. The efficacy of physical activity to improve the mental wellbeing of healthcare workers: a systematic review. Mental Health and Physical Activity. (2024);26:1–12. https://doi.org/10.1016/j.mhpa.2024.100577