People love to say anxiety is just worry. Or fear. Or overthinking. Like it’s something you can talk yourself out of if you try hard enough. But that explanation barely scratches the surface. Because anxiety doesn’t start with thoughts. A lot of the time, it starts in the nervous system, Dr Kunal Bahrani, Chairman and Group Director, Neurology – Yatharth Hospitals told TOI Health.
Here’s what stress does to your health
This is why anxiety can feel so frustrating. You know you’re safe. You know nothing bad is happening. You’ve told yourself that a hundred times. But your body doesn’t believe it. Because anxiety isn’t a logical problem. It’s a regulation problem.You can think rationally and still feel anxious. You can understand your triggers and still react. You can do everything “right” and still have symptoms. That doesn’t mean you’re failing. It means your nervous system needs support, not judgment.Seeing anxiety as neurological shifts the conversation. It moves us away from blame and toward understanding. To help us understand this better, Dr Kunal Bahrani has shed light on a few questions.
How do anxiety, brain fog, and memory issues overlap, and when should someone suspect a neurological cause rather than just stress?
Anxiety and stress can genuinely create brain fog because the brain stays in a constant alert mode. Sleep becomes lighter, attention gets scattered, and the mind keeps multitasking internally, so the brain doesn’t properly register or store information. That’s why memory feels weak: often the issue is poor focus and low mental energy rather than true memory loss. People may also feel heaviness in the head, restlessness, and mental exhaustion, which further reduces clarity. A neurological cause should be suspected when symptoms are sudden, progressive, or unexplained, especially if they worsen over weeks to months despite rest. Red flags include episodes of confusion, fainting, seizures, new imbalance, weakness or numbness, slurred speech, vision changes, severe new headaches, personality change, or memory lapses that disrupt daily functioning. In such cases, medical evaluation becomes important. 
What kinds of neurological conditions most commonly present with symptoms that look like anxiety or “brain fog”?
Some neurological and related conditions often appear “psychological” at first because they affect energy, cognition, and mood. Migraine is a common cause, people can experience mental slowing, sensitivity to light/noise, dizziness, and fatigue even without a classic headache. Focal seizures can mimic panic attacks, causing sudden fear, strange sensations, blank spells, or confusion afterward. Post-concussion syndrome, multiple sclerosis, and sleep disorders are also causes for persistent fog, poor focus, irritability, and memory trouble. Less commonly, inflammatory brain conditions, autoimmune disorders, or infections can begin with mood change and cognitive symptoms. Medication side effects (sedatives, some allergy medicines) and post-viral fatigue states can also create prolonged fogginess.
How can someone tell the difference between normal worry and anxiety that may be linked to brain health or a neurological issue?
Normal worry is usually linked to a real situation and reduces once the issue improves or a plan is made. It may feel unpleasant, but daily functioning remains mostly intact. When anxiety is linked to brain health or neurological causes, it may feel different: sudden onset without a clear trigger, worsening over time, or appearing alongside neurological signs like imbalance, numbness, unusual headaches, tremors, speech changes, or vision disturbance. Another clue is pattern, if episodes are brief, stereotyped, and repetitive with confusion or exhaustion afterward, it may suggest migraine or seizure-like activity rather than only anxiety. Also, if someone feels “mentally slow,” disoriented, or unusually forgetful despite low stress, it deserves attention. Persistent symptoms that don’t improve with rest and routine changes should be evaluated.
What are the most effective ways to diagnose whether these symptoms are stress-based or neurologically based?
The best diagnosis starts with a detailed history, onset, progression, triggers, sleep quality, recent infections, head injury, medication use, alcohol/substance use, and family history. A clinician will check for warning signs through a neurological exam balance, reflexes, strength, sensation, speech, and memory. Medical screening tests are important because many physical causes mimic anxiety and fog: CBC, thyroid profile, vitamin B12, iron studies, vitamin D, blood sugar, and electrolytes. If cognitive symptoms are prominent, cognitive screening or formal neuropsychological testing helps separate attention-based “pseudo-memory” problems from true memory impairment. Depending on symptoms, tests like MRI brain, EEG (for suspected seizures), or a sleep study (for sleep apnea) may be recommended by your doctor.
What practical steps can people take right now to support brain health and reduce symptoms?
For memory, reduce overload, single-task instead of multitask, write reminders, keep fixed spots for essentials, and break work into short focus blocks with brief breaks. Stress regulation matters like slow breathing, grounding techniques, and limiting constant notifications can lower mental noise. If symptoms continue, review medication side effects, alcohol intake, and sleep quality. People should also consider simple medical checks like thyroid, B12, and iron, since deficiencies commonly cause fog. If red flags appear, confusion episodes, weakness, speech/vision changes seek medical evaluation promptly rather than self-managing.Medical experts consulted This article includes expert inputs shared with TOI Health by: Dr Kunal Bahrani, Chairman and Group Director, Neurology – Yatharth HospitalsInputs were used to explain how anxiety is not just about emotions; rather it can be due to brain-based causes.Do you have any questions you’d like us to ask a doctor? Let us know in the comment box below.