How Mini Strokes Affect Your Personality

A stroke can cause damage to the brain, which can result in changes to a person's behaviour and emotions. This can manifest in various ways, such as becoming more anxious, losing interest in hobbies, or experiencing uncontrollable laughter or crying. These changes can be challenging for both the individual and their loved ones and may affect their quality of life. In this article, we will explore the impact of mini strokes on personality and the strategies available to manage and treat resulting behavioural changes.

Emotional instability

A stroke can lead to emotional instability, which can manifest in various ways and is often linked to the damage that the stroke inflicts on the brain. The cerebellum, which is part of a neural pathway that helps us monitor our expression of emotions, is often disrupted after a stroke, leading to difficulties in controlling emotions. This can result in crying or laughing uncontrollably, a condition known as pseudobulbar affect.

Signs of Emotional Instability

The signs of emotional instability after a stroke vary from person to person, but some common indicators include:

• Crying or laughing for no apparent reason
• Intense expression of emotions that seem disproportionate to the trigger
• Feelings of being overwhelmed by emotions with a lack of control
• Quick mood swings
• Extreme moods, such as mania or euphoria, although these are less common

Coping Strategies for Emotional Instability

• Breathing techniques: Taking slow, deep breaths can help calm and centre yourself when experiencing intense emotions.
• Muscle relaxation: Try to relax your face and body muscles to reduce physical tension associated with emotional distress.
• Distraction techniques: Focus your attention on something else to shift your thoughts away from overwhelming emotions.
• Awareness and communication: Let your loved ones know about your condition so they can understand and provide support.
• Therapy and medication: Cognitive therapy and social support can aid in managing emotions. Antidepressants and Nuedexta (dextromethorphan/quinidine sulfate) are also available as treatment options.
• Self-care: Engaging in physical activities, relaxation techniques, and mindfulness practices can help manage emotional instability.
• Support groups: Interacting with other stroke survivors can provide a sense of community and understanding.
• Professional help: If emotional instability persists or interferes with your daily life, consider seeking professional help from a psychologist or counsellor.

Loss of social inhibitions

A stroke can lead to changes in behaviour, due to the damage to the brain or emotional problems. This can manifest as a loss of social inhibitions, where the survivor behaves in ways that are considered socially inappropriate. This can include taking food from a stranger's plate, insulting people, undressing or urinating in public, or making inappropriate comments.

Generally, stroke survivors who display such behaviour do not understand that their actions are unacceptable and are unlikely to apologise or correct their behaviour. This can be challenging for caregivers and family members responsible for the survivor's safety and care.

The loss of social inhibition is most commonly associated with a stroke in the frontal lobe, which is responsible for making predictions and adjusting behaviour accordingly. When this area is affected, the survivor's behaviour may not align with their "normal" personality. It is important to note that their statements or actions are not reflective of their true feelings but may be phrases or behaviours picked up from unrelated settings, such as television shows.

To manage loss of social inhibitions, caregivers can provide consistent reminders of appropriate behaviour. Interventions such as using a lap belt on a chair may be necessary if the survivor repeatedly jumps out of it. Creating a comfortable and familiar environment with minimal stress can also help improve impulsive behaviour.

While some personality changes after a stroke may improve over time, others may require medication or therapy. It is important to consult a doctor for guidance on managing specific behavioural changes.

Anger, irritability, and aggression

The frontal lobe plays a crucial role in reasoning, problem-solving, and controlling basic impulses like anger. When the frontal lobe is damaged due to a stroke, it can affect emotional regulation and lead to aggressive behaviour. Additionally, damage to the brain after a stroke may inhibit the brain's serotonin system, which is responsible for carrying signals between neurons. This disruption can increase the prevalence of angry or aggressive behaviour.

To cope with anger and aggression after a stroke, it is essential to understand the triggers. Common triggers include overstimulation, confusion, disruption of routine, and a lack of control over the environment or physical functions. Identifying these triggers can help in managing and reducing the frequency of angry outbursts.

Medication can also be an effective treatment option for aggressive behaviour after a stroke. Selective serotonin reuptake inhibitors (SSRIs) are commonly prescribed antidepressants that work by increasing serotonin levels in the brain. Fluoxetine (Prozac) has been found to be particularly effective in reducing "post-stroke anger proneness" and can help improve emotional incontinence.

Therapy and counselling can also play a vital role in managing anger and aggression after a stroke. A therapist can help identify triggers, develop strategies for emotional regulation, and provide support to both the survivor and their caregivers.

In summary, anger, irritability, and aggression are common secondary effects of a stroke, especially if the frontal lobe is affected. While these behaviours can be distressing, there are effective treatment options available, including medication and therapy. Understanding the triggers and seeking appropriate help are crucial steps in managing and improving these symptoms over time.

Apathy

A stroke can cause apathy, which is a reduction in goal-directed activity in the cognitive, behavioural, emotional, or social domains of a patient's life. Apathy occurs in one out of three patients after a stroke. It can manifest as a lack of motivation to do things, a loss of interest in life, and a lack of emotional response. Apathy can be a sign of depression, but it can also happen on its own. It is often misdiagnosed as other post-stroke conditions such as depression.

The effects of apathy can include functional disability, slower recovery to normal functioning, and an increased risk for vascular disease, dementia, and mortality. It can also impact a person's quality of life and emotional well-being.

There are limited treatment options for post-stroke apathy, and high-quality trials are scarce. Antidepressants may have limited effects, and acetylcholine and dopamine pharmacotherapy, behavioural interventions, and transcranial magnetic stimulation may be more promising avenues for treatment.

It is important to recognise and address apathy after a stroke, as it can impact a person's recovery and long-term outcomes.

Cognitive changes

A stroke can cause damage to the brain, which can lead to changes in cognitive skills, including trouble with language, problem-solving, reading, and simple mathematical calculations. Some stroke survivors experience forgetfulness, losing things, or neglecting important tasks.

• Language difficulties: Stroke survivors may have trouble speaking, understanding speech, or both. This is known as aphasia.
• Problem-solving and decision-making: Strokes can impact the ability to think critically, solve problems, and make decisions.
• Memory loss: Memory issues can range from short-term memory problems to more severe long-term memory loss.
• Reading and mathematical calculations: Some stroke survivors may find it difficult to read or perform simple mathematical calculations.
• Cognitive deficits: Stroke survivors may struggle to understand concepts that they previously had no trouble with.

It's important to note that the effects of a stroke depend on the area of the brain that is affected. Strokes that impact the frontal lobe, parietal lobe, or temporal lobe are more likely to result in cognitive changes.

If you or someone you know is experiencing cognitive changes after a stroke, it's important to seek help from a healthcare professional. Treatment options such as cognitive-behavioural therapy, brain retraining techniques, and medication can help manage and improve these changes.

Frequently asked questions