Excerpted from "Behavior Changes After Stroke," appearing in the Stroke Connection Magazine January/February 2005.
Cognitive deficits are changes in thinking, like difficulty solving problems. This category also includes dementia and memory problems, as well as many kinds of communication challenges.
“We tend to see more short-term memory problems in people with left-brain stroke,” says Dr. Spradlin. “Long-term memory is usually preserved, but they may also have difficulty learning new information. They will likely need to have things repeated and be reminded over and over.
“People with right-brain strokes have memory problems of another kind — they tend to get things out of sequence or misinterpret or confuse information.” These survivors may mix up the details surrounding an event. Usually, they can recall events but get confused about when they happened or who was involved. For example, they may think a family member visited this morning rather than last night.
Communication in all its forms is often altered after a stroke, but the location of the stroke makes a difference as to what will be affected. In addition to communication problems like aphasia, a condition affecting the ability either to understand or process language, communication deficits may include decreased attention, distractibility and the inability to inhibit inappropriate behavior. “Some survivors are unable to ‘read’ people, for instance, not understanding the emotional context of a message or not understanding body language,” said Dr. Spradlin. “Some experience a deficit we call perseveration, in which the person is unable to refrain from certain behaviors. They can’t seem to ‘put the brakes on.’ They might not be able to get off a specific topic during conversation. As you might guess, family members can get very frustrated.”
Problem-solving ability is sometimes affected, usually more in survivors of right-brain strokes. “This is due in part to these survivors being impulsive and having decreased awareness of their deficits (See Improving Awareness to Speed Recovery). They think they can do things safely that they actually can’t do. For example, get up and walk or drive or even return to work. They tend to be impulsive and fail to think before they act. This reflects an inability to think through a situation rationally.”
Cognitive rehabilitation is usually provided on an outpatient or home basis by speech language pathologists. Neuropsychologists and occupational therapists can also help with cognitive rehab. There are computer software programs available to help survivors regain skills, too. “There are compensatory strategies like use of a ‘memory notebook’ to record important information as well as what they have done, etc. For higher-level patients, we use PDAs (personal digital assistants). We also encourage computer games and activities to exercise the mind, things like word puzzles, watching Wheel of Fortune, and playing cards or dominoes — thinking games.”