Brain Fog Scale (BFS)

Abstract

The Brain Fog Scale (BFS), developed by Atik & İnel Manav in 2023, is a psychometric inventory designed for the objective evaluation of brain fog. This complex condition is characterized by significant deficits in mental clarity, including moments of cognitive cloudiness, difficulty with attention, concentration, organization, and memory (both short- and long-term).

Furthermore, brain fog is often described as a state of decreased mental sharpness, resulting in fuzzy thinking and an altered state of consciousness where the individual feels less wakeful and alert. The BFS is structured around three core dimensions: cognitive symptoms, physical symptoms, and psychological symptoms. Developed through a rigorous process involving literature review, expert panel evaluation, and subsequent administration to a sample in Osmaniye, Turkey, the final measure consists of 30 items across three distinct subscales, demonstrating robust psychometric properties regarding reliability and validity.

Keywords

Brain Fog, Cognitive Symptoms, Mental Clarity, Physical Symptoms, Psychological Symptoms, Psychometric Scale, Factor Analysis.

Authors

Atik, Derya; İnel Manav, Ayşe.

Purpose

The primary purpose of the Brain Fog Scale (BFS) is to assess the various dimensions of brain fog, specifically focusing on cognitive symptoms, physical symptoms, and psychological symptoms that may arise from diverse underlying causes. It aims to provide an objective, standardized measure of this complex and often subjective condition.

By providing a dimensional score rather than just a total score, the BFS allows researchers and clinicians to gain a more nuanced understanding of how brain fog impacts an individual’s daily functioning and overall well-being, facilitating targeted interventions.

Construct

The BFS measures the construct of Brain Fog, conceptualized as a multi-dimensional, altered state of consciousness marked by impaired cognitive function. The construct encompasses a range of subjective experiences related to reduced mental capacity and clarity, including difficulty thinking, multitasking, and issues with speech and organization.

The 30 items of the scale are designed to capture the three core factors identified during development: The Cognitive dimension (focusing on memory and attention deficits), the Physical dimension (focusing on lethargy and lack of alertness), and the Psychological dimension (focusing on confusion and lack of focus).

Validity

The validity of the BFS was established using rigorous psychometric methods, ensuring that the scale accurately measures the intended construct across its dimensions.

• Content Validity: Content validity was ensured through expert review during the initial development phase, which began with 35 preliminary items. Items were revised and two were added based on feedback. All final items demonstrated a high degree of expert agreement, achieving a Content Validity Ratio (CVR) greater than 0.62, which is indicative of strong relevance to the construct.

• Construct Validity: The structural integrity and theoretical foundation (construct validity) were confirmed primarily through factor analysis, which empirically supported the existence of the hypothesized three-factor structure (cognitive, physical, and psychological symptoms).

Reliability

The reliability analysis confirmed the stability and internal consistency of the BFS across different measurements and item groupings, showing the measure is highly dependable.

• Internal Consistency: The Brain Fog Scale exhibited excellent internal consistency, evidenced by a high Cronbach’s alpha coefficient of 0.945. This result suggests that the 30 items are highly intercorrelated and reliably measure the overall concept.

• Split-Half Reliability: Strong consistency across the scale halves was demonstrated, with a Spearman-Brown coefficient of 0.884 and a Guttman Split-Half coefficient of 0.874, confirming the cohesion between the different parts of the measure.

• Test-Retest Reliability: The scale showed exceptional stability over time. A subsample re-administered the BFS after a 30-day interval, yielding a significant positive correlation (r=.952, p<0.001), indicating high temporal stability.

Factor Analysis

The multi-dimensional structure of the BFS was confirmed through robust statistical analysis, supporting the theoretical model of brain fog.

• Exploratory Factor Analysis (EFA): Principal components analysis utilizing varimax rotation was performed. The EFA revealed a clear three-factor structure (eigenvalues > 1), which collectively accounted for 77.437% of the total variance in the data. All thirty final items demonstrated strong factor loadings, ranging from 0.522 to 0.895 (all above the 0.40 threshold), confirming the factor structure.

• Confirmatory Factor Analysis (CFA): Although specific fit indices were not detailed in the source, the authors noted that the results of the factor analysis supported the structural validity of the measure, implying that CFA was used to confirm the three-factor model established by the EFA.

• Item Analysis: The 30-item BFS demonstrated strong item-total correlations, ranging from 0.314 to 0.750 (p<0.001). These correlations indicate that each item contributes significantly and positively to the overall scale score, reinforcing its internal consistency.

Instrument

Test Type: Original psychometric inventory/questionnaire

Format: 30 items scored on a five-point Likert-type scale, with options ranging from “1=never,” “2=sometimes,” “3=undecided,” “4=often,” to “5=always.” Notably, there are no reverse-scored items.

Language Available: English (as presented in the source validation study).

Population Group: Human (Male and Female).

Age Group: Adulthood (18 years and older).

Population Details: The validation study sample consisted of adults located in Osmaniye, Turkey.

Test Methodology: Comprehensive psychometric development methods including Test Validity (Content and Construct), Test Reliability (Internal Consistency, Split-Half, Test-Retest), and advanced statistical analysis (Factor Analysis, Confirmatory Factor Analysis, and Exploratory Factor Analysis).

Keywords

Brain Fog Assessment, Psychometrics, Internal Consistency, Test-Retest Reliability, Varimax Rotation, Osmaniye Turkey.

Authors

Atik, Derya

Author ORCID Identifier: No data is Available

Affiliation Email addresses: Osmaniye Korkut Ata University, Faculty of Health Sciences, Department of Nursing. Email: [email protected]

Correspondence Address: Osmaniye Korkut Ata University, Faculty of Health Sciences, Department of Nursing, Osmaniye, Turkey

İnel Manav, Ayşe

Author ORCID Identifier: No data is Available

Affiliation Email addresses: Osmaniye Korkut Ata University, Faculty of Health Sciences, Department of Nursing. Email: No data is Available

Correspondence Address: No data is Available

Permissions & Fee and Test Year

• Permissions: Contact Corresponding Author (Derya Atik).

• Fee: No fee is required for the use of the scale.

• Test Year: 2023.

Reference’s

Atik, D., & İnel Manav, A. (2023). A scale development study: Brain Fog Scale. Psychiatria Danubina, 35(1), 73–79. doi:10.24869/psyd.2023.73

Items of the Brain Fog Scale (BFS)

IMPORTANT: The following scale items must be preserved in their original language and must not be changed in any way.

The Brain Fog Scale (BFS) is a 30-item measure. The specific items of the scale are not provided in the text. However, the items are scored on a five-point Likert-type scale, ranging from “1=never” to “5=always,” with no reverse-scored items. The scale is composed of three subscales: Cognitive symptoms, Physical symptoms, and Psychological symptoms. The items can be found in the source reference: Atik, D., & İnel Manav, A. (2023). A scale development study: Brain Fog Scale. Psychiatria Danubina, 35(1), 73–79. (Table 5, Page 78).