Menopausal ‘brain fog’ or dementia?—a practical guide for clinicians

Cognitive symptoms commonly described by patients as menopausal 'brain fog' are increasingly recognised during the menopause transition and can cause significant distress, anxiety and concern about early dementia. This BMS Tool for Clinicians provides a practical clinical overview of how to distinguish menopause-related cognitive symptoms from mild cognitive impairment and dementia. Brain fog around the time of menopause is typically subjective, fluctuating and associated with perimenopausal symptoms such as sleep disturbance, vasomotor symptoms and mood change, while dementia is more likely to be progressive, objectively impairing and associated with functional decline. The Tool summarises key features for history-taking, assessment and escalation, including consideration of medical, psychological and lifestyle contributors. It highlights the importance of reassurance, education, management of modifiable factors, workplace support and appropriate use of hormone therapy where indicated. A structured approach can help clinicians validate patient concerns while identifying red flags that require further cognitive assessment or specialist referral.