Stroke Impact: Personality Changes And Brain Injuries

can a person have a personality change after a stroke

A stroke can affect a person's emotions and personality, and these changes can be challenging to adjust to for the person and their loved ones. Changes in personality are common after a stroke, and they can range from minor to major. While some changes may disappear over time, others may require treatment or therapy. Understanding and managing these personality changes can be crucial for both the stroke survivor and their caregivers.

Characteristics Values
Personality changes Self-centred attitude, emotional lability, apathy, depression, anger, irritability, aggression, disinhibition, impulsiveness, loss of empathy, loss of sense of humour, loss of social inhibitions, jealousy
Emotional responses Laughing or crying for no reason, mood swings, intense and unpredictable emotions, extreme emotions
Behavioural changes Overindulgence, oversharing of personal matters, ignoring danger signs, escalating minor problems, physical aggression, lack of motivation, loss of interest in activities, fatigue, stress, anxiety, becoming easily upset, crying more easily
Cognitive changes Forgetfulness, confusion, loss of cognitive skills, difficulty with language, problem-solving, reading, mathematical calculations, memory loss
Treatment Counselling or therapy with a licensed mental health practitioner, medication, cognitive behavioural therapy, behavioural management training, anger management, support groups

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Emotional instability

It is common for people to experience emotional instability after a stroke. This can manifest in various ways, such as:

  • Uncontrolled emotions: This includes sudden and unpredictable emotional changes, such as laughing at something sad or crying at something happy. This is known as pseudobulbar affect (PBA) and is characterised by mood changes and uncontrollable expressions of emotion.
  • Apathy: A lack of interest or motivation to do anything, which may require an evaluation by a neuropsychologist if it doesn't improve.
  • Anger: Feeling and acting angry, or shutting down and not sharing emotions. Some people may become aggressive after a stroke.
  • Impulsive behaviour: Doing risky things or acting without thinking, which may be caused by damage to the part of the brain that controls behaviour.

Strategies to Manage Emotional Instability:

  • Be aware of triggers: Identify what triggers your emotions, such as fatigue, stress, anxiety, or overcrowded environments, and try to avoid or manage these triggers.
  • Ignore the emotional response: Continue with the conversation or task, signalling to others to ignore your emotional response as well.
  • Take a break: Regain control of your emotions by taking a short walk or doing something different to distract yourself.
  • Relaxation and breathing exercises: Try slow, deep breaths and focus your attention on something else to help calm yourself.
  • Seek professional help: A psychologist or therapist can provide cognitive and behavioural strategies to manage your emotions.
  • Medication: Antidepressants and other drugs can help manage PBA and anxiety.
  • Support groups: Connecting with others who have experienced a stroke can provide valuable advice and social support.
  • Therapy and counselling: Talking to a therapist, psychologist, or counsellor can help you develop strategies to handle your emotions effectively.

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Loss of cognitive skills

A stroke can cause a loss of cognitive skills, which can be distressing for the survivor and their loved ones. This may include difficulty with language, problem-solving, reading, and simple mathematical calculations. Survivors may also become forgetful, misplacing items or neglecting important tasks.

The loss of cognitive skills can result from a stroke in almost any region of the brain, but it is most common following strokes that affect the frontal, parietal, or temporal lobe.

Cognitive deficits can cause confusion, and survivors may struggle to understand concepts that they previously had no trouble with. This can lead to survivors making frequent mistakes, or even lying about errors to avoid embarrassment.

There are several ways to manage cognitive deficits. Brain retraining techniques, such as computer programs or in-person therapy, may help restore cognitive skills. Memory issues can improve over time, and medication for problems such as sleeping difficulties may also help with memory. Other strategies to help with memory loss include:

  • Designating specific places for frequently used items, such as keys or coats
  • Using memory cues, such as associating a name with a song
  • Keeping a notebook to organise important information
  • Breaking down complex tasks into simple steps
  • Practising conversations in a quiet, distraction-free environment

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Aggression

Aggressive behaviour is a common effect of a stroke, with 11% to 35% of patients experiencing it in the acute stage of recovery. Aggression can manifest in physical ways, such as hitting, kicking, biting, and throwing objects, as well as verbal ways, like screaming, refusing treatment, and muttering hostile words.

The frontal lobe, in particular, plays a role in reasoning, problem-solving, and controlling basic impulses like anger. When the frontal lobe is damaged, it can affect emotional regulation and lead to aggressive or combative behaviour. This is known as emotional incontinence, or the inability to control emotions.

Other factors that can trigger aggressive behaviour include:

  • Overstimulation, such as excess lights or sounds
  • Confusion, especially in the acute stage of recovery
  • Disruption of routine and daily structure
  • Lack of control over the environment or physical functions

Neurochemical dysfunction, such as a disruption of the brain's serotonin system, can also increase the prevalence of aggressive behaviour. Selective serotonin reuptake inhibitors (SSRIs) can be used to treat this. Fluoxetine (Prozac) has been shown to improve "post-stroke anger proneness".

To cope with aggressive behaviour, it is important to understand the triggers and develop strategies to manage it. This may include working with a therapist or counsellor, medication, or making changes to one's environment or routine.

Signs of a Dying Stroke Patient

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Self-centred attitude

A person's behaviour can become self-centred after a stroke, regardless of their disposition before the stroke. This is often the result of the stroke's neurological impact, specifically damage to the right supramarginal gyrus or the anterior insula in the brain's right hemisphere. These areas are responsible for empathy, allowing us to put ourselves in another person's position and feel for them. A stroke in the frontal lobe may also contribute to self-centred behaviour, as this area helps regulate emotion and control impulsivity.

Self-centred behaviour after a stroke can manifest in various ways. For example, individuals may lose the ability to empathise with others, appear unaware of how their behaviour impacts those around them, or display egocentricity more commonly associated with a young child. They may also become very demanding of their family members, expecting them to drop everything to cater to their smallest needs and responding with outbursts when they don't get their way.

It's important to remember that self-centred behaviour after a stroke is not intentional or personal. The stroke and the resulting tissue damage in the brain are likely causing these personality changes. While not all strokes cause self-centred behaviour, and recovery from a stroke is constantly evolving, it can be challenging for caregivers to navigate. Here are some strategies to help survivors and caregivers cope:

  • Gently bring up the self-centred behaviour with your loved one. Explain that personality changes after a stroke are common and why they are happening. This can help relieve confusion and improve their ability to cope.
  • Take care of yourself to avoid burnout. Caregiver burnout is real, so make sure to schedule some time for self-care each week to relax and do things that bring you joy. This will help you become more prepared and refreshed to take care of your loved one.
  • Don't take things personally. Understand that your loved one may be unable to control their behaviour or may be upset with themselves and their difficulty coping after the stroke. Give them time to process, as they may be working through the stages of grief. However, pay attention to aggressive behaviour and seek help from your medical team if it becomes concerning.
  • Encourage your loved one to do things on their own, to whatever degree is safe. While it's natural to want to help your loved one as much as possible, doing everything for them is not sustainable in the long run. Allowing them to be more independent will give them autonomy and boost their recovery.
  • Join a support group. Being a caregiver can be both physically and mentally draining, so it's essential to seek support from others going through similar experiences. Support groups can provide encouragement and valuable resources, such as information about community resources, medical equipment services, or exercise programs.

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Pseudobulbar Affect (PBA)

PBA is often associated with damage to the prefrontal cortex, the area of the brain that helps control emotions. It is commonly seen in people who have experienced a stroke, as well as those with neurological conditions such as Alzheimer's disease, amyotrophic lateral sclerosis (ALS), multiple sclerosis (MS), and traumatic brain injuries. PBA is one of the most frequently reported post-stroke behavioural disorders, with prevalence rates ranging from 28% to 52%. It is often underdiagnosed, as it can be mistaken for clinical depression or bipolar disorder. However, PBA episodes are typically sudden and episodic, while depression is characterised by more sustained emotions that closely relate to the underlying mood state.

The treatment for PBA may include antidepressants or other medications. The first FDA-approved medication for PBA is a combination of dextromethorphan and quinidine, which has been shown to help control outbursts of crying and laughing in people with MS and ALS. Other strategies for managing PBA include tracking episodes in a diary, connecting with others who have PBA, and practising slow, deep breathing during an episode.

PBA can significantly impact an individual's social functioning and relationships. It can lead to social withdrawal and interfere with daily activities, work, and overall healthcare. It is important for families and caregivers to recognise the pathological nature of PBA and understand that it is an involuntary syndrome that can be managed.

Frequently asked questions

Emotional lability is common after a stroke. You may experience strong emotions, uncontrollable crying or laughing, or mood swings. You may also feel anxious, depressed, angry, irritable, or aggressive.

You may experience impulsiveness, apathy, or a lack of motivation. You may also behave in ways that seem inappropriate or unsafe to others.

You may experience social anxiety or avoidance, and you may find it difficult to drive, leave the house, or get out of bed. These factors can lead to loneliness and isolation.

Recognise that these changes are common and often challenging. Be patient and understanding towards yourself and your loved one. Seek medical help and treatment, such as therapy or medication. Join a support group and surround yourself with a supportive network. Make changes to your routine and environment to minimise stress.

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