Thinking, understanding, memory and fatigue after a stroke

A stroke can affect thinking, understanding and memory (called cognitive processes of the brain) as well as physical functioning. Tasks such as learning new skills, recognising faces and objects, and processes such as memory and concentration can all be affected. It is common for people to experience increased tiredness, or fatigue, after a stroke. Behaviour and personality can also occasionally be affected.

Some of the people we spoke to found it hard to explain their symptoms whilst others would dismiss them. For example, trouble remembering things was put down as something everyone experienced, or, for older people, as a normal part of ageing. Other people were keen to point out that they had noticed a significant change in their memory or cognitive skills since their stroke. 

A few people had been through specific tests for memory and other cognitive functions. These were seen as helpful because they could help confirm the specific problem and lead to help and advice on how to overcome it.

Getting information about some of the cognitive changes after a stroke had been reassuring. Stroke related support groups were all seen as a good source of information.

Fatigue and concentration
Feeling extremely tired in the first few weeks after a stroke was very common. While some found this passed as they got stronger and recovered [Interview 10] others felt it continued or occasionally got worse. One woman described how her fatigue, which she described as a “neurological fog”, eventually disappeared. Another man had recently retired because he had found the fatigue had become too much.

Increased tiredness hindered people's abilities to concentrate on things like reading or complicated tasks like using a new piece of electronic equipment. Lack of concentration and problems with memory (see below) could make people feel like their intelligence had decreased.

Physical impairments such as walking and hand function could also feel more prominent and difficult to deal with when people were feeling particularly tired.

Going to bed earlier, having a sleep in the afternoon and trying not to do too much without a break were all ways that people coped with the increased fatigue.

Memory of the time around the stroke was sometimes blanked out and several people said they were embarrassed when they met people again who they had seen in hospital but did not remember. A few had also been told that they had had trouble remembering even familiar faces during this time. One well known effect of a stroke can be that people don't recognise family members and the wife of a man we spoke to explained that he had been unable to recognise his own young daughter for the first few days which she had found very distressing. 

Some people experienced problems with memory in the longer term, most often their short term memory. This could mean that they often repeated themselves, did not remember things they had been asked to do, were easily distracted and forgot what they were doing or saying or could not remember things they had been doing the day before. Several people found that they struggled with keeping appointments and had learnt to write everything down. 

Some people found specific problems in remembering how to tell the time, the price of things, other numbers or sequences whilst other people also had specific problems recognising and remembering faces of new people or problems remembering their way around new surroundings. 

Personality and behavioural changes
Occasionally personality can be affected by a stroke because of changes in the way that the brain is working. Two of the carers that we spoke to felt that their relative had become more bad tempered and snappy. Whilst some of this was put down to frustration at their disability they also felt there had been an unexplained change in personality. One woman said her mum had become more snappy but she had also noticed she now swore which she did not do before and she had also had become uncharacteristically flirty. Another woman commented that she felt that she was less passive since her stroke, which she was comfortable with.

One man said he had poor risk assessment which meant that he thought that he could do things he couldn't. This meant he could put himself in danger by attempt to do things he couldn't do. 

Other changes in perception and cognition

Stroke can very occasionally result in changes in perception.

One man said that in the immediate aftermath of his stroke he had what was called 'symptom blindness' in which he thought he could walk and do other things when in fact, he was not yet able to do them. Another man said his sense of taste had changed and a couple of people who were artistic thought their perception of colour and consequently their painting ability had changed. One woman had also experienced colourful visual and auditory hallucinations.

Hallucinations after a stroke are relatively rare and in older people may also be linked to dementia. A woman whose mother had had a stroke and suffers vascular dementia described how her mother talked about people coming into her room at night even though there was nobody there.

Last reviewed June 2017.
Last updated August 2011



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