> After a Stroke
Memory and Thinking
A Stroke does not affect all aspects of the brain equally. Neither
does it affect all aspects of memory and thinking. Depending on
the part of the brain that has been damaged, the severity and recency
of the Stroke, varying problems with memory and thinking occur.
Many people affected by Stroke find their ability to remember day-to-day
events, people’s names or even faces is not as good as previously.
It may be difficult to follow instructions, or find one’s
way around new places. It is important to allow time to re-learn
these things. Notes, prompts or other devices can assist. Others
may find solving simple problems, reasoning through a task or organising
themselves difficult, needing extra supervision and guidance. Management
of home affairs such as budgeting, handling new equipment or organising
a meal may require assistance.
Personality
Changes in personality following a Stroke may be rare but often
very disturbing to the family. Personality is the unique combination
of an individual’s thoughts, feelings and reactions toward
themselves, others and their environment. After a Stroke some may
not seem the same person as before. The way in which they think,
feel and react may be altered. Family and relatives need to understand
the new and puzzling changes. Problems and activities once tackled
easily may be difficult or impossible, while other tasks are unaffected.
People may become confused, self-centred, uncooperative and irritable,
and may have rapid changes in mood. They may not be able to adjust
easily to anything new and may become anxious, annoyed or tearful
over seemingly small matters.
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Emotions
Loss of control over emotional expressions such as laughter or
crying is called emotional lability. Physical changes within the
brain itself can temporarily interfere with or destroy the normal
controls over emotions. A person affected by Stroke may laugh or
cry uncontrollably for no apparent reason and be unable to stop.
Family and friends sometimes misinterpret the laughter or tears
and attempt to scold or console them accordingly. Being able to
understand that this is a result of the Stroke and offer support
in these situations is the key.
A person affected by Stroke may experience decreased motivation
and impaired ability to initiate an activity. These issues are a
direct result of changes within the brain. With mild motivation
problems, the person appears apathetic but carries out normal activities
quite adequately, particularly familiar activities. In more severe
cases, some people do little beyond simple self-care tasks, and
to the observer may appear disinterested. This is not the case,
but simply a side effect of Stroke. Gentle guidance, prompting,
support and encouragement will assist.
Depression
Depression often occurs in people who have had a Stroke. They mourn
the loss of their previous self. They may have many fears, uncertainties
and altered feelings about themselves, as well as experience losses
in social activity, ponder questions about future prospects, financial
security and returning to work. The person may see little purpose
in living and express thoughts of death.
In situations such as this, depression may become an obstacle to
rehabilitation. They need reassurance, time and understanding. People
who talk of dying may be signalling for assistance, for someone
to listen and share their problems. Depression may be treated with
medication and psychological counselling. There are varying degrees
of depression, and initial recognition that depression has developed
is an important step. Depression is a highly unrecognised side effect
of Stroke and it is necessary to persist until the condition is
correctly diagnosed and treated.
According to a Report in Stroke, Journal of the American Heart
Association, “Because many Stroke patients are in the same age group
in which Alzheimer’s disease is prevalent, medical professionals
can’t always be sure of the causes of dementia. Robert G. Robinson,
MD of the Department of Psychiatry at the University of Iowa, says,
“The symptoms of dementia due to Stroke or Alzheimer’s disease are
similar. The difference is that, in Alzheimer’s disease, the condition
is progressive, but, in Stroke patients, the symptoms are at their
worst at the time of the Stroke and then tend to improve somewhat.”
The situation is complicated by the fact that depression is often
considered a “natural” part of a person’s post-Stroke condition
and in many cases goes untreated. “Our findings provide another
compelling reason to evaluate all Stroke patients for depression
and to treat depression aggressively when it’s found”, Robinson
says. (For more detail see; Depression following Stroke)
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© Stroke Recovery Association NSW
PO Box 3401 PUTNEY NSW AUSTRALIA 2112
Telephone: + 61(02) 9807 6422 or 1300 650 594
Fax: + 61(02) 9808 6173
email :info@strokensw.org.au
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