Delirium After Stroke: Understanding The Connection

Strokes are a leading cause of death and disability in the US. They occur when there is a disruption in blood flow to a part of the brain, resulting from a ruptured blood vessel or a blockage in the blood supply. The effects of a stroke can vary depending on the location of the obstruction and the extent of brain tissue affected. One of the possible consequences of a stroke is delirium, which involves disturbances in attention, awareness, and cognition. Delirium can manifest as aggressive behaviour, such as hitting or hurting others, as well as verbal behaviours like cursing or hostile muttering. While delirious behaviours are often associated with other conditions like dementia or infections, they can also occur following a stroke and usually subside as other delirious symptoms improve.

Post-stroke anger

Causes of PSA

The exact causes of PSA are not fully understood, but several factors have been implicated:

• Neurochemical dysfunction: Brain injuries can lead to changes in serotonin levels, which may contribute to anger and aggression.
• Frustration and environmental factors: Stroke survivors may experience frustration due to neurological deficits, unfavourable environments, or challenging family dynamics, which can trigger anger.
• Genetic predisposition: Genetic variations, such as monoamine oxidase A (MAO-A) polymorphisms associated with low enzyme activity, may increase the risk of PSA.
• Lesion location: Lesions involving the fronto-lenticulocapsular-pontine base area are particularly associated with PSA.
• Other risk factors: Young age, male sex, previous stroke, high National Institutes of Health Stroke Scale (NIHSS) score, and diabetes mellitus have also been linked to PSA.

Impact of PSA

PSA can negatively impact the quality of life of stroke survivors and increase the burden on their caregivers. It can lead to distress, embarrassment, and social isolation. Additionally, PSA can be episodic and unpredictable, making it challenging for caregivers to manage.

Treatment of PSA

PSA can be treated or prevented using various approaches:

• Pharmacological therapies: Selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine and escitalopram, are first-line treatments for PSA. Other options include beta-adrenergic antagonists and lithium.
• Psychological interventions: Counselling or education for patients and caregivers may be beneficial, although more research is needed in this area.
• Neuroleptics: In the acute stage, neuroleptics like haloperidol can be used to control severe aggressive behaviour and prevent harm to the patient and others.

Prevention of Stroke Triggered by Anger

Given that anger is a recognised risk factor for stroke, managing anger effectively may help prevent stroke occurrence. This can include living in less stressful conditions and having adequate social support.

Delirium

A stroke is a disruption of blood flow to the brain, which can cause brain cells and tissue to become damaged and die within minutes. The effects of a stroke depend on the location and extent of the brain injury, as well as chemical changes. These factors influence the behavioural and emotional changes observed after a stroke.

Post-stroke emotional and behavioural changes are common and can include feelings of irritability, fear, frustration, anger, grief, sadness, anxiety, and depression. In some cases, more extreme behavioural changes can occur, such as aggressive behaviour towards others.

While the emotional and behavioural changes following a stroke can be distressing for both the patient and their caregivers, it is important to remember that many of these changes tend to improve over time. Treatment options such as pharmacological therapies and psychological interventions can also help manage these symptoms.

Additionally, anger has been identified as both a risk factor and a triggering factor for stroke. Studies have found a link between high levels of anger and an increased risk of stroke, particularly in individuals with low socioeconomic status or those living in urban areas. Managing anger through interventions and improving social support may help reduce the risk of stroke.

Aggressive behaviour

To manage aggressive behaviour after a stroke, it is important to learn your triggers and develop strategies to avoid or mitigate them. Medications, such as selective serotonin reuptake inhibitors (SSRIs), can also help treat aggression by increasing serotonin levels in the brain. Psychotherapy, such as cognitive behavioural therapy (CBT), can also help individuals understand and manage their aggressive behaviour.

It is important to note that aggressive behaviour can put both the individual and others at risk, so seeking professional help is essential.

Emotional incontinence

A stroke can cause a range of emotional and behavioural changes. The brain controls our behaviour and emotions, so when it is impacted by a stroke, survivors often experience feelings of irritability, fear, frustration, anger, grief, sadness, anxiety, and depression.

One specific emotional change that can occur after a stroke is emotional incontinence. Emotional incontinence can manifest as sudden emotional outbursts, such as crying or laughing, that are disproportionate to the situation or occur at inappropriate times. It is caused by damage to the brain, specifically the frontal-lenticular-brainstem pathway, which can affect the production of serotonin and other neurotransmitters that regulate mood and emotion. Emotional incontinence can be treated with antidepressants, particularly selective serotonin reuptake inhibitors (SSRIs), which can help to improve mood and reduce the severity of emotional outbursts.

In addition to emotional incontinence, strokes can also cause personality changes, mood changes, and behavioural changes. These changes can include increased aggression, irritability, impulsivity, and a lack of inhibition. It is important to recognise and address these emotional and behavioural changes, as they can impact the survivor's quality of life and increase the burden on their caregivers.

The good news is that many emotional and behavioural changes resulting from a stroke tend to improve over time. Early treatment and rehabilitation can also help to improve outcomes and reduce the risk of long-term complications and disabilities.

Post-stroke depression

A stroke is a disruption of blood flow to the brain, which can be caused by a ruptured blood vessel or a blockage in the blood supply. The effects of a stroke depend on the location of the obstruction and the extent of brain tissue affected. As the brain controls our behaviour and emotions, a stroke can impact a person's mood and outlook, and cause chemical changes that have significant effects on the brain.

The emotional impact of a stroke can also lead to feelings of delirium, particularly in older people. Infections like a chest or bladder infection can cause sudden confusion (delirium). Other causes of delirium include low blood sugar and head injury.

Frequently asked questions