Attention & cognition

Attention problems and brain fog: measure first

Silvia A. Bernardi, M.D. · Psychiatrist & Neuroscientist · New York & Milan · Updated October 2026

“I can't focus” has many causes. ADHD is one. So are depression, anxiety, poor sleep, medication side effects, thyroid problems, substance use, long COVID — and the hormonal transition of perimenopause, when many women notice for the first time that words, names and concentration slip. Treating attention without measuring it risks treating the wrong thing.

A measurement-based approach

Evaluation combines a full psychiatric history with objective measurement. MindFirst Neuropsychology is an at-home cognitive assessment that measures sustained attention, working memory, processing speed, verbal memory and executive function, with reaction times on every task. Sleep data from your wearable shows whether the nights explain the days. Because the testing can be repeated with parallel versions, we can compare performance on and off a medication, rather than relying on impressions.

Perimenopausal brain fog

Cognitive complaints in perimenopause are real and common. They are linked to fluctuating estrogen, disrupted sleep and night sweats, and mood changes, and they usually do not mean a degenerative process. Measurement helps separate what is attention, what is memory, and what is sleep — and coordination with your gynecologist about hormonal treatment is part of the plan.

When it is ADHD

When the history and the measurements support ADHD, treatment options include stimulant and non-stimulant medications, chosen and dosed with follow-up measurement, and practical strategies for structure and organization.

Research behind the approach

Adult ADHD has been a research focus for Dr. Bernardi since her training in Florence with Stefano Pallanti. With Carlos Blanco's group at Columbia, and with Stephen Faraone and Samuele Cortese, she published national epidemiological studies of adult ADHD — its lifetime impact, and how it differs between women and men. That work is why this practice pays particular attention to women, whose attention difficulties are often recognized late, sometimes only when perimenopause removes the compensation that held them together.

Questions

How is adult ADHD diagnosed?
Through a careful history of attention problems beginning in childhood and their effect across settings, ideally combined with objective cognitive testing and evaluation of other causes such as depression, anxiety, sleep problems and medications.

Is perimenopause brain fog real?
Yes. Many women experience difficulties with word-finding, concentration and memory during perimenopause, linked to hormonal fluctuation, sleep disruption and mood changes. These symptoms usually improve and are not typically a sign of dementia.

Can cognitive testing show whether ADHD medication works?
Repeating parallel versions of objective attention and memory tasks on and off medication gives a measurable comparison of the medication's effect, alongside the patient's own experience.