What to explain
I would like to discuss whether anxiety, another health problem or both could be contributing to my brain fog. It began around this time, and these are the tasks that have changed. Could we review what needs checking and choose a treatment plan?
Questions to take in
- Which anxiety disorder, if any, fits my symptoms? What information is still missing?
- Could sleep, depression, trauma, pain, migraine, medicines or substances also be involved? Do the physical symptoms suggest a thyroid, standing-related or heart-rhythm problem?
- Which examination or test would answer the specific question? What would the result change?
- What could therapy or medication help with? What side effects, interactions and withdrawal effects matter for me?
- If I am pregnant, breastfeeding, trying to conceive or have recently given birth, how does that change the choices?
- Which changes in anxiety, sleep, concentration and daily life should we review, and when?
- What will we check if the anxiety improves but the thinking problem remains?
- Which changes need urgent help?
Questionnaires and checks to discuss
GAD-7 Anxiety Screener
Seven questions about the previous two weeks give a total from 0 to 21. A score of 10 or more often prompts a fuller assessment. Bring the item answers as well as the total.
Read the test guidePHQ-9 Depression Questionnaire
Nine questions record depression symptoms over the previous two weeks. Anxiety and depression can occur together. Report thoughts of death, suicide or self-harm directly.
Read the test guideMedication review
Include prescriptions, non-prescription medicines, supplements, inhalers, recent dose changes and missed doses. Caffeine, nicotine, alcohol, cannabis and other substances also matter.
Read the test guideSleep study
A full sleep study, or polysomnogram, records sleep stages, breathing, oxygen, heart rate and movements. Snoring, gasping, witnessed pauses and marked daytime sleepiness can give sleep testing a clear purpose. Some sleep-apnea tests use a portable device at home to check breathing and heartbeat.
Read the test guideThyroid function tests
Testing usually starts with TSH and may include free T4 or other tests. Symptoms, examination, medicines, pregnancy or postpartum changes and previous results help determine what is useful.
Read the test guideStanding heart rate and blood pressure
Measurements after lying down and while standing help assess symptoms that repeatedly worsen upright and ease on lying down. Bring existing readings with their position, time, symptoms and device details; do not keep repeating a test that makes you feel faint.
Read the test guideHeart-rhythm recording
A pulse reading shows rate. An ECG records the heart’s electrical activity, including its rate and rhythm. A portable ECG can record it over a longer period. Episodes that start and stop suddenly, feel irregular or occur with fainting or chest pain may need this assessment.
Read the test guideWhat to bring
Your GAD-7 answers, total, date and the language or version used. Include a PHQ-9 if you have completed one.
Three examples of tasks that changed: following a conversation, reading, cooking, working, driving, paying a bill or making an ordinary decision. Say whether you forget information, lose your place or feel detached.
A brief record covering up to seven days if it helps show the timing. Include relevant sleep, worry, panic, meals, substances, activity or period changes. Record useful events rather than monitoring every symptom all day.
Every medicine and supplement, including recent starts, stops, dose changes and missed doses.
Previous results and a short treatment history: what was tried, how long, what improved, unwanted effects and why it stopped.
A written note or trusted person if it is hard to remember and explain the main concern.
Put the problem that most affects safety or daily life first. Tell the clinician about the rest of your concerns too, so you can agree what to cover now and what needs a further appointment.
What helps the clinician distinguish the problems
Anxiety may be contributing when concentration repeatedly worsens during worry, panic or checking, or after sleep disrupted by anxiety. You may still complete a task by slowing down, rereading or asking for information again. Describe whether treatment changed those difficulties as well as the anxiety.
Other details may change the assessment: symptoms that remain when anxiety is quiet, progressive difficulty or a new neurological symptom. Describe recurring changes after standing or meals separately from when the problem first began, such as after an infection, head injury or medicine change. Snoring, gasping, morning headaches and marked daytime sleepiness deserve their own sleep history.
These observations help the clinician choose questions, examinations and tests. They are not a score for deciding whether the problem is “mental” or “physical.” Both can need treatment.
What the research numbers mean
A 2016 review combined 177 samples and 22,061 people. Higher anxiety was associated with poorer working memory. To combine different tests, the researchers put their results on a common statistical scale. The average effect, g = −0.334, was about a third of a standard deviation: a unit based on how much people’s test scores differ. The minus sign means higher anxiety went with lower scores. It does not mean that people lost 33.4% of their memory, or show what caused one person’s symptoms.
It included 2,740 adults from 15 US primary-care clinics. At the selected cutoff, sensitivity was 89% and specificity was 82%. Sensitivity describes how many people with the condition screened positive; specificity describes how many without it screened negative.
A 2025 Cochrane review covered 48 studies, 19,228 adults, 27 countries and 24 languages. Around the recommended cutoff of 10, average sensitivity for GAD was 64% and specificity was 91%. Results varied widely. A low score can miss GAD, and a high score still needs an interview.
The score describes anxiety symptoms, not memory or daily thinking. At follow-up, compare whether the person can do more, make fewer errors or complete the same work with less effort.
Age, pregnancy and screening
Children and teenagers need an age-appropriate assessment that includes their own account, school, sleep, physical symptoms, family observations and safety. In older adults, new confusion or decline also calls for review of medicines, sleep, pain, hearing, vision and other medical or neurological causes.
Pregnancy, breastfeeding and plans for pregnancy can change medicine risks and benefits. Include this information before starting, stopping or changing treatment. GAD-7 score bands do not differ between men and women, but interpretation still depends on the person's symptoms and circumstances.
In the US, the USPSTF recommends routine anxiety screening for ages 8–18 and adults aged 19–64, including pregnancy and after birth. Evidence is insufficient for routine screening at age seven or younger or at 65 and older. These recommendations concern people without recognized symptoms. They are not a reason to withhold assessment when someone has a problem.
If a broad panel of tests is not recommended
Anxiety is assessed from symptoms, history and their effect on daily life. A blood panel cannot establish the diagnosis. Ask which alternative explanations have already been checked and which still fit.
- Give the reason for the test you are asking about: a new weight change, palpitations, a medicine change, fever, symptoms on standing or another specific problem. Ask what the result would change. If testing is not useful now, agree which new or continuing symptoms should bring you back.
Where to get help
US United States
- Start with primary care or a licensed mental-health professional. Ask whether the service treats your type of anxiety, what sessions include, costs with your insurance and remote options. Primary care can also review the physical symptoms and medicines.
UK England
- Adults can self-refer to NHS Talking Therapies for anxiety and depression without an existing diagnosis. Most services accept people aged 18 or over; some accept 16- and 17-year-olds. A GP can review physical symptoms, medicines, pregnancy-related questions or other health conditions.
AU Australia
- A GP can assess the symptoms and discuss a Mental Health Treatment Plan. Eligible people may receive Medicare support for up to ten individual and ten group sessions per calendar year. Referral and review requirements apply, and a gap payment may remain. Ask about the cost before booking.
At follow-up
- Compare the particular changes you agreed to review: anxiety, sleep, concentration, memory, detachment and ordinary tasks. Explain what helped, how long any change lasted and which difficulties remain. Bring that account even if the questionnaire score improved.
Sources behind this handout.
- 01
NICE CG113: GAD and panic disorder in adults
Source - 02
NIMH generalized anxiety disorder overview
Source - 03
NIMH: mental-health medicines
Source - 04
Heart Rhythm Society consensus on POTS
Source - 05
NHS: underactive thyroid
Source - 06
NHS: heart palpitations
Source - 07
NHS: when a seizure needs an ambulance
Source - 08
NHS Greater Glasgow and Clyde: serotonin syndrome
Source - 09
Spitzer et al.: validation of the GAD-7
Source - 10
Aktürk et al.: GAD-7 and GAD-2 diagnostic accuracy
Source - 11
Kroenke, Spitzer and Williams: the PHQ-9
Source - 12
NHLBI: sleep studies
Source - 13
NHS: sleep apnoea
Source - 14
NHS: overactive thyroid symptoms
Source - 15
NHS: electrocardiogram
Source - 16
Friedemann Smith: safety-netting advice
Source - 17
GAD executive functioning systematic review and meta-analysis
Source - 18
Eysenck et al.: attentional control theory
Source - 19
Moran: anxiety and working memory
Source - 20
USPSTF: screening for anxiety in adults
Source - 21
USPSTF: screening for anxiety in children and adolescents
Source - 22
NHS: self-referral for talking therapies
Source - 23
Healthdirect: mental-health treatment plans
Source