Cognitive Fatigue

Cognitive fatigue is one of the most common and long-lasting symptoms after a brain injury. It can happen early on, after a mild, moderate, or severe brain injury. In fact, up to 73% of brain injury survivors report cognitive fatigue averaging 5 years after sustaining their injury. Cognitive fatigue is also one of the least understood conditions by others around you, even your caregiver. They are generally wondering while frustrated why you are tired, you have not done much. But the ongoing sluggish performance of the brain hijacks all your energy, and leads to a unique kind of tiredness and fatigue all over.

So, what exactly is cognitive fatigue? Those who have sustained brain injuries can describe cognitive fatigue as a sense of mental and physical tiredness, exhaustion, lack of energy, and low vitality. Physical observations include yawning frequently, and sometimes an appearance of confusion, or easily losing attention and concentration. But that’s not all. It impacts the whole body like physical tiredness, except it’s your mind instead of your muscles. On a cellular level, it is believed to be caused by high levels of inflammation and changes to hormones that determine your mood, energy, and focus.

It is important to note that different people have different levels of stamina, and so, after a brain injury, that usual level of stamina drops according to the severity of your brain injury. It is also important to note that various factors can contribute to increased cognitive fatigue after brain injury. This includes focusing on a mental task for a while, and using higher thoughts. You can also feel this kind of brain drain if you’re on alert or stressed out. Other things that can exacerbate cognitive fatigue include overworking, lack of sleep, stress, and spending too much time on the computer and cell phone.

Our experience

For me, cognitive fatigue happened early on after my accident, and again after my brain surgery. But I kept powering through it, as if it was part of recovery time, and without knowing what or why this was happening. This lasted for several years each time, but resolved itself in both cases. Sarah, on the other hand, still reports cognitive fatigue to date, 23 years later. But in Sarah’s case, she had the initial brain hemorrhage, followed shortly by 2 back-to-back sessions of Gamma Knife radiation surgeries, and 3 more every 5-7 years thereafter. So, her brain was battered and cooked on a frequent basis, and sometimes it felt like multiple brain injuries. In any case, and as we keep iterating, no two brains are alike, and each brain injury is unique.

Over the years, Sarah has developed a dynamic sort of remedies, according to what was happening at any given time. Generally, when cognitive fatigue happens, she tries to sleep it off, but what happens when you wake up with cognitive fatigue? That seems to be the hardest part. Remember, cognitive fatigue is the result of a sluggish or tired brain, and it can happen anytime. So, here are some of the common remedies to keep in mind.


The worst part about cognitive fatigue is that you can not control when it happens and how long it will last. But there are things that you can do to help the symptoms, as preventative remedies. There are also things that you can do to combat cognitive fatigue when it happens. Please note that some of those remedies might appear as a suggestion that brain injury survivors should step away from any mental and even physical challenge. That is not true, the general remedies for cognitive fatigue are the acknowledgment that brain injury survivors are now playing a game of what you can get and when you can get it done. This is like saying you are working with a less than standard battery life, so what you can do will depend on the current status of your battery life.

Here are some general tools and options to help those affected by cognitive fatigue after brain injury. Be frugal about how you spend your time, as a preventative measure, and limit your tasks to low-yield activities when you are feeling those cognitive fatigue events. Try the time-box technique, where you break down projects or daily tasks into set periods of time, which allows you to accomplish more than you would with less organization. Also, get rid of unnecessary distractions, give your eyes a break, reduce cognitive fatigue with exercise, and take time off. Most important, get enough sleep.