Cognitive Impairments after Stroke

A stroke results in certain cognitive impairments, depending on its severity. As per collective research studies, 49 to 91% of the patients suffer cognitive impairment(s) in the first-month post-stroke. These impairments include difficulty in solving problems, memory problems and certain communication challenges. Even when the stroke is mild or the patient shows goods recovery, certain cognitive deficits are common. Memory and thinking related impairments are very common. Problems with concentration and memory are especially common because of damage to the brain. In many cases, these deficits remain persistent, lasting for years.

While motor deficits after stroke are characteristically more obvious, cognitive problems are identified much later. This justifies why the stroke rehabilitation efforts often attempt to improve limb function rather than addressing cognitive deficits.

Cognitive rehabilitation is usually provided by speech-language therapists. Depending on the stroke severity, occupational therapists and neuropsychologists can also participate in the cognitive rehabilitation program. Strategies like using a Memory Notebook’ (to record important information and what the survivor has done in a day) and Thinking Games (such as word puzzles, watching Wheel of Fortune, and playing cards) are emerging as compensatory methods for post-stroke cognitive rehabilitation.

Memory related problems

Several studies reveal that people with left-brain stroke tend to experience more short-term memory problems. Such stroke survivors’ long-term memory is usually preserved, but they may have difficulty learning new information, which is why they need to be reminded over and over and have things repeated.

The patients with right-brain strokes tend to get things out of sequence or confuse information or misinterpret. As a consequence, they may mix up the event details. Even though they can recall events, they get confused about when they happened or who was involved.

Communication deficits

An individual’s communication competence is also affected after a stroke. The location of the stroke decides how the stroke survivor’s ability to comprehend or process language will be affected. Aphasia, which results from damage to the left side of the brain (the area responsible for language) make it hard for stroke survivors to understand written or spoken language, read or write, or express their own thoughts.
In addition to Aphasia, post-stroke communication deficits may include decreased attention, distractibility, the inability to understand the emotional context of a message and the inability to understand body language. Dysphagia, the difficulty or discomfort in swallowing (common in stroke patients) often complements the problem. Some survivors even refrain from certain behaviors such as not getting off a specific topic during conversation.

Problem-solving and Decision making challenges

Sometimes, the problem-solving ability is affected in survivors of right-brain strokes. Such stroke victims become impulsive and are often not aware of such deficits. They may walk perfectly or drive to work independently, but they tend to be impulsive and fail to think before they act, developing an inability to think through a situation reasonably.

Decision making, one of the elements of Executive Functions, is also commonly impaired by stroke. Decision-making, which involves long-term memory, working memory, and emotional intelligence, is affected in different ways due to memory-related impairments and problem-solving issues. While severe stroke survivors may find it hard to make a decision at all, some may find making simple decisions such as ‘what toothpaste to buy’ challenging. Poor judgment in relationships or in business can have devastating consequences.