Loss of Cognitive Skills
The loss of cognitive skills after a stroke can happen after a stroke in almost any region of the brain, but most often in the frontal lobe, the parietal lobe or the temporal lobes.
Changes in cognitive skills include trouble with problem solving, reading difficulties, and trouble with simple mathematical calculations. Some stroke survivors become forgetful, forgetting names, or losing things or forgetting to take care of important tasks. Cognitive deficits can also cause confusion or may make it difficult to understand concepts that a stroke survivor would have previously been able to understand.
The loss of cognitive skills can be very distressing for stroke survivors, and many stroke survivors may be in denial, making excuses for frequent mistakes, or even lying about errors to avoid embarrassment.
Building up cognitive skills is a challenge, but just as physical disability can improve with physical therapy, cognitive disabilities can improve with dedicated cognitive therapy.
Many stroke survivors find themselves becoming very emotional or inappropriately crying or laughing. Some stroke survivors experience a condition called pseudobulbar affect, which is characterized by mood changes and uncontrollable emotional expressions.
Lack of Motivation
A stroke can lead to a lack of motivation, which is called apathy. Apathy occurs after most types of brain injury. There are several reasons for post-stroke apathy.
The decline in cognitive abilities (problem solving and thinking skills) after a stroke can make many tasks seem too challenging and unsolvable. Additionally, the development of post-stroke depression, having less responsibility to deal with after the stroke, and sometimes the feeling that “nobody will notice” what you do, can all lead to apathy.
Lastly, apathy may also occur due to changes in the structure and function of the brain secondary to the stroke itself.
Some stroke survivors become unexpectedly hostile and angry, behaving in ways that are mean or physically aggressive. Aggression, like the other behavioral and personality-related stroke changes, is often a result of both the emotional feelings about the stroke and the stroke-induced brain injury.
Aggression is particularly noticeable in stroke survivors who have a stroke pattern that produces vascular dementia. Vascular dementia occurs when many small strokes happen over time, leading to a buildup of injuries throughout the brain, and resulting in a distinctive type of dementia. Vascular dementia is characterized by a decline in memory and thinking skills, confusion, trouble finding things, trouble with directions, and changes in behavior.
Denial of a Stroke: Anosognosia
Anosognosia describes a stroke survivor’s inability to recognize that he or she has had a stroke. Anosognosia is manifest by an interesting overconfidence and unawareness that there is anything wrong after a stroke. In fact, a person who has anosognosia may express surprise and bewilderment at the fact that there is any medical care being administered at all.
Stroke survivors who have anosognosia present a challenging problem for loved ones and caregivers, who try to offer assistance and care, often with no cooperation. Sometimes stroke survivors who have anosognosia treat those who are trying to help them with dismissal or rejection.
Lack of Empathy
The lack of empathy after a stroke is caused by brain damage that affects regions of the right side of the brain. A lack of empathy is a behavioral change that is usually upsetting for friends and loved ones, but is typically unnoticed by the stroke survivor.
It is not easy to predict whether a lack of empathy will improve after a stroke, as some stroke survivors can show improvement, while others do not.
Loss of Sense of Humor
A sense of humor requires insight and the quick thinking. Humor is often based on the recognition that dissimilar ideas do not belong together and that they are funny and amusing when placed together.
Many types of stroke can diminish a stroke survivor’s sense of humor. A stroke survivor who was previously funny might not be able to construct jokes and a stroke survivor who would have been able to recognize and laugh at jokes might not be able to do so anymore.
A loss of sense of humor can be difficult to recover from, because this stroke effect is caused by a loss of cognitive skills. However, understanding that the lack of humor is the result of a stroke, and not a personal rejection, can help in preventing hurt feelings and misunderstandings when a stroke survivor does not respond to lighthearted joking as expected.
Loss of Social Inhibitions
Some stroke survivors may behave in ways that are considered socially inappropriate after a stroke of the right or the left frontal lobe. Behaviors such as taking food from a stranger’s plate, insulting people out loud or even undressing or urinating in public, may pose challenges for the caretakers and family members who are primarily responsible for the safety and care of a stroke survivor.
Generally, a stroke survivor who displays socially unacceptable behavior does not have the insight to understand that the actions are not acceptable, and is unlikely to apologize or try to correct the behavior.
The language or insults of a stroke survivor who has suffered from a frontal lobe stroke are not necessarily consistent with a person’s ‘normal’ pre-stroke personality or beliefs. And it is very important to be aware that mean statements are not reflective of what a stroke survivor ‘really feels, deep down inside,’ but are more likely to be phrases that he or she heard in a completely unrelated setting, such as in a book or on a television show.
The loss of social inhibition can be somewhat better controlled when the stroke survivor is comfortable, in a familiar environment, and under as little stress as possible.
A rare type of stroke causes a syndrome called Othello Syndrome, which is characterized by irrational and illogical jealousy, particularly in the context of romantic relationships. This syndrome can affect stroke survivors as a result of brain injury affecting areas of the right cerebral cortex.
A Word From Verywell
A stroke can cause major personality changes that can make you feel as if you have lost yourself or that you’ve lost the loved one you used to know so well. Personality changes after a stroke can be emotionally draining for everyone involved.
However, if a stroke survivor and loved ones understand that the source of the behavior comes from stroke-induced brain damage, it can reassure everyone in knowing that the unpleasant behavior is not premeditated or intended to be personally insulting. High functioning stroke survivors who learn about the typical post-stroke behavioral changes can gain enough insight to be able to make some changes, which can result in more satisfying interpersonal relationships.