Excerpted from "Behavior Changes After Stroke," appearing in the Stroke Connection Magazine January/February 2005. (Last science update March 2013)
Some survivors experience apathy and don’t seem to care about anything. “People often mistake this for depression because survivors are content to sit and stare at the wall all day,” says Dr. Spradlin. “The best response is to get them active and moving. Give them a choice of what to do or where to go, but make it clear they have to choose to do something, they can’t just lie in bed.”
Other survivors experience neglect, an attentional disorder in which the patient does not pay attention to things on one side of the body. Neglect can run the gamut from someone who doesn’t recognize paralyzed limbs as their own to those who ignore food on one side of the plate or words on one side of the page. Neglect occurs most often in right-hemisphere strokes and thus results in inattention to the left side.
Of course, driving is extremely dangerous for anyone with this disorder.Family members can help survivors by encouraging them to pay attention to the neglected side. For instance, talking to them from their affected side helps them to focus and concentrate on that side. Stimulation and encouragement to use the neglected side also helps decrease their neglect.
Another personality change that occurs after stroke is impulsiveness. “Survivors with this disorder are unable to think ahead,” says Dr. Spradlin. “They may move too quickly, or get behind the wheel when they have left-side neglect. We see this more in people with right-side or frontal lobe strokes.”Read more about one-side neglect.
Are These Changes Permanent?
Personality changes after stroke can be distressing to survivors and family members alike, but they are not always permanent. “It really depends on what the personality change is,” says Dr. Spradlin. “Sometimes they mellow out.”
Certainly, depression need not be permanent, especially with the array of anti-depressant drugs and the increasing availability of talk therapy and support groups.
In a situation involving impulsiveness or inappropriate behavior, behavioral interventions may help — consistently reminding the survivor to slow down or putting a lap belt on a chair so he or she can’t just jump up. Consistent verbal and visual cuing and repeated reminders can help a person with poor impulse control to slow down.
The personality changes that stroke can cause can be intense for everybody concerned. And there is no guarantee that they will go away. Of course, this situation is full of opportunities for guilt, despair, anger, shame and depression — and not just for the survivor. “I tell all the stroke families I work with, there is life after stroke, but you have to stay active and stay around people. That’s why support groups are so important.”