Clouding of Consciousness

Clouding of consciousness, also known as mental fog , is an abnormality in consciousness. The sufferer experiences a subjective sensation of mental clouding described as feeling "foggy" being in a "dreamy state" or feeling "out of it". Pathophysiologically, it is believed to be a manifestation of an abnormality in the regulation of the “overall level” of cortical function, referred to by neurologists as “arousal”. Thus, some authors prefer the more objective term “abnormal level” of consciousness over the subjective term “clouding” of consciousness. In the 1817 German treatise Verdunkelung des Bewusstseins, Greiner first coined and pioneered the term clouding of consciousness as the main pathophysiological feature of delirium.

Psychopathology

Clouding of consciousness is usually mentioned, in company with other mental symptoms, as part of a severe and acute delirium syndrome with the exception that there are what are called “subsyndromal” or “chronic” varieties of delirium, which may instead be mild and chronic. However, some sources say that delirium should be seen as a “unitary” syndrome in which the duration and severity is arbitrary and the associated mental symptoms do not merely accompany the clouding of consciousness but are directly caused from the clouding of consciousness. As one modern author put it, “It should be apparent that cognition is not possible without a reasonable degree of arousal”. Evenmore, a reduced level, an increased level, as well as an oscillating level of arousal explains the hypo-, hyper-, as well as mixed varieties of delirium respectively. The duration, severity, and oscillatory pattern is dependent on the nature of the underlying aetiology.

Depending on the severity, the associated mental symptoms can include inattention, short term memory impairment, difficulty paying attention to what people say, reduced awareness of the surroundings, disorientation, poor verbal comprehension (aphasia), apraxia, agnosia, difficulty abstracting, difficulty thinking clearly (formal thought disorder), dream-like visual hallucinatory imagery, misinterpretations or delusional beliefs, psychomotor abnormalities and/or emotional liability. In severe cases there may be dream-like visual hallucinatory imagery and hyperactivity whereas in mild cases there may simply be inattention and forgetfulness. The ability to focus, sustain and shift attention is said to be particularly linked to clouding of consciousness and is emphasized as the core clinical feature of it. As one author put it, “attention can be viewed as 'the sentry at the gate of consciousness'”.

Its Recognition

Conventional doctors all too often don't recognize it and mislabel it while researchers neglect it, especially in nongeriatric adults and children, because it is “expected” to happen during severe illness. Conventional doctors also have a tendency to “psychologize” it as one author put it. Alternative medicine practitioners popularly use the term “brain fog”; however there is no mention as to whether they intend the term to be synonymous with the conventional term clouding of consciousness.

Is Brain Fog The Same Thing As Mental Fog/Clouding of Consciousness?

Alternative medicine practitioners recognize and promote a mental disorder concept called "brain fog", which is claimed to be not recognized by conventional medicine.

Alternative medicine practitioners define Brain fog as unusually poor mental function, associated with confusion, forgetfulness and difficulty concentrating. A number of medical or psychiatric conditions and treatments can cause such symptoms, including heavy metal poisoning (in particular mercury poisoning), menopause, chronic fatigue syndrome, fibromyalgia, mood disorders, ADHD (primarily inattentive), drug abuse, and sleep disorders (including disrupted sleep). The term brain fog is not commonly used to describe people with dementia or other conditions that are known to cause confusion and memory problems,^{[citation needed]} but it can be used as a synonym for sleep inertia or grogginess upon being awakened from deep sleep.

This Section Might Have To Be Deleted Because It Might Not Be Clouding of Consciousness

Postoperative Cognitive Dysfunction (POCD) refers to cognitive problems (with memory, learning and the ability to concentrate) following surgery. There has been very limited research into POCD, but existing reports suggest that the incidence of POCD increases with age, it can last for long periods of time, with 2–3 months considered long-term.^{[citation needed]}

POCD has been studied through various institutions since the inception of the IPOCDS-I study centred in Eindhoven, Netherlands and Copenhagen, Denmark. This study found no causal relationship between hypoxia and low blood pressure and POCD. Age, duration of anaesthesia, introperative complications, and postoperative infections were found to be associated with POCD.^{[citation needed]}

POCD to be differentiated from postoperative delirium has a longer duration and no lability or fluctuations in impaired cognitive functioning. Some patients who demonstrated POCD at 10–14 days were found to have improved scores at 3 months, while others continued to demonstrate POCD at periods longer than 1 year. This suggests that in certain at risk patients, POCD may be a permanent alteration of cognitive functioning.^{[citation needed]}

Treatments

Treatment generally involves correcting any underlying medical conditions. For example, if the patient is found to be suffering a form of hypothyroidism, the mental declining effects associated with hypothyroidism can be corrected with thyroid hormone replacement therapy, although many times patients continue to endure confusion and a sense of dementia.^{[citation needed]} Additionally, occupational therapy may be helpful for some people. Neurofeedback can improve symptoms for some people.

In Fibromyalgia patients, cause for cognitive dysfunction (sometimes referred to as "fibro fog") is often related to the inability to fall into a restorative REM sleep, thus, treatment may include a prescription sleep aid or medication normally prescribed for shift work disorder.

See also

• ADHD predominantly inattentive
• Cognitive orthotics
• Depersonalization disorder
• Excessive daytime sleepiness
• Four boxes test
• Generalized Anxiety Disorder

• Insomnia
• Lyme disease
• Major Depressive Disorder
• Mild cognitive impairment
• Mixed Anxiety-Depressive Disorder
• Post-chemotherapy cognitive impairment
• Pumphead syndrome
• Sluggish cognitive tempo

External links

• Study of POCD
• Goteborg
• amsterdam
• blackwell-synergy.com
• [1] An Update on Postoperative Cognitive Dysfunction