Veterans experience chronic pain at a rate twice higher than civilians. Brain fog (BF), a phenomenon of mental cloudiness associated with functional challenges in cognition, is one of the least studied symptoms of chronic pain. Pain interference, a construct of chronic pain, can limit participation with activities. Both BF and pain interference can disrupt quality of life (QoL) in Veterans by limiting health and meaningful participation. The relationship between BF and pain interference on QoL has not been investigated. Thus, the objective of this study is twofold: 1) understand the experience and 2) explore the impacts and the possible mitigation of pain interference of BF on the QoL, in Veterans with pain symptoms and BF. First, a qualitative descriptive method was employed using content and matrix analyses, to describe the impacts of brain fog on QoL in Veterans with BF and pain symptoms. The content analysis revealed the triggers, impacts, management strategies, and suggestions for healthcare professionals. The matrix analysis showed that women described difficulty managing BF with competing roles (e.g., motherly duties). Next, we conducted a cross-sectional study Veterans, exploring whether the perceived level of pain interference in Veterans with BF and pain symptoms affected measures of QoL. Results indicated Veterans with BF and high pain interference showed more mental health symptoms (p=0.003), and less perceived level of confidence with abilities (0.036) and physical health (p=0.003), than Veterans with BF and low pain interference. Post-hoc tests revealed no significant differences across gender. Next, to explore how QoL constructs we related, we performed an exploratory correlational analysis, revealing significant correlations between perceived level of confidence with abilities and 1) mental health (r=-0.48), 2) physical health (r=-0.44), and 3) functional cognition (-0.44). This study contributes to the overall knowledge of BF, guiding recommendations for the development of an assessment and research priorities. / Thesis / Master of Science (MS) / ‘Brain fog,’ a symptom seen in chronic pain, is described as feelings of mental cloudiness. Veterans may experience brain fog and pain symptoms more often than civilians. We wanted to learn about the experience of brain fog and how it affects the lives of Veterans with pain symptoms. First, we used a qualitative study to explore their experiences. Veterans told us about the impacts, triggers, and management strategies related to brain fog. Then, to understand the impact of brain fog on Veteran’s quality of life, three related factors were used (health-related quality of life, functional cognition, and perceived confidence with abilities), evaluated in terms of how much pain symptoms interfered with functioning. Veterans with brain fog and high pain interference had more mental health symptoms, and poorer physical health and confidence with their abilities. Overall, this study will hopefully provide some insight into how to better support Veterans.

The intent of this thesis is to provide an in-depth overview of the neurological manifestations associated with long COVID. The review aimed to assess the cognitive functioning symptoms associated with SARS-CoV-2 post-infection (PASC), investigate the potential mechanisms by which SARS-CoV-2 affects the nervous system, contributing to cognitive fatigue, brain fog, and cognitive dysfunction, and explore the parallels between SARS-CoV-2 and Alzheimer’s Disease. Neuroinflammation emerges as a shared element among these mechanisms, significantly impacting cognitive function. The parallels between COVID-19 and Alzheimer's Disease offer insights into how Alzheimer's affects cognition, aiding in understanding COVID-19's impact. The review underscores a notable gender disparity: women exhibit a greater susceptibility to the adverse effects of COVID-19, yet research in this domain remains limited. It advocates for further investigation into sex-specific differences and emphasizes the importance of understanding and spreading awareness about long COVID's impact on neurocognitive function and the nervous system, given the tendency among many medical professionals to underestimate its significance.