A stroke can affect the way your brain understands, organises and stores information. This is also known as cognition.
Here we explain the different ways a stroke can affect your cognition, the problems this can cause and what you can do about them. It's aimed at people who've had a stroke, but there is information for family and friends as well.
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On this page:
- Why have my memory and thinking been affected?
- Diagnosing cognitive problems
- Types of cognitive problems after stroke
- Are there treatments that can help?
- What can I do about cognitive problems?
- Tips for family and friends
Why have my memory and thinking been affected?
Problems with memory and thinking (cognitive problems) are very common after a stroke. They are most common soon after a stroke and like many effects of stroke, the fastest recovery takes place in the days and weeks after a stroke. But recovery can continue for months or years.
What is cognition?
Every second you receive a huge amount of information from the world around you, which your brain has to understand, organise and keep.
Different parts of your brain control different things. If one of the parts of your brain that control cognition is damaged by a stroke, then this can affect your ability to do certain things. If your cognition is affected, then you could find it difficult to concentrate or remember certain things. You may also find it difficult to work out how to do something or know how to respond to what's going on around you.
Diagnosing cognitive problems
When you're in the hospital, you should be assessed to find out if you have any cognitive problems. However, some cognitive problems are not easy to identify, and some might only be noticeable after you return home.
It's likely that you'll need to complete a cognitive assessment. This will tell you more about the problems you're having and why they're happening.
The assessment is usually done by a doctor or an occupational therapist (or sometimes a psychologist) and involve a lot of questions, which can make you feel like you're taking an exam. You may be asked to answer really easy questions or do things that are very simple, which can make you wonder what the point is.
Still, it's important that you do them, as the results of the assessment will help your stroke team decide the best way to help you.
Types of cognitive problems after stroke
There are several different types of cognitive problems. Read more about each one, and how it's diagnosed and treated:
- Problems with planning and problem-solving (executive function)
- Problems noticing things on one side (spatial neglect)
- Problems moving or controlling your body (apraxia)
- Controlling movement and finding your way around (visual perception)
- Confusion and denial (anosognosia)
- Problems recognising things (agnosia)
Cognitive problems are usually worst during the first few months after a stroke, but they can and do get better. They're likely to improve most quickly over the first three months, as this is when your brain is at its most active, trying to repair itself. It's still possible for problems to improve after this, but you may find that it takes longer. Recovery can continue at a slower pace for months or years. Treatments for cognitive problems focus on ways to cope with the problems, rather than 'fix' them. An occupational therapist can assess you and help you learn coping strategies. This may involve using aids (such as writing in a diary or using labels and reminders) that can help you manage. Or it may involve learning other techniques that can help you. If your problems are quite specific or severe, you may be referred to a clinical neuropsychologist. This is a doctor who specialises in the way the brain works. They often work with people who have had a brain injury or stroke. Whether you receive treatment or not, your problems should continue to be monitored to make sure that you get the support you need for them. Even if you don't need support straight away, you may once you've been discharged from the hospital, so your doctor and stroke team should make sure that you get it.
Having cognitive problems does not mean that you have dementia. Many people worry about this, but dementia gets worse and worse over time, whereas cognitive problems after stroke often get better. Find out more about vascular dementia.
Are there treatments that can help?
What can I do about cognitive problems?
1. Get some help
If you think you may be experiencing some of the problems we've described, the first thing to do is to speak to your GP. They will make sure that there isn't anything else that could be causing the problems, such as an infection or side effects of medication. Depression and anxiety are both common after a stroke, and can make a person perform less well on cognitive tasks. So if you feel depressed or anxious, let your GP or occupational therapist know. It's easy for people, including doctors, to forget that there are effects of stroke you can't see. So don't wait to be asked about them. If you're finding it hard, tell someone. Make it clear how your problems are affecting you and ask what support you can get.
2. Don't be too hard on yourself
Having cognitive problems after a stroke is nothing you can control or need to feel bad about. You just need to be patient with yourself. You're not stupid, even though you may feel that way. Allow yourself more time to get things done and don't expect too much of yourself. Brain injury is a serious condition that needs diagnosis and rehabilitation, in the same way you need treatment and rehabilitation after another type of physical injury like a broken leg.
I've had to learn not to beat myself up about not being able to rememberMary
3. Stay active
Being as active as you can may help with cognitive problems and it can also help with emotional problems like low mood and anxiety. If you can, try to aim for aerobic exercise that gets your heart beating and makes you slightly out of breath can help. This could be a sport like swimming or running, or you can try gardening or brisk walking. Read our information for more ideas about being active after a stroke.
4. Get enough rest
Fatigue is very common after a stroke, and it can make it even harder to concentrate or remember things. Plan your day so that you balance being busy with taking breaks and resting. You're not going to be able to take life at the same pace as you did before, at least not to begin with. Take breaks when you need to and make sure you get plenty of sleep at night. It will help you to focus if you do. Read more about fatigue after a stroke.
- Returning to work
Cognitive problems can take a long time to improve, so if you go back to work too soon you could find it a lot more difficult than if you went back a little later. An occupational therapist can give you advice about the best time to go back to work and can also talk to your employer about how they can support you when you do. Read more about going back to work after a stroke.
Balance being busy with taking adequate rest. My brain is definitely slower when I'm tired or run downJo
5. Look into aids and equipment
There are aids and equipment that you may find helpful, especially for problems with memory. Your occupational therapist will be able to suggest some to you.
6. Find ways to relax
Your mind needs to rest just as much as your body. Even small things like going for a short walk, listening to music or having a quiet moment to yourself in another room can help to calm your mind. Some people find mindfulness or meditation really helpful. Relaxing can be difficult if you have a busy home life, but it's important that you find a way to rest your mind when you get tired or frustrated.
One of the biggest things I learned was mindfulness meditation. It made a huge difference on calming my mind before using it.Cath
7. Tell people what's going on
Cognitive problems are nothing to be embarrassed about, so be up-front with people about them. We all feel awkward when we don't know what to do, so explaining to someone what they can do to help (speaking slowly or writing things down, for example) will make it easier for you both. It will also stop them from getting offended if you don't remember something from your last conversation, or think that you're bored if you get distracted.
Be open with people. I just tell people that I struggle with memory and making quick responses sometimes. I've never had a bad response.Jo
8. Talk to someone who understands
Cognitive problems can affect your confidence and how you feel about yourself. Talking about it can really help. Many people find support groups useful because you can talk about problems with people who are going through the same thing. If you prefer not to join a group, try talking to a friend or family member instead - whoever you feel comfortable confiding in when you're finding it tough. Look for a stroke club or group in your area, or log on to My Stroke Guide, our free online self-management tool.
Tips for family and friends
It can be difficult to know how to help someone with cognitive problems, so here are some tips to help you:
1. Be patient
Someone might need longer to respond or carry out a task, and this can feel frustrating if you're trying to help. Let your friend or family member do things in their own time. If there's something bothering you, explain the problem calmly and focus on what you can both do to make it better.
2. Be encouraging
Do therapy exercises with your friend or family member and think of ways to make them fun. Cooking a meal can be a good way to practise planning and problem-solving, for example. If progress is slow, it can be easy to think that things will never get better, so help them by celebrating all their successes, however small.
3. Give information in the right way
If your friend or family member is finding it hard to concentrate or remember things, you can help by giving information in a way that suits them, including:
- Breaking tasks down into individual steps.
- Giving simple instructions, one at a time, rather than a list of things to do.
- Keeping it brief: they might not be able to follow a 20-minute update about your day. Just start with the headlines.
4. Don't do everything for them
It's natural to want to help, but it's better to help someone do things on their own rather than do it all for them. So if they ask you what day it is, suggest they look at the paper to find out. You could help by preparing an activity, such as putting out the things they need. Tidy up and de-clutter the area. They may be able to dress themselves, or make a sandwich, if they have the things they need and a clear space.
5. Help them get support
If someone needs more support, contact the GP or stroke team.