Brain Fog Scale (BFS)

Abstract

The Brain Fog Scale (BFS; Atik & İnel Manav, 2023) is an inventory/questionnaire designed to objectively evaluate the level of brain fog, a condition characterized by moments of cloudiness, a lack of focus and mental clarity, difficulty thinking and multitasking, and problems with attention, concentration, speech, organization, and short- and long-term memory. Brain fog also involves fuzzy thinking, a state of confusion, and decreased mental sharpness, and is considered an altered state of consciousness where an individual is less wakeful and alert than usual. The BFS assesses three key dimensions of brain fog: cognitive symptoms, physical symptoms, and psychological symptoms. The development of the scale began with a literature review, leading to an initial pool of 33 items. These items were then evaluated by experts for intelligibility and relevance, and subsequently revised based on feedback. The refined measure was administered to a sample of individuals in Osmaniye, Turkey, with data collection taking 15-20 minutes per participant. Through factor analysis and item analysis, a 30-item scale with three distinct subscales was developed. The study also reported robust results concerning the reliability and validity of the BFS.

Keywords

Brain Fog, Cognitive Symptoms, Mental Clarity, Physical Symptoms, Psychological Symptoms

Authors

Atik, Derya; İnel Manav, Ayşe

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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 measure of this complex condition.

Validity

Content Validity: The content validity of the BFS was established through expert review. All items included in the final scale demonstrated a Content Validity Ratio (CVR) greater than 0.62, indicating strong expert agreement on their relevance. Additionally, two items were added to the scale and several items were reworded based on expert feedback during the initial development phase, which started with a preliminary scale of 35 items.

Construct Validity: The construct validity of the BFS is supported by the results of factor analysis, which confirmed the structural integrity and theoretical underpinnings of the measure.

Reliability

Internal Consistency: The Brain Fog Scale exhibited high internal consistency, with a Cronbach’s alpha coefficient of 0.945, indicating that the items within the scale are highly intercorrelated and measure the same construct.

Split-Half Reliability: The scale demonstrated strong split-half reliability, with a Spearman-Brown coefficient of 0.884 and a Guttman Split-Half coefficient of 0.874, suggesting consistency across different halves of the scale.

Test-Retest Reliability: A subsample of participants completed the BFS twice with a 30-day interval between administrations. The results showed a significant positive correlation between the two measurements (r=.952, p<0.001), indicating excellent stability of the scale over time.

Factor Analysis

Exploratory Factor Analysis (EFA): Principal components analysis with varimax rotation was utilized for the exploratory factor analysis. The results indicated that thirty items had a factor loading higher than 0.40, with loadings ranging from 0.522 to 0.895. The EFA yielded a clear three-factor structure (eigenvalues > 1), which collectively accounted for 77.437% of the total variance in the data, supporting the multi-dimensional nature of brain fog as conceptualized by the subscales.

Confirmatory Factor Analysis (CFA): While EFA was performed, no specific details on the results of Confirmatory Factor Analysis are provided in the text. However, the text mentions “Results of the factor analysis support the structural validity of the measure,” implying that CFA was likely used to confirm the structure identified by EFA.

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

Instrument: Brain Fog Scale (BFS)

• Test Type: Original

• Format: Items are 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 within the scale.

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

• Population Group: Human (Male and Female).

• Age Group: Adulthood (18 years and older).

• Population Details: The study participants were adults located in Osmaniye, Turkey.

• Test Methodology: The development and validation of the BFS involved comprehensive methodological approaches including: Test Validity, Construct Validity, Content Validity, Test Reliability, Internal Consistency, Split-Half Reliability, Test-Retest Reliability, Factor Analysis, Confirmatory Factor Analysis, and Exploratory Factor Analysis.

Keywords

Brain Fog, Cognitive Symptoms, Mental Clarity, Physical Symptoms, Psychological Symptoms

Authors

Atik, Derya

• Author ORCID Identifier: No data is Available

• Affiliation: Osmaniye Korkut Ata University, Faculty of Health Sciences, Department of Nursing

• Email Address: [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: Osmaniye Korkut Ata University, Faculty of Health Sciences, Department of Nursing

• Email Address: No data is Available

• Correspondence Address: No data is Available

Permissions & Fee and Test Year

• Permissions: Contact Corresponding Author.

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

• Test Year: 2023

References

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)

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).