What was I just saying? 9 reasons you can't focus

You walk into a restaurant to meet a friend and remember you were supposed to meet somewhere else. You leave your boss's office and, quick as that, forget the deadline she gave you for a new project. You had your keys in your hand, you were just holding them, and now they're gone — again. What's going on? Here, nine possibilities for why your mind is wandering, and expert advice on how to get your concentration back.

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1. Your numbers are low.
Fuzzy mindedness could signal a vitamin or hormone deficiency, especially if you're also feeling unusually tired. For example, hypothyroidism – too-low levels of thyroid hormone – could be to blame, says Robert Orford, MD, consultant at the Mayo Clinic's Preventive Medicine Division in Scottsdale, AZ. "If there's a deficiency in thyroid hormone, metabolism slows, which reduces blood flow and cellular function in various parts of the brain," Dr. Orford says. B-12 deficiency and related anemia can have similar symptoms. Most people get plenty of B-12 in their diet, but an underlying condition such as Crohn's or celiac disease can prevent your body from absorbing it.

Try this: Schedule an appointment for a physical with a doctor who'll take time with you. Make a list of any other health changes you've noticed that could help pinpoint the source of your problems concentrating. "You want a comprehensive medical exam, including blood tests," says Dr. Orford. Also ask your doctor to test for cardiovascular risk factors such as hypertension, high cholesterol, metabolic syndrome or prediabetes: if left untreated, they can cause cognitive decline.
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2. Your hormones have gone haywire.
If you're nearing the end of your baby-making years, your inability to think clearly may signal the start of perimenopause — that run-up to menopause when menstrual cycles become irregular and estrogen drops. Lack of concentration is a common complaint of perimenopausal women, says Kimberly Pearson, MD, a psychiatrist at Massachusetts General Hospital's Center for Women's Mental Health. "They describe it as feeling fuzzy. That's the word a lot of women use. They feel like their vocabulary is diminishing, like they're not as sharp, not as crystal clear."

Try this: If other signs point to perimenopause (hot flashes, night sweats, vaginal dryness), consider short-term hormone replacement therapy to get you over the hump. "Women who go on replacement notice such a shift," says Dr. Pearson. "They say, 'Oh my God, I have my brain back.'" If HRT is out because of the health risks involved, ask your doctor about the possibility of taking a low-dose, concentration-boosting stimulant such as Ritalin instead. "And exercise seems to help everything," says Dr. Pearson.

3. You've changed your meds.
Anti-depressants can affect mood and concentration when you go on or off them. Antihistamines, sedatives, and anti-anxiety medications can cause lingering drowsiness, and antidepressants, beta blockers, and other medicines can cloud your mind. People who take statins sometimes notice a loss of mental clarity, says Dr. Orford. A daily dose of Coenzyme Q10 may counteract this effect. As for sleeping pills — please.
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Try this: Write down all the meds you take or recently stopped taking and review this list with your doctor. Ask if any of them are known to cause concentration problems when people go on or off them, or mix them with other medications, or take them long term. Educate yourself about the drugs on your list so you can have a more fruitful discussion. Go to the National Library of Medicine's PubMed Health, MedLine Plus, and DailyMed Web sites for good information.
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4. You're quitting smoking.
Yaaay! Two things to remember when you're tempted to cheat: 1. The more and longer you smoke, the more gray matter you lose. That's proven. The sooner you quit, the more you maintain. 2. Yes, you'll have trouble concentrating as you go through nicotine withdrawal, says Christopher Kahler, PhD, professor of behavioral and social sciences in the public health program at Brown University. It's a common complaint. But that passes, and the mental-health boost you get from quitting more than compensates: You did what? You quit smoking? Wow. "There's a lot of psychological benefit to it," he says.

Try this: The happier you feel when you tackle quitting, the more likely you are to succeed, says Kahler. His tips for boosting mood: Track three good things that happen to you each day and write about them each night. Write a letter of thanks to someone you never thanked for something and deliver it. If you can spend some of the money you save by not smoking, skip the material purchases and do something fun with a friend. Shared experiences generate lasting happiness.

5. Your diet has deteriorated.
What you eat can have a major impact on mental clarity, says Laura Middleton, PhD, assistant professor of kinesiology at the University of Waterloo in Ontario. Bad eating habits increase your risks of obesity, hypertension, high cholesterol and related ills that can impair cognitive function, and being overweight or obese makes it harder to stay active, which is essential for brain health.

Try this: Middleton's motto is "If it's good for the heart and cardiovascular system, it's good for the brain." She advises sticking to the principles of the Mediterranean Diet: A diet high in fish and vegetables and lower in meat, saturated fat and processed foods. If sweets and other junk food are your downfall and you're able to cut back, magic can happen: Brain fog, energy crashes, hunger pangs may dissipate.
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6. You think busy means fit.
You may be incredibly busy, but if you're stuck at a desk or behind the wheel of a car most of the day, you won't be engaged in the kind of physical activity your mind needs. To stay sharp, you need to keep moving. Among other things, exercise increases production of a substance called brain-derived neurotrophic factor that helps the brain rewire itself and slows formation of plaques that accompany Alzheimer's disease. Start exercising, and you could feel sharper and more able to focus within a month. "It takes a few weeks to get into it," says Middleton, "but then positive changes happen quickly."

Try this: Shoot for 30 minutes of cardiovascular activity three to five times a week. "If you can build to an hour, that's great," says Middleton, and weight training also seems to improve brain function. Middleton and her colleagues found in a recent study that being active throughout the day may do more to help keep your mind sharp as effectively as purposeful exercising. "Anything that contributes to movement matters — doing chores, gardening, getting out of your chair to stretch," she says.

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7. You have anxiety overload.
Your boss gave you a bad evaluation and you know she has to cut staff, the IRS wants to audit your taxes, and your doctor wants to order another round of tests. And you wonder why you can't concentrate? Of course you can't. That's how the brain responds to real or imagined threat. We become hyper-alert to our surroundings ("Shhh! What's that?"), but ask us to focus on a task or follow a conversation, and forget it.
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Try this: If you can't concentrate because you're too busy worrying, stop and do something fun to clear your head, says Susan Nolen-Hoeksema, PhD, professor and chair in the department of psychology at Yale. Go for a walk, try a new recipe, play with the dog. Now think of one small thing you can do to address your worry and do it, even if it's just talking to a friend. Taking small, positive actions reduces the psychological stress that destroys concentration and bathes the brain in harmful stress hormones. Taking action can also stimulate healthier brain function. A 2009 study found that when people suffering from depression were helped to take small steps toward re-engaging in life, not only did they start feeling better but areas of their brain associated with motivation and pleasure that had been under-active revved back up. "And this is without medicine," says lead author Gabriel S. Dichter, PhD, assistant professor of psychiatry at the University of North Carolina Chapel Hill School of Medicine. "Just changing behavior jump-started the brain to function in a healthier way."

8. Your plate overfloweth.
You work ten-hour days and stop to check on your widowed mom on your way home. You're chairing the church fundraiser again this year because you did such a great job last year and everybody begged you to do it again. You've got to get the invitations out for your daughter's birthday party, the dog needs to go to the groomer, you need a haircut, and your in-laws are arriving next weekend for their annual visit. Even if you're not super-worried about any of these things, having too much on your to-do list could mean you're setting yourself up for distractions and forgetfulness. "It happens to men and women," says Dr. Orford. "They have so much going on they can't keep up. Their minds get overloaded."

Try this: "I try to take regular little breaks," says Nolen-Hoeksema. "I'll program my Blackberry to buzz me to stop for five minutes and breathe and regroup. It really helps me take a step back, which can be hard to do, and often I'll realize, 'I could delegate that,' or 'This isn't that important' or 'I can put this off.'"  Carrying a written reminder to "Stay focused" or "Get back to Number 1," whatever that means to you, can help, too. Saying "no" may not come naturally but you can build your skills. "It takes practice and realizing that the world doesn't cave in," says Nolen-Hoeksema. Working with a buddy helps. Hers is her husband. "We have a deal that when I say 'no,' he gives me a treat. If it's a small thing, it might be a candy bar. If it's a big thing, he takes me to dinner. Or I just email him and say, 'I said "No,"' and he emails back, 'Congratulations!'"
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9. It's just the way you're wired.
If a new job or relationship is making your problems with focus, organization, time-management and follow- through newly apparent to others, but the truth is they're not at all new to you — you've been struggling with them all your life — you could have undiagnosed Adult Attention Deficit Hyperactivity Disorder (ADHD). You don't have to be hyper to be a candidate, says J. Russell Ramsay, PhD, co-director and co-founder of the Adult ADHD Treatment and Research Program at the University of Pennsylvania School of Medicine. Symptoms can take many forms, including impatience, distractibility, forgetfulness, impulsiveness, and having trouble finishing tasks.

Try this: Rate yourself on the World Health Organzation's Adult ADHD Self-Report Scale. If you score high, "it's worth following up with a specialist," says Ramsay. Visit add.org or chadd.org to find one in your area, or ask a specialist in childhood ADHD for a referral. Meds work, and finding the right one is your first priority. But old habits and defenses die hard. Cognitive behavioral therapy can help you replace them with healthier coping skills. Focused attention meditation — focusing on a sound, image or your breath and bringing attention back to that focus when it strays — helps, too. A 2009 study found that new meditators who practiced daily for three months were more able to stay focused and dismiss distractions with less effort and without making their brains work so hard.


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