A Brain Fog Evaluation That Measures, Then Looks for Causes

A brain fog evaluation at Willow & Stone has two jobs. First, describe the problem as concretely as possible: when it started, what it affects, and, where it helps, a measured baseline of memory, attention and reasoning. Second, look for what is driving it: sleep, mood, anxiety, medications, hormones, nutrient or thyroid problems, or a mix. This page explains how that evaluation is put together, what each part can and can’t tell you, and what to expect afterward. It is a service page; if you want a broad explanation of why brain fog happens, our existing guides cover that.

Why measure brain fog at all

“Brain fog” covers a lot: losing words mid-sentence, rereading the same paragraph, forgetting why you walked into a room, feeling slow. Two people with the same complaint can have very different problems. Measuring helps sort that out. A Creyos assessment is one way; it is a clinician-ordered set of short online tasks scored against more than 85,000 people, explained fully in the Creyos assessment guide.

A measured result also protects against two opposite mistakes: dismissing a real decline as “just stress,” and assuming the worst when performance is actually typical. If you only want to know whether a self-test is worth trying first, see brain fog tests and what they can show.

How the evaluation is put together

1. History. When the fog began, what was happening then (illness, a new medication, a move, a baby, perimenopause, a stressful job), what makes it better or worse, and how it affects work and home.
2. Mood, anxiety and attention screens. Depression and anxiety are among the most common causes of trouble thinking, and lifelong attention problems can surface as “fog” when demands rise.
3. Sleep. Schedule, snoring, waking unrefreshed, shift work.
4. Medication and substance review. Prescriptions, over-the-counter sleep aids and allergy pills, supplements, alcohol and cannabis.
5. Labs, when your history points to them. Ordered selectively, not as a fixed panel.
6. Cognitive baseline, where useful. A Creyos assessment, if you and your clinician decide it adds something.

The evaluation itself is the 90-minute integrative psychiatric evaluation ($300), with follow-ups at $150; ask our team about lab costs. Whether Creyos is part of that fee or billed separately, and whether you take it at home or in the Arlington office, is confirmed when you book.

The cognitive baseline: what Creyos adds

If your clinician uses Creyos, you complete a set of short tasks on a computer or a tablet of 8 inches or more (phones are not recommended). Each task takes two to three minutes; the full 12-task battery runs about 40 minutes, though a clinician may choose a subset. Which tasks and questionnaires you’ll be given is something to ask our team.

The report shows where you fall relative to people your age in each area. That pattern can be informative. Slowed reasoning with intact memory points one way; poor short-term memory with normal attention points another. It cannot tell you why. Creyos is registered and listed with the FDA as a Class II, 510(k)-exempt computerized cognitive assessment aid; it is not FDA-cleared or approved and does not diagnose any condition.

One caveat matters here: the normative group was recruited online and was not screened for health conditions, and practice effects mean a second attempt tends to score a little higher. The guide to reading Creyos results explains the scores and the validity flag.

Labs: looking for medical contributors

Several common, checkable conditions list thinking problems among their symptoms. MedlinePlus lists “problems concentrating or thinking” with iron deficiency anemia, problems concentrating with low vitamin B12, and fatigue, feeling slowed down and low mood with an underactive thyroid. These are worth ruling in or out before attributing fog to stress or a psychiatric cause.

Labs are ordered based on your history, not as a standard bundle. If you already have recent results, bring them; there is no reason to repeat a normal test from last month. Lab costs depend on the tests and your lab or plan, which is worth asking our team about. If you are in Texas, insurance may cover medically indicated labs depending on the plan.

Sleep, mood and medications: the usual suspects

Sleep

In a large online study using these same tasks, people who reported about four hours of sleep a night performed roughly like people eight years older on overall cognition, while short-term memory held up. Before blaming anything else, it is worth knowing how you actually sleep. More in sleep and cognitive performance.

Mood and anxiety

Depression slows thinking and saps concentration, and anxiety crowds out working memory. Sometimes fog is the most noticeable sign of a depression the person hasn’t named. See cognitive symptoms of depression.

Medications

Some medications dull thinking, especially in combination. The AGS Beers Criteria, expert guidance for adults 65 and older, advise avoiding anticholinergic drugs and benzodiazepines in people with cognitive impairment because of their effects on the brain, and in a large cohort study the most common strong anticholinergics were tricyclic antidepressants, first-generation antihistamines and bladder medications. A structured psychiatric medication review looks at the whole list. Medication-related brain fog covers the common culprits. Please don’t stop a prescribed medication on your own; some need a gradual taper.

Fog after a viral illness is its own question, discussed in long COVID brain fog.

What happens after: a plan, not a promise

Results are reviewed with you and turned into a plan that follows what was found. That might mean treating a low iron or B12 level with your primary care provider, addressing a sleep problem, adjusting a medication with your prescriber, treating depression or anxiety, or nutrition and lifestyle work through functional and nutritional psychiatry. When medication choices have been difficult, GeneSight pharmacogenomic testing may add information.

We can’t promise to cure brain fog, and no one honestly can. Some causes resolve quickly once found; others improve gradually; sometimes the answer is managing a condition rather than eliminating it. If something outside psychiatry needs attention, such as a neurological concern, we will say so and point you to the right specialist.

A repeat cognitive assessment may be part of follow-up, so you and your clinician can compare with your baseline. When, and whether, is confirmed when you book. Keep the limits in mind: practice effects, sleep the night before and mood on the day all move scores. Retesting explained covers what counts as real change.

When brain fog needs urgent care instead

For gradual memory concerns in older adults, when to get memory concerns tested explains who to see first.

Who this is for and how to start

This evaluation suits adults (and teens 10 and up, with a parent) whose fog has lasted weeks to months and is affecting work, school or home, especially when it comes with low mood, anxiety, poor sleep, attention problems or a recent medication change. If your main questions are about why fog happens in general, our long-standing guide to brain fog, fatigue and mood swings is the better starting point.

Visits are in person in Arlington or by telehealth for patients physically in a state where Dr. Forbes is licensed. Insurance is accepted for Texas patients only, depending on the plan; elsewhere care is direct-pay with a superbill. See pricing and book through the consultation page.

Common Questions

Sources & Further Reading

• MedlinePlus — Anemia due to iron deficiency
• MedlinePlus — Anemia due to vitamin B12 deficiency
• MedlinePlus — Hypothyroidism
• Wild CJ et al. 2018, Dissociable effects of self-reported daily sleep duration on high-level cognitive abilities, Sleep (PubMed 30212878)
• 2023 American Geriatrics Society Beers Criteria update (PMC)
• Gray SL et al. Cumulative use of strong anticholinergics and incident dementia. JAMA Intern Med 2015 (PMC)
• Creyos — Understanding the Creyos Health Normative Database (PDF)
• Creyos — Report Interpretation Guide (PDF)
• FDA — Product classification PTY, computerized cognitive assessment aid, exempt

This article is general education, not a diagnosis or advice for your situation. Creyos results support, and never replace, a clinical evaluation; only a clinician who has evaluated you can diagnose a condition or recommend treatment. Do not start, stop, or change a medication without talking to the clinician who prescribes it.