Stroke's Impact: Personality Changes And Unseen Shifts

A stroke can cause significant personality changes, making individuals feel as though they have lost themselves or that their loved ones have become unrecognisable. These changes can be emotionally draining for everyone involved. However, it is important to remember that such behaviour is a result of stroke-induced brain damage and is not premeditated or intended to be insulting.

Personality changes can occur due to damage to the brain or emotional problems. The stroke's impact on the brain can alter biological activity, leading to depression and other mental health issues. Additionally, the emotional impact of a stroke can affect behaviour, as individuals deal with the shock and the many emotions that arise from this life-altering event.

While some changes may be long-term, it is reassuring to know that these behavioural shifts are common and that there are effective strategies to manage them.

Loss of cognitive skills

A stroke can cause a loss of cognitive skills, including trouble with language, problem-solving, reading, and simple mathematical calculations. This can lead to forgetfulness, such as forgetting names, losing things, or neglecting important tasks.

The loss of cognitive skills can occur after a stroke in almost any region of the brain but happens most often when strokes affect the frontal lobe, the parietal lobe, or the temporal lobe.

The loss of cognitive skills can be distressing, and people may make excuses or even lie about their errors to avoid embarrassment.

Some memory issues may improve over time, and medication for other issues, such as sleeping problems, can help with memory as well.

Strategies to help manage memory loss include:

• Designating specific places for frequently used items, such as keys and coats.
• Using memory cues, such as songs, to help remember things.
• Keeping a notebook with important information organized into sections, including phone numbers, medications, and directions.
• Breaking down complex tasks into simple steps.
• Practicing conversations in a quiet, distraction-free environment, gradually expanding to talking with others.

Therapies such as brain retraining techniques may also help restore cognitive skills.

Emotional instability

Emotional lability, or emotional instability, is a common condition after a stroke, where a person experiences strong emotions that are difficult to control. This can manifest as intense mood swings, uncontrollable laughing or crying, and emotional responses that seem out of character or disproportionate to the situation.

Causes of Emotional Instability

Strategies for Managing Emotional Instability

For those experiencing emotional instability after a stroke, there are several strategies that can help:

• Awareness of triggers: Identify triggers that may set off emotional responses, such as fatigue, stress, anxiety, or crowded environments.
• Ignoring or addressing the response: One approach is to ignore the emotional response and continue with the current activity, signalling to others to do the same. Alternatively, you can choose to address it directly by explaining your situation and what works best for you.
• Taking a break: Stepping away from a stressful situation and engaging in relaxing activities, such as walking or breathing exercises, can help regain control of your emotions.
• Psychological support: Seeking help from a psychologist or therapist can provide additional strategies for managing emotions and improving cognitive function.
• Medication: In some cases, medication such as antidepressants or Nuedexta (dextromethorphan/quinidine sulfate) may be prescribed to help manage emotional instability.
• Social support: Sharing your experiences and challenges with loved ones or support groups can provide a sense of understanding and reduce feelings of isolation.
• Breathing and relaxation techniques: Slow, deep breaths and relaxing your face muscles can help to calm and centre yourself when experiencing intense emotions.
• Distraction techniques: Focusing your attention on something different can sometimes help to shift your emotional state.
• Communication: If possible, informing others about your condition can help them understand and manage their expectations.

Outlook for Emotional Instability

While emotional instability can be a challenging aspect of recovering from a stroke, it is important to remember that these changes are not intentional and are a result of stroke-induced brain damage. With time, patience, and the right support, many individuals can manage and improve their emotional responses.

Aggression

Causes of Aggression

There are several factors that can cause aggression after a stroke. These include:

• Emotional factors: The sudden and shocking nature of a stroke can lead to many emotions, such as frustration, fear, and anger, which can contribute to aggressive behaviour.
• Brain injury: Damage to the brain caused by the stroke can affect a person's ability to control their emotions, leading to aggression. This is particularly common in stroke survivors who have had a large stroke or who have vascular dementia.
• Pain: Physical pain after a stroke can make a person irritable and more prone to aggression.
• Fatigue: Tiredness after a stroke can lead to irritability and aggressive behaviour.
• Cognitive issues: Changes in cognitive abilities, such as decision-making and impulse control, can contribute to aggressive behaviour.

Managing Aggression

It is important to seek medical help if you or someone you know is experiencing aggression after a stroke. Here are some strategies that may help manage aggression:

• Learn your triggers: Identify what triggers your anger and try to avoid those situations.
• Develop a strategy: Work with your family and friends to come up with a signal that indicates when you are acting aggressively. They can also give you space if needed.
• Cognitive behavioural therapy (CBT): CBT can help you understand and manage your emotions and behaviour.
• Medication: Antidepressants and other medications can help reduce anger and aggression.
• Support groups: Joining a support group can provide you with a community of people who are going through similar experiences.
• Relaxation and breathing exercises: Taking a break and practising relaxation techniques can help you regain control of your emotions.

Inappropriate behaviour

A stroke can cause a person to behave 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 standing too close to others.

These behaviours are often associated with a frontal lobe stroke, which affects a person's ability to make predictions about what will happen and adjust their behaviour accordingly. Individuals with this type of stroke are often not self-aware and need a high level of caregiving.

Other causes of inappropriate behaviour after a stroke include:

• Loss of social inhibitions: A stroke can damage parts of the brain that affect a person's perceptions of other people's emotions and facial expressions, leading to a lack of empathy and self-centred behaviour.
• Aggression: Frustration, anger, and irritability are common after a stroke, and can lead to aggressive behaviour if not managed effectively.
• Apathy: A lack of motivation and interest in activities can cause a person to behave inappropriately, such as refusing to do anything that does not provide immediate results.

It is important to seek professional help if you or someone you know is exhibiting inappropriate behaviour after a stroke. Treatment options such as therapy, medication, and support groups can help manage these behaviours and improve interpersonal relationships.

Depression

Causes of Post-Stroke Depression

• Physical limitations: Weakness, vision loss, and coordination problems may make stroke survivors feel disempowered or handicapped.
• Health worries: After a stroke, survivors may worry about their health or experience anxiety about their mortality. The resulting feelings of helplessness or hopelessness can contribute to post-stroke depression.
• Brain changes: Stroke-induced damage can alter the brain's biological activity, leading to depression.
• Delays in treatment: Many stroke survivors are reluctant to seek treatment for depression due to concerns about what others will think or a belief that treatment won't help.

Treatment for Post-Stroke Depression

Post-stroke depression is typically treated with a combination of prescription antidepressant medication and counseling. Cognitive Behavioral Therapy (CBT) is often recommended, as it helps individuals identify and change unhelpful thought patterns and develop a more positive, problem-solving approach. Other behavioral management techniques, such as anger management training, can also be beneficial.

Frequently asked questions