Cognitive and emotional changes after stroke: What patients and families should know

Stroke can cause changes in how someone thinks, feels, remembers or behaves. These changes can have greater impact on patients than a stroke’s physical effects.

Cognitive, emotional and behavioral changes can affect patients during their stroke rehabilitation and impact their everyday activities, relationships and level of independence.

Stroke affects patients differently physically and cognitively. Specific cognitive, emotional or behavioral changes depend on the stroke’s extent and the areas of their brain impacted. Read more on stroke and its causes, symptoms, risk factors and treatment.

In this article, you will learn how rehabilitation can help stroke patients address common cognitive, emotional and behavioral changes, what those changes may look like and how families can support stroke patients dealing with these effects.

What cognitive changes can happen after a stroke?

Cognition refers to the ability to think, understand, focus, recall memories, make decisions and solve problems as well as the mental processes that go into those activities.

Someone may experience a range of cognitive challenges after stroke.

• Patients may experience memory loss and have difficulty remembering names, faces, stories or information. They may also forget information and skills that result in learning difficulties.
• Memory loss may lead to planning and organization challenges because patients may misplace items or experience trouble with activities that were routine pre-stroke.
• Patients may experience attention or concentration challenges because their brain is having difficulty filtering surroundings or remaining focused on a single task.
• After stroke, patients may have issues processing information or it may take someone longer to do things following a stroke.
• Patients may have trouble reasoning, making judgments or solving problems following stroke.
• After a stroke, patients may also have difficulty judging the space around them, which can cause concerns with physical safety.[1]

Stroke patients may have difficulties with activities like managing household responsibility, completing complex tasks or following instructions due to cognitive changes. This can make it harder for patients to return to their everyday routines at home or work following stroke.

Depending on the exact nature of their stroke, patients may experience all, some or even none of these changes. Also, you should not consider these changes will necessarily become permanent.

In certain cases, patients appearing to have cognitive difficulties may instead have communication challenges. To learn more about communication difficulties after a stroke, read about speech therapy’s role in stroke rehabilitation.

Potential emotional and behavioral changes after a stroke

Stroke survivors may also experience a range of changes in their emotions, mood, motivation or behavior.

• Stroke survivors can experience depression because their brain injury makes it difficult to feel positive emotions or because life changes following stroke can cause sadness, hopelessness or similar feelings.
• Anxiety, which can appear as fear, feelings of worry, nervousness or unease, can accompany depression for stroke survivors.
• Following stroke, people may experience anger, irritability or frustration at what happened or at changes it has caused. The stroke itself can also cause changes in the brain that create these feelings.[2]
• Stroke survivors may feel apathy and appear not to care about anything following their stroke. This differs from depression.
• Stroke can cause cognitive deficits, resulting in impulsive behavior where someone does not have the ability to understand or think about consequences.[3]
• Following stroke, people can experience changes in their ability to express or control their emotions. This is called the pseudobulbar affect (PBA) and occurs when these areas of the brain that control emotion are injured, as is possible with stroke. As a result, people may have involuntary bouts of anger, laughter, crying or other emotions.[4]

These emotional and behavioral changes can occur because of how stroke directly impacted someone’s brain or because of physical, social, cognitive or lifestyle changes someone encounters. It does not mean their stroke recovery is failing.

If patients experience any of these changes after stroke, they should speak with a healthcare professional. Treatment and evaluation can help address someone’s mental health following stroke. Support from their medical team, family and caregivers also helps patients address mental, emotional and behavioral health following stroke.

How can cognitive and emotional changes affect everyday life?

Cognitive and emotional changes from stroke can impact patients as significantly as physical changes and affect their ability to live as independently and safely as possible.

• Patients may struggle to manage daily routines or responsibilities like finances, schedules or medications because of memory loss or challenges with planning, organization or concentration.
• Cognitive changes related to concentration and processing information can make it harder for patients to make decisions or solve problems in everyday situations they may encounter at home or in the community.
• When patients have memory loss or difficulty concentrating or processing information, they may find it hard to communicate or interact with others. Depression and other emotional changes can also affect social interaction.
• Effects of cognitive and emotional changes can make it hard for patients to return to work or community activities they engaged with before their stroke or even participate in rehabilitation.
• Similarly, patients may struggle to maintain relationships or family roles because of their stroke’s cognitive and emotional impacts.

Encountering these everyday challenges, whether on their own or alongside physical changes caused by stroke, can frustrate both patients and families.

Treatment, resources and support can help address these changes as part of stroke recovery.

Rehabilitation and support for emotional and behavioral changes

A stroke rehabilitation plan can help patients address cognitive changes they experience because of their stroke, while also supporting their mental, emotional and behavioral health following a stroke.

While a speech therapist will evaluate patients for cognitive changes after a stroke, a rehabilitation psychologist or mental health professional may evaluate patients for emotional and behavioral changes.

Support for cognitive, emotional and behavioral changes takes several forms.

Speech therapy can help patients modify their environment and remove distractions to help address cognitive challenges. Additionally, changing the pace and structure of communication with patients can provide further support. A speech therapist may also work with patients on improving visual or auditory attention to improve concentration and focus.

Different approaches work for different patients. Speech therapy can identify which strategies work for which patients.

Participating in group settings with others who may be experiencing similar challenges can also provide support. For example, communication-based speech therapies can help patients regain comfort and confidence in social settings by introducing them to social situations and teaching them ways to compensate in real-time for any deficits.

Members of the rehabilitation team may coordinate with each other to discuss strategies for supporting the patient. A speech therapist may work with patients on memory exercises that help them remember the skills physical and occupational therapy are implementing during their sessions. For example, occupational therapists may help patients work on getting dressed while a speech therapist may ensure patients remember the order in which they put on clothes.

Educating patients, families and caregivers about the cognitive and emotional changes they may experience because of stroke can increase understanding and improve patients’ attitude and mood.

When needed, stroke patients may meet with a mental health professional who can assess them and provide appropriate treatment. Additionally, families or caregivers should address new or worsening emotional or behavioral concerns regarding patients with their medical team.

Depression, anxiety or other emotional changes following a stroke are treatable; you should not ignore them or assume they are unavoidable. Treatment and support can make a difference.

Supporting a loved one through cognitive and emotional changes

Stroke survivors are not the only ones impacted by these cognitive, behavioral and emotional changes. Families and caregivers feel the effects and must navigate them as well.

If these changes occur, it is important to remember the behavior may not be intentional but rather is a direct result of the stroke.

Families and caregivers can help by noticing any emotional, behavioral or cognitive changes or concerns and sharing those with a medical professional and the rehabilitation team.

When families and caregivers actively participate in stroke rehabilitation and maintain a positive, encouraging outlook, it can support stroke recovery for their patients. Patients in inpatient stroke rehabilitation may benefit from families bringing them items from home that can trigger memory recall or positive emotions.

Families and caregivers should also pay attention to their own well-being.

Developing a dedicated support system can help patients, families and caregivers all navigate the stroke recovery journey.

Cognitive and emotional recovery at Good Shepherd

Stroke rehabilitation should not just address the physical impacts of a stroke. It should also account for how stroke impacts someone’s everyday life and help them work through the emotional and behavioral changes they may experience.

Our multidisciplinary approach at Good Shepherd enables us to consider your rehabilitation needs and goals together rather than in isolation. Your team will work alongside you and your family to develop stroke rehabilitation plans that pursue your goals, address your challenges and account for your needs and abilities.

Good Shepherd’s physical medicine and rehabilitation physicians can coordinate your treatment plan to meet your physical, cognitive and everyday needs. Meanwhile, speech therapy and occupational therapy can help you build the skills needed to return to your everyday activities while physical therapy helps you build your strength and mobility.

In addition, our rehabilitation psychologists at Good Shepherd Rehabilitation Hospital can help navigate emotional and behavioral changes, working alongside our physicians, nurses and therapists as part of inpatient stroke rehabilitation.

Our Cognitive Communication Skills Group can provide you an opportunity to improve your communication skills in a supportive, outpatient group setting.

From inpatient rehabilitation at Good Shepherd Rehabilitation Hospital to outpatient stroke rehabilitation at 20 locations across eight counties in eastern Pennsylvania with a variety of technologies, we can support you and your family at each step of your stroke rehabilitation.

Take the next step in your journey today.

You can also call us at 1-888-447-3422 (44-REHAB) or contact us online.

[1] Cognitive Effects of Stroke | American Stroke Association

[2] Depression and Stroke | American Stroke Association

[3] Personality and Mood Changes | American Stroke Association

[4] Pseudobulbar Affect (PBA) | American Stroke Association