Dear Katie -

Hi, and welcome to the forum. What you've described is a problem for a lot of us. Myself included. Over the years, many people have posted on it, often using a term with which there's immediate mutual recognition: "brain fog."

The best study that was done on this is reported in an article that is freely available of the RSDSA website: Neuropsychological deficits associated with Complex Regional Pain Syndrome, Libon DJ, Schwartzman RJ, Eppig J, Wambach D, Brahin E, Peterlin BL, Alexander G, Kalanuria A, J Int Neuropsychol Soc. 2010 May;16(3):566-73. Epub 2010 Mar 19. (Right-click on the highlighted title to open the article in a new tab.) While the article is pretty technical, its key findings, based on comprehensive neuro-psych testing of 137 RSD/CRPS patients is straightforward once you understand a single term, "Executive functions," which the Wikipedia article of the same name defines as follows:

Executive functions is an umbrella term for cognitive processes that regulate, control, and manage other cognitive processes, such as planning, working memory, attention, problem solving, verbal reasoning, inhibition, mental flexibility, task switching, and initiation and monitoring of actions. The executive system is a theorized cognitive system in psychology that controls and manages other cognitive processes. It is responsible for processes that are sometimes referred to as executive functions, executive skills, supervisory attentional system, or cognitive control. The prefrontal areas of the frontal lobe are necessary but not sufficient for carrying out these functions.

http://en.wikipedia.org/wiki/Executive_functions

So with that, here are the key findings of Neuropsychological deficits associated with Complex Regional Pain Syndrome:

Approximately 35% of patients presented with no neuropsychological impairment (CRPS group1). The remainder of our sample presented with either mild dysexecutive deficits (CRPS group 2; 42% of patients) or a more global profile of cognitive impairment involving reduced performance on tests that assess working memory/mental search (executive tests) along with problems on tests of naming and memory (CRPS group 3; 22% of patients). It is important to mention that, as far as we could determine, these patterns of neuropsychological impairment are independent of the spread of CRPS (i.e., number of limbs involved), illness duration, and medication use.

Bottom line: roughly 2/3's of CRPS patients have either mild or significant impairment of their "executive functioning" - showing up as anything from a loss or organizational skills to a loss of working memory and/or mental search skills - and of that larger group, another 1/3rd have more general problems of recalling names or other memory issues.

Lucky me, I'm in the 22% of the patient population with BOTH ISSUES, and get to walk around with a diagnosis of "mild cognitive impairment." Now, I can still read and understand technical papers, but if you tell me that tomorrow is Wednesday, and I know I have an appointment Wednesday morning, I may very well not realize that my appointment is tomorrow! I'm disorganized to the point that I rarely complete anything I start (certainly if left to my own devices) and can easily become confused in just sorting out ten separate pieces of paper. Then too, I will probably not be able to recall without prompting the name of a movie I saw two weeks ago. (Whereas, in a prior life, I was a business bankruptcy attorney who could if called upon write out a detailed affidavit about everything that was said in a phone call with an opposing counsel three weeks beforehand, when at the time the cal didn't seem important enough to warrant taking notes in the first place.) At my worst, until I started a new treatment, I could often recall the substance of a conversation I had only two days earlier, without having any idea of who I had been speaking with! (And based on the report of my psychiatrist, my most significant humiliation occurred a couple of years ago, when I qualified for SSD along with a recommendation from the reviewing physician that I not be in charge of the administration of my own benefits.)

That said, I have been lucky in getting good medical treatment. I've been on Wellbutrin and Namenda for quite a while and can't even imaging where I would have been without them. But my big break came last summer when - first under the supervision of my treating psychiatrist - I began hooking a 9-volt battery to my head in something called Transcranial Direct Current Stimulation (tDCS) in an attempt to alleviate the pain, spasms and other physical side-effects of CRPS. And I did so along with a number of other people on this forum, through a long running thread called t.D.C.S. Update Could remission be within my reach and your's too? http://neurotalk.psychcentral.com/thread160980-12.html But in a short while, I ran into some technical issues with the use of my tDCS device, and was persuaded to go to Atlanta to see a psychiatrist/pain management physician who specialized in the use of TDCS, James Fugedy, MD.

In Atlanta, I learned that while all of our attention on tDCS was on its application to the motor cortex in our attempts to control pain, it could also be used on a part of the brain closer to the forehead - the "dorsolateral prefrontal cortex" - in order to improve executive functioning. And indeed, there are a lot of published studies that support its use in this regard. But there are also a number of good articles that are accessible to people without medical training. These include to the following:

1. Amping Up Brain Function: Transcranial Stimulation Shows Promise in Speeding Up Learning. Fields RD (2011). Scientific American.

2. Brain Zaps Improve Math. Carpenter, J. (2010). Science Now.

3. TDCS guided using fMRI significantly accelerates learning to identify concealed objects. Clark VP et al (2012). NeuroImage; 59(1): 117–128. [AND]

4. Zap your brain into the zone: Fast track to pure focus. Adee, S (2012). New Scientist, Issue 2850.

I've been using it now for about four months. And while my level of organization is nowhere near recovered, I can tell and people have told me that my word recall is much better, I'm much sharper and faster in conversations than I was, and that gradually, I am in fact doing a much better job of staying on task. And at least for the last few months, I can recall with whom I had that conversation!

Apologize for barraging you with all this information (I tend to do that and regret that on occasion it's brought a few threads to a screaming halt) but in this case, you have asked about a topic that is near, if not dear, to my heart.

Please take a look at the tDCS thread (but be warned that it's now up to 12 pages and 460 posts) and if its of interest to you, hopefully you can have the opportunity to pursue it with a physician who has some familiarity with tDCS, where there is an antibiotic of all things - Seromycin (cycloserine) - that has been shown to greatly increase brain plasticity and thereby the effectiveness of tDCS. I would be more than happy to post links to articles from medical journals to that effect, as well as other "peer-reviewed" journal articles on the benefits of tDCS, should you be interested in either seeing or sharing them with a physician.

I hope this is useful and not too overwhelming.

Mike