Of all the areas of life that stroke affects, its impact on the survivor’s personality may be the most difficult for family and friends to understand and become accustomed to. “Emotional changes are typical after any type of stroke,” says Dr. Janet Spradlin, a rehabilitation psychologist at St. Anthony Rehabilitation Center in Oklahoma City. “Depression is very common after any life-changing health challenge, especially if it means a loss of independence.”
While depression is the most common emotional change after stroke, other psychological changes can be equally debilitating or frustrating.
Cognitive Challenges
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.
Personality Changes
Some survivors experience apathy and don’t seem to care about anything. “People often mistake this for depression because survivors are content to sit and stare at the wall all day,” says Dr. Spradlin. “The best response is to get them active and moving. Give them a choice of what to do or where to go, but make it clear they have to choose to do something, they can’t just lie in bed.”
Are These Changes Permanent?
Personality changes after stroke can be distressing to survivors and family members alike, but they are not always permanent. “It really depends on what the personality change is,” says Dr. Spradlin. “Sometimes they mellow out.”
Depression
Depression occurs in about 40 to 50 percent of all stroke survivors. It can occur soon after the stroke or several months later.
Depression can be caused by biochemical changes in the brain caused by the stroke. When the brain is injured, the survivor may not be able to feel positive emotions, which can lead to depression, says Dr. Robert Robinson, a psychiatrist at the University of Iowa and a researcher who studies post-stroke depression. Depression can also be a normal psychological reaction to the losses from stroke.
Symptoms of Depression:
* Persistent sad, anxious or “empty” mood
* Feelings of hopelessness, pessimism
* Feelings of guilt, worthlessness, helplessness
* Loss of interest or pleasure in hobbies and activities that were once enjoyed, including sex
* Decreased energy, fatigue, being “slowed down”
* Difficulty concentrating, remembering, making decisions
* Insomnia, early-morning awakening, or oversleeping
* Appetite and/or weight changes
* Thoughts of death or suicide, or suicide attempts
* Restlessness, irritability
If five or more of these symptoms persist for longer than two weeks, depression may be the cause. Talk to your physician or psychiatrist about treatment possibilities.
One-side Neglect
One-side Neglect: Improving Awareness to Speed Recovery
by Jan Davis, Occupational Therapist and President, International Clinical Educators, Port Townsend, Wash.
Published in Stroke Connection Magazine March/April 2003
Have you seen your stroke survivor leave food on half of their plate? Forget to put their recovering arm into a shirt sleeve? Bump into the door jam with the left side of their wheelchair? Not turn their head in your direction when you speak? If you have noticed any of these things, you've very likely witnessed one-side neglect.
One-side neglect can be very frustrating and is often misunderstood. Neglect is more than not being able to use the recovering side. Think of it as a lack of awareness of that side. This common effect of stroke can reduce the possibility of independent living and increase potential of painful injury.
Possible Causes of One-Side Neglect
Visual
In some cases, the stroke injures the optic nerve, which sends information for the eyes to the brain. This is called a "visual field deficit" or "hemianopsia," and it means that the person only sees out of a part of each eye, instead of the whole eye. This is different from blurred vision and cannot be corrected by glasses. If you want to understand how this might feel, take a pair of glasses and mask half of each lens with tape. Now look at the world around you. When part of our visual field is blocked, we are less aware of that side.
Sensory
Many people experience some numbness or loss of feeling in the face, arm or leg. It may be temporary, or it may be more severe. I have known of people who awaken during the night, frightened that some stranger is lying in bed next to them, not knowing that it is their own arm that they are seeing but unable to feel. When we experience numbness of any kind, we are less likely to be aware of, or use, that side.
Perceptual
It is not uncommon for a stroke affecting the left side of the body to impair judgment and contribute to poor safety awareness. Often described as perceptual problems, the inability to take in information and make sense of the surrounding world is extremely complex. Occupational therapists and speech pathologists provide specific therapy to help with perceptual problems.
Information from the American Stroke Association web site (more)
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