Stroke's Cognitive Impact: Strategies For Recovery And Rehabilitation

A stroke can have a significant impact on cognitive abilities, affecting the way the brain understands, organises and stores information. This can result in damage to areas of the brain responsible for perception, memory, association, planning, concentration and more. Up to 60% of stroke survivors may experience some form of cognitive impairment in the first year after a stroke, with problems with memory and thinking being very common. The severity and localisation of the stroke will determine the type and level of cognitive difficulties experienced. Treatments for cognitive problems focus on ways to cope with the issues, rather than 'fix' them.

Memory and concentration problems

Memory problems can range from forgetting childhood events to not remembering what you watched on TV yesterday. You may find it hard to remember something you have just been told, but might recall something that happened years ago. This is because short-term memory is often more affected than long-term memory.

Concentration problems can make simple activities require much more effort. A stroke can affect your brain's ability to screen out distractions, making it difficult to follow a conversation or even focus on a simple task like making a cup of tea.

• Speak to your doctor: They can check if there is anything else causing your problems, such as an infection or side effects of medication. They may refer you for an assessment to help determine what is happening and why.
• Exercise: Physical activity is good for your brain as well as your body and can help with any emotional problems you may be experiencing. Aim for aerobic exercise that gets your heart beating and makes you slightly out of breath.
• Get plenty of rest: It's harder to concentrate when you're tired, so make sure to plan time to rest throughout the day.
• Break tasks down into smaller steps: Focus on finishing one step before moving on to the next.
• Remove distractions: If you're trying to focus on a conversation, turn off the TV or move to a quiet room. Keep your workspace clear of clutter.
• Use prompts and reminders: Use a calendar or diary to keep track of appointments. Leave a notepad and pen by the telephone to write down important information. Set reminders on your phone to help you remember to take medication.
• Keep things in the same place: Use labels on cupboards and drawers to help you remember where things go.
• Write a to-do list: Write a list for the next day before you go to bed so you know what you have to do when you get up.
• Stick to a routine: Doing certain tasks at the same time each day can help prompt you on what you need to do.
• Be kind to yourself: Remember that a stroke is a major brain injury and it's nothing to be embarrassed about. Allow yourself more time to get things done and don't expect too much from yourself.

Impaired problem-solving and decision-making

A stroke can cause a range of cognitive impairments, including impaired problem-solving and decision-making abilities. These issues can arise from damage to the brain's frontal lobe, affecting the ability to work through problems and make decisions effectively.

Problem-solving abilities are often impacted in individuals who have experienced a right-brain stroke. They may become impulsive and fail to consider their actions before executing them. Memory loss caused by the stroke can further hinder problem-solving skills, as individuals may struggle to recall how similar issues were resolved in the past.

Decision-making, a crucial aspect of executive function, can also be compromised after a stroke. This can manifest as difficulty in making simple choices, such as selecting a product at the store, or an inability to make decisions at all. Poor decision-making can lead to adverse consequences in relationships or business ventures.

Rehabilitation and therapeutic interventions can help address these challenges. Neuropsychologists may employ Problem-Solving Therapy to enhance coping skills, teaching patients to identify problems, generate solutions, make choices, and evaluate the outcomes. Memory Notebooks, where individuals record past problem-solving experiences, can serve as a compensatory tool. Additionally, engaging in thinking games, such as word puzzles or card games, may aid in restoring executive function.

While cognitive impairments following a stroke can be debilitating, there is hope for improvement. Most cognitive gains occur within the first three months after a stroke, but the brain continues to forge new neural connections even after this period. Early screening, diagnosis, and treatment are vital to support stroke survivors and facilitate their recovery journey.

Communication difficulties

Communication problems are very common after a stroke. A stroke can affect the way the brain understands, organises and stores information. Language is controlled by several different areas of the brain working together, so a stroke can alter communication, with its location influencing what will be affected.

Around one-third of stroke survivors experience aphasia, a condition that affects the ability to understand or process language. Aphasia can also affect a person's ability to read and write. It happens when an individual is no longer able to understand or use language. Aphasia will affect people differently, and no two people will have the exact same difficulties.

Dysarthria is another common condition post-stroke, where an individual is not able to control the muscles in their face, mouth and throat, making it difficult to speak clearly. This can result in slurred or slow speech, or a quiet-sounding voice.

Apraxia of speech is when an individual cannot move the muscles in their face, mouth or throat in the correct order when speaking, making it difficult for others to understand them.

Communication problems do not affect intelligence. However, they can cause issues with attention, distractibility and the inability to inhibit inappropriate behaviour. Problem-solving ability is sometimes affected, typically in survivors of right-brain strokes.

Communication problems can be treated using speech and language therapy. A speech and language therapist can help improve speech, reading and writing, as well as teach other ways to communicate, such as gestures or electronic devices.

Most communication problems do improve, but it is difficult to predict how much or how long it will take, as this differs for everyone. Problems tend to be worse in the first few weeks and will improve within the first three to six months. However, recovery can continue for months or years.

Impact on daily life and independence

The impact of a stroke on cognitive abilities can have a profound effect on a person's daily life and independence. The brain injury caused by a stroke can result in damage to areas of the brain responsible for perception, memory, association, planning, concentration, and more. The severity and localisation of the stroke will determine the type and level of difficulties experienced, which vary from person to person.

One of the most common issues faced is difficulty with planning and organising daily tasks. The brain usually works in the background, allowing us to complete tasks based on prior knowledge, experience, and learned behaviour. After a stroke, a person might not be able to think of how to do a simple task or may get the sequence wrong, such as putting on shoes before socks. Orientation can also be affected, with people unsure of the date, day of the week, or even who they are with.

Problem-solving can become challenging, and making decisions, understanding numbers, and managing money can be difficult. Memory problems could result in difficulty storing or recalling information, such as appointments, important dates, or what someone just said.

Concentration is required for effective cognitive function, and stroke survivors often experience problems with concentration due to damage to specific areas of the brain. Tiredness, pain, and emotional problems can also impact a person's ability to stay focused and concentrate, leading to difficulties following a television programme or conducting a conversation. Multitasking can become very challenging.

Cognitive problems after a stroke can be improved, especially in the first three months, as the brain creates new neural pathways. Strategies such as using a diary, day planner, calendar, or notepad can help with memory and perception problems. Photos and pictures can help trigger memories, and mobile phones can be used to set alarms, reminders, and memos throughout the day. It is important to not overload oneself and to finish one task before starting another.

Overall, the impact of a stroke on cognitive abilities can significantly affect a person's daily life and independence. The difficulties experienced can vary depending on the type and severity of the stroke, but they often include problems with planning, memory, concentration, problem-solving, and orientation. However, improvements can be made, especially in the first few months after a stroke, through various strategies and rehabilitation techniques.

Emotional and behavioural changes

Understanding Emotional and Behavioural Changes

Stroke survivors often experience a range of emotional and behavioural changes. This is because a stroke impacts the brain, which controls our behaviour and emotions. The area of the brain injury and chemical changes can have significant effects on an individual's emotions and behaviour.

Common Emotional and Behavioural Changes

• Irritability and aggression: Stroke survivors may exhibit signs of irritability or become aggressive. This can be directed at themselves or others.
• Disinhibition: Survivors may say or do things that seem inappropriate to others, exhibiting a lack of inhibition.
• Impulsivity: Acting without thinking or doing things that are unsafe or inappropriate can be observed. This can include making decisions without considering the consequences.
• Anger and frustration: Feelings of anger and frustration are common and may be directed at oneself or others.
• Grief and sadness: Stroke survivors may experience grief and sadness due to the loss of their previous life and the adjustments they need to make.
• Anxiety and depression: These emotions are common at any stage after a stroke and can impact the survivor's overall well-being.
• Forgetfulness and inattention: Stroke survivors may experience difficulties with memory and concentration, leading to forgetfulness and inattention.
• Confusion: Disorientation and confusion are also common emotional responses to stroke.
• Emotional lability: This refers to emotional responses that seem out of proportion or context. Survivors may cry or laugh uncontrollably, exhibiting emotional responses that appear out of character.

Strategies for Coping with Emotional and Behavioural Changes

• Awareness of triggers: Identify triggers that may cause 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 conversation or task. Alternatively, you can choose to address it directly by informing others about the stroke and your needs.
• Taking a break: Regain control of emotions by taking a short walk or engaging in a different activity. Relaxation and breathing exercises can also help.
• Psychological support: A psychologist can provide cognitive and behavioural strategies to manage emotional and behavioural changes.
• Routine changes: Consider making changes to your routine if certain situations or environments are consistently triggering. One-on-one activities in a quiet environment may be preferable to stressful situations.
• Treatment options: Cognitive behavioural therapy, behavioural management training, and medication (such as anti-depressants) can be explored as treatment options.
• Support for carers and family: Carers and family members may also need support to cope with the emotional and behavioural changes in their loved one. Modifications to the home environment and respite care can be considered.

Frequently asked questions