Depression and mental changes

Because a stroke affects the brain, its functions – from memory to mental health – can be affected.

• Mood and depression
• Memory and thinking  
• Understanding sensory information

Mood and depression

Many people who survive a stroke feel fear, anxiety, frustration, anger, sadness and a sense of grief for their physical and mental losses. These feelings are a natural response to the effects of a stroke. Some emotional disturbances and personality changes are also caused by the physical effects of brain damage. These feelings may or may not be depression.

Depression is a sense of hopelessness that disrupts a person’s ability to function. It is common among stroke patients. Caregivers struggling with new responsibilities and roles are also at risk of becoming depressed. Depression can be treated and the faster you are treated, the better. It is important to recognize the signs and get help fast.

10 warning signs of depression:

1. Feelings of sadness, anxiety, irritability, nervousness, guilt, worthlessness or hopelessness.
2. Changes in your sleep pattern (difficulty sleeping or sleeping more than normal).
3. Changes in appetite, or gaining or losing weight without trying.
4. Loss of interest in activities you used to enjoy.
5. Restless or sluggish behaviour.
6. Persistent or recurring headaches, chronic pain or digestive disorders (such as stomach aches, nausea, constipation or diarrhea).
7. Difficulty concentrating, remembering things or making decisions.
8. Fatigue or loss of energy.
9. Changes in work style or productivity.
10. Thoughts of suicide or death.

If you have two or more of these symptoms for more than two weeks, contact your doctor. Treatment can involve speaking to a trained mental health professional such as a social worker, taking antidepressant drugs, or both.

If you are having thoughts of suicide, get professional help right away.

Looking at your abilities

Your doctor needs to tell the difference between the sadness you feel about the stroke and its effect on your life and depression. You will be asked questions about your mood and how you are coping. The doctor may also do a physical exam to rule out other causes.

Helpful tips 

• Stick to your treatment plan. Don’t skip sessions, even if you don’t feel like going.
• Take medication (drugs) as prescribed.
• Learn about depression. Knowing more can motivate you to stick to your plan.
• Pay attention to the warning signs. Let your doctor know if the symptoms return. Have family members watch for them too.
• Get active. Physical activity can reduce symptoms.
• Find someone to talk to about how you are feeling, such as a healthcare professional, a good friend or someone from your house of worship.
• Get involved. Try to do activities that bring you joy, such as visiting grandchildren, gardening or volunteering.
• Avoid alcohol. It can make the symptoms of depression worse.

Who can help?

Your doctor or psychologist plays a key role in diagnosing and treating depression. Your family and friends can play a role in providing the support you need.

Is it "the blues" or clinical depression? Learn more about your feelings after a stroke.

StrokEngine provides information on stroke rehabilitation and interventions from quality articles, websites and systematic reviews. Visit StrokEngine to learn more about depression.

Memory and thinking

A stroke – whether major or minor – can affect your ability to learn and remember. Here are some ways in which memory loss can affect your life.

Learning and remembering new information
You may be able to remember things that happened before the stroke, but have trouble learning and remembering new information. For instance, you might remember how to play bridge, but not be able to learn a new game like canasta.

• Applying information to a new setting
  For example, you may learn how to move from a wheelchair to a bed in the hospital, but not be able to do it at home.
• Needing reminders
  For example, you may forget to brush your teeth without someone telling you to.
• Becoming confused or lost
  You may get lost even though you are in a familiar place. Or you may lose track of the time or date.
• Problem solving
  Solving a problem requires memory, planning and the ability to make decisions. If your stroke has affected the parts of your brain that control these abilities, you may find it difficult to solve problems. 
• Attention span
  You may find it difficult to stay focused on the information you want to remember, use or act on. 

Looking at your abilities

Your healthcare team will ask you questions to help them figure out how the stroke affected parts of your thinking processes and memory. For instance, they might ask you what the date is. Or, they might ask you to remember three words and then ask you to repeat them minutes later. Your doctor will examine the assessment results decide what is causing the problem.

Memory problems can be caused by many things other than a stroke. Some of these can be treated. For instance, being depressed or eating a poor diet can affect your memory. Getting treatment for your depression and changing your diet may help your memory improve.

Helpful tips

• Avoid rushing into things. Stop and think before starting a new task.
• Have a routine where you know what will happen and what to expect.
• Concentrate on one thing at a time.
• Remove any distractions, such as the TV or radio, when you need to concentrate.
• Keep a journal or list of items that are important to you. This might include a list of friends with their picture by their names.
• Break tasks into small steps and finish one step at a time.
• Be patient with yourself. Getting angry or frustrated will only make it more difficult to remember.
• Allow your family, friends and caregivers to help you.
• Ask people to break the message up into smaller pieces when they talk to you.
• Don’t be shy about asking people to repeat things.
• Look at how memory problems might affect your safety at home. Do you need reminders to turn off the stove or lock your doors?
• Find ways to help you remember to take your medications.

Who can help?

Your healthcare team will assess your memory and ability to solve problems. They will work with you to adapt to this challenge.

Understanding sensory information

Sensory information refers to what your senses are telling you. The senses are vision, hearing, touch, taste, and smell. A stroke can affect how you process what your senses are telling you. That means you may have problems understanding what is going on around you.

Here are some ways a stroke might affect your senses:

“Neglect” one side of the body
You may be less aware of the side of the body affected by the stroke. This is called unilateral neglect. For instance, people with damage on the right side of the brain may ignore the left half of their body. This can lead to things like forgetting to dress the left side. Or it might mean leaving the left arm hanging over the side of the wheelchair.

Apraxia
This means you find it difficult to do something on purpose, even though you have the physical ability and you know how to perform the task. For instance, you may not be able to dress properly.

Spatial relations, depth and distance perception
This is how you see objects relating to each other and how you relate to objects in the environment. For instance, you may have trouble judging the height of steps or trip on uneven pavement. When you are moving from bed to a wheelchair, you might push toward the side that was affected by the stroke. Impaired perception might make you knock things over, miss the chair when sitting down or trip over rugs.

Perseveration (repeating)
This means uncontrollably repeating a word, phrase or action. It makes you unable to move on to the next activity or thought. Examples include washing your face over and over or repeating the same word many times.

Impulsivity
This means acting too quickly without thinking things through. After a stroke, you may behave unsafely and act on sudden urges. For instance, you might get up quickly from a wheelchair before putting the brakes on.

Time awareness
Some stroke patients do not recognize or understand the passing of time. For instance, they might ask about having dinner 30 minutes after finishing lunch.

Vision problems
These can include double vision and partial loss of vision in one or both eyes. Another type of vision problem is visual neglect. This happens when you are less aware of your environment on the side that was affected by the stroke. For instance, you might only see half of a clock.

Looking at your abilities

Different members of the healthcare team will figure out the type and extent of the problem. For example, an eye doctor might help with vision problems. An occupational therapist would assess the type of neglect.

How your caregivers can help

You may not always be aware of these problems. That’s why it is so important that those who care for you use a consistent strategy to help. Here are some strategies for each of the sensory problems described:

Neglect on one side of the body

Talk with your healthcare team about ways to keep using your affected limb in daily activities. You may ask your caregiver to: 

• Place the weak arm where you can always see it.
• Gently stroke the affected arm to increase your awareness of it.
• Give you cues such as asking, “Where is your left arm?”
• Encourage you to help when positioning your affected limb.

StrokEngine provides information on stroke rehabilitation and interventions from quality articles, websites and systematic reviews. Visit StrokEngine to learn more about unilateral spatial neglect interventions.

Apraxia

Talk with your healthcare team about the best strategy to get you to do tasks that you know how to do: physical cues, verbal cues, or demonstration.

• Have your caregiver use short, simple instructions and to break the task down into several simple steps, for example, to brush your teeth.
• Have your caregivers place their hand over your hand to guide you in the task.
• Have your caregivers encourage you to repeat and practice the task.

Spatial relations, depth and distance perception

Talk with your healthcare team about the best assistive devices to use, such as fluorescent tape at the edge of steps or the bathtub, or using a non-spill cup.

• Have your caregivers encourage you to repeat and practice using a non-spill cup.
• Make sure that your environment is clutter-free.

Perseveration

Talk to your healthcare team about the best strategy for your caregivers to help you reduce your repetitive motions or speech.

• Help the stroke survivor to plan out a task.
• Provide clear, step-by-step instructions.
• Assist the survivor to stop between steps in order to initiate the next step.
• Provide hand over hand and visual cueing for tasks.
• Give the survivor time to practice the sequences.
• When the survivor repeats a sentence or a word, change the conversation or topic in order to redirect their thoughts.  person's thoughts.

Impulsivity

Talk to your healthcare team about ways your caregivers can help you to stay safe in your environment by:

• Encouraging you to slow down.
• Breaking tasks into small steps.
• Telling you to stop and perform a specific task.
• Giving clear, specific instructions.
• Setting up your living space to be as safe as possible.

Time awareness

Talk to your healthcare team about ways to help you relate to time by having your caregivers:

• Link events to other events, not to time. For example, have them say “Bingo is after lunch” rather than “Bingo is one hour after lunch.”
• Create a daily schedule and review it often.
• Keep to the same schedule.
• Use a digital clock or talking clock.
• Acknowledge the way you perceive time but also clarify the correct time.

Vision problems

Talk to the healthcare team about the best strategies for your caregivers to use, based on their assessment of your specific problem.

• If you experience visual neglect:
  • Arrange the environment to stimulate your affected side.
  • Use visual cues such as coloured tape or a flashing light.
  • Use a reference point or anchor on the affected side, such as a red line at the edge of a table.
  • Scan your environment like a lighthouse – visually sweep the environment from one side to the other.
• If you experience visual field problems:
  • Turn your head toward the affected side.
  • Place items on your affected side to increase awareness of that visual space.
• Your healthcare team may recommend the use of an eye patch or prism glasses, if necessary.

Who can help?

Occupational therapists are the experts on the healthcare team for assessing sensory problems. However, your entire healthcare team can help you adapt to any sensory changes caused by a stroke.

The Heart and Stroke Foundation provides practical knowledge and skills to help care for stroke survivors. Tips and Tools for Everyday Living: A Guide for Stroke Caregivers is designed for healthcare providers and is also a useful reference for family caregivers. Read more about the Guide.

The Heart and Stroke Foundation has a Living with Stroke^TM program for stroke survivors who have completed their active rehabilitation and are living in the community. It focuses on building skills, sharing experiences and lending support. Find a Living with Stroke^TM program in your area.

Last reviewed: November 2010

Last modified: January 2012