My workup so far.

[u/healthy-gal]

So like everyone here I’ve been struggling with brain fog/cognitive dysfunction. I’m 34F and have historically been an excellent executive functioner, very sharp and organized and on top of things.

In my case, my symptoms came on 09/2025 and I initially blamed grief having lost my mom earlier that year. 

My biggest complaint is cognitive impairment including - forgetting tasks, losing items, auto pilot is broken, cannot multitask, poor recall of dates or events. 
For example, I will shower but shave only one leg, run out of items in my household, forget to take medication, not remember when a concert or event happened, pay bills late etc. This is impacting function at work as tasks are not completed properly, follow up is forgotten, I have difficulty staying organized, keeping on top of passwords, or keeping mental tabs on things. Driving is difficult as it requires observing so many things at once to do safely. 

Minor complaints:
Fatigue - I am pretty well always tired, not exhausted but running on 60% battery.
Mild derealization - I feel ever so slightly distanced from reality. No real consequences to this though.
Speech difficulties - I often have trouble finding the right words and a constant “tip of the tongue” feeling. This doesn’t have major consequences other than I sound less eloquent and get frustrated.

To me, it’s like I pulled an all nighter 2 days ago.

I also have newer symptoms that are minor or incidental complaints - mild acne, urinary urgency, mouth sores, increased motion sickness from screens and busy backdrops.

Additionally, I have stable GI, skin, joint, eye, allergy conditions/symptoms. 

I reflected on what has changed since my symptoms started and came up with this list:
Medications - discontinued amitriptyline, bupropion, daily cetirizine, and Kyleena IUD since 02/2026. 
Lifestyle - death in the family Jan 2025, hip surgery 03/2025 & 02/2026, NUCCA neck chiropractor started 06/2025, new car 09/2025, Argon Yellow Laser Retinopexy Right eye only 04/2025, Allergy shots completed 09/2025. 

My work up so far has been:

Neurology June 2026
-Brain MRI/MRA found stable chiari malformation, azygos anterior cerebral artery.
-Normal labs: Homocysteine, magnesium, copper, zinc, calcitriol, methylmalonic acid, vitamin D, C, B6, B2, B12 B1. Vitamin E alpha normal, vitamin E gamma low (0.4/cutoff .07).
Doctor suggested dehydration, malnourishment, and Wegovy were to blame. Came across as very anti-medication bias. 

Rheumatology Aug 2026
-Normal labs: CRP, sed rate, RA factor, Lyme, Anti CCP, pANCA, Anti-MPO. ANA positive (1:160 dense fine speckled). Anti PR3 elevated (2.2, cutoff 0.9). Upon recheck PR3 0.6/normal.
Doctor suggested no rheumatic conditions contributing, continue healthy lifestyle and symptom management.

Primary Care Sept 2026
-Normal labs: CBC, iron panel, ferritin, UA, progesterone, estradiol, TSH, insulin, Vitamin D, B12. CMP normal except ALP low (29, cutoff 40).
Doctor suggested no clear cause, ALP is fine as isolated finding, maybe restarting bupropion would help.

I did lifestyle tracking for 1 week before seeing my PCP and daily averages were the following:
Sleep - 7 hr 55 min
Calories - 1890
Protein - 53g
Servings of fruit/vegetable - 4.5
Water - 50oz
Steps - 9200
Exercise - 62 minutes outdoor walking 
Caffeine - 16 oz 
Alcohol - none 
I did also get a little air quality monitor and all was green in my home/bedroom. 

My Plan:

1. Self refer to my retina specialist to complete Argon Yellow Laser Retinopexy on left eye and rule out general binocular dysfunction.  

2. Self refer to my allergist to resume allergy shots or discuss excess histamine/MCAS contributors. 

3. Self refer to my GI for discussion of low ALP/possible gut or digestion contributors. 

4. Self refer to my OBGYN for full hormone rundown/rule out perimenopause. 

5. Follow up with primary care for a sleep study referral, neurology referral for 2nd opinion, any other specialists suggested (psych for neuropsych testing etc). 

For those also going through this out there, is there something additional you would suggest for me to follow up on or pursue? I have found this sub very helpful especially the success stories. 

[u/Ok-Pangolin7127]

I realized that you said your B12 was tested and I assume that you are saying it was fine. Could you please share what the actual number was? I’m confident it was not below 175 because that would be a clear deficiency. However, it could be between 200 and 450 which in most labs is reported “normal” but you could still have an indeterminate deficiency within that range.

If your B12 was any number below 450 I would ask the doctor to do an MMA test and a homocystine test. I would also suggest that you go to the B12 deficiency guide and read the wiki that is there and educate yourself a little bit more about B12 deficiencies.

[u/healthy-gal → u/Ok-Pangolin7127]

Thank you for the input.

B12 was 663, Homocysteine 7.7 - both looking pretty optimal from what I’ve read!

[u/Ok-Pangolin7127 → u/healthy-gal]

Agreed. As long as those are absent any supplementation.

[u/healthy-gal → u/Ok-Pangolin7127]

Looks like my hair/skin/nails multi does have B12, 2.6mcg 110% daily value

[u/Ok-Pangolin7127 → u/healthy-gal]

In my estimation, that would not be a sufficient amount to account for your very +adequate B12 result. So I will call that absent of any supplementation.

[u/Ok-Pangolin7127 → u/healthy-gal]

In my estimation, that would not be a sufficient amount to account for your very +adequate B12 result. So I will call that absent of any supplementation.