Dealing with Changes in Cognition Following a Stroke

Cognition is continually changing and adapting to novel information you receive. It is modified throughout our lifespan and is based on genetic and environmental factors. A change in cognition or thinking processes is common in a stroke.

Cognition changes

Cognition is the term used to describe all the mental processes your brain uses throughout the day, including perception, knowledge, problem-solving, judgment, language, and memory. Information is collected through a person’s senses, combined with memory to form thoughts, guide physical actions, complete tasks, and help understand the world around the person.

Cognition may change due to environmental factors, including fetal alcohol syndrome, before birth. For children, inadequate stimulation and minimal opportunities for learning can result in poor cognitive development. It can also decline as we age due to other factors such as the social environment, the built environment, air pollution, and the composition of people living in an environment. Even heat, cold, and insufficient oxygen or hypoxia can impair cognition.

Medical conditions and various lifestyle components can heighten the risk of cognitive decline, including diabetes, high blood pressure, depression, obesity, smoking, high cholesterol, minimal physical exercise/activity, and low educational level.

Medical disorders like Alzheimer’s Disease, Parkinson’s Disease, Traumatic Head Injury (vehicle accident or even a fall), Substance Abuse or Addiction, and Stroke can result in cognitive decline.

According to the Stroke Alliance of Europe (SAFE), as many as two-thirds of stroke survivors may experience cognitive impairment because of their stroke.

Common cognitive difficulties after stroke

The location and severity of the stroke will affect the type and level of difficulties experienced by a person and will vary from individual to individual.

• Actions are automatic; a person does not have to think about putting toothpaste on a toothbrush, how to boil water, putting underwear on before pants, or operating a TV remote.
• Orientation to person, place, and time may be impaired.
• Solving problems such as what to do when your sink drain becomes clogged may become difficult. Working with numbers and managing money can be problematic.
• Using one’s memory may be a challenge from something recent like remembering a phone number or what someone just said to you or from the past like an appointment or how to use the coffeemaker.
• Concentration is decreased and is easily affected by fatigue, pain, emotional problems, attempting to do too many activities at once, and other distractions.

Cognition retraining and improvement

It is important to begin cognitive retraining immediately after the stroke when optimum improvement is expected, especially in the first 3 months. Repetition is also very helpful as the brain will create new neural pathways to make up for those that no longer work. Seek the services of an occupational therapist or cognitive trainer. Sometimes speech therapists provide cognitive retraining. Occupational and speech therapy services can be provided in the hospital, outpatient, or at home. Search the internet for your nearest cognitive trainer. Sometimes they may be in a rehabilitation hospital.

In the meantime, below are some interventions that can be tried to improve cognition.

Encourage the patient to use a diary, day planner, calendar, or notepad. Writing down appointments and creating to-do lists can help remember them.

Keep photos and pictures available for the person to look at as they may ‘trigger’ their memory.

Have them refer to the calendar, newspaper, or diary to help remember the day and date.

Encourage them to make notes of important conversations, date them, and identify who it was with.

Help the person make notes, lists, and labels to place at key locations around the house to serve as prompts. Put a list on the bathroom mirror on how to sequence morning grooming.

Assist the patient in programming their mobile phones with alarms, reminders, and memos to remind them throughout the day of important information, including medication time and other events.

Help the person prioritize their day and ensure they only work on one task and one step at a time.

Keep instructions clear and brief with no more than 5 or 6 words to a sentence and only 1 or 2 instructions at a time.

Ask the patient to repeat what you have said in their own words until you both feel they understand what has been said.

Keep rooms quiet, free of extraneous sounds, visual distractions/clutter, and hectic activity. Turn off the tv or radio when conversing with the client or vice versa. This is especially important during reading or learning a new activity.

Work with the patient to develop and implement routines. To relearn steps, bathing, dressing, and grooming in the same order may be helpful.

Try to engage them in activities that can help to stimulate problem-solving skills. Board games such as connect 4, chess, and checkers are examples. Paper and pencil activities like crosswords, puzzles, and brain teasers can also be used. Consider one of many phone apps that will stimulate thinking processes.

Ensure they take regular rest breaks throughout the day. This could be by walking, listening to music, meditating, working on a hobby, relaxation techniques, or basic quiet time.

Exercise is important too.