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COMMON EMOTIONAL AND
PERSONALITY CHANGES
AFTER STROKE
strokeassociation.org/
After a stroke, people often experience emotional and behavioral changes. This is because the brain controls our behavior and emotions. A stroke may make a person forgetful, careless, annoyed or confused. Stroke survivors may also feel anxiety, anger or depression. Their behavior depends on which part of the brain is affected and how extensive the injury is.
Depression
Depression is common after stroke, affecting about one-third to two-thirds of all survivors. The symptoms can be mild or severe, often starting in the early stages of stroke recovery. Stroke survivors should be assessed for depression and treated when it occurs. It’s important to identify and treat post-stroke depression (PSD) as soon as possible. Untreated, it can lead to being in the hospital longer and can limit a survivor’s functional recovery.
The symptoms of PSD may vary and change over time, but patients and families should watch for:
The symptoms of PSD may vary and change over time, but patients and families should watch for:
• Persistent sad, anxious or “empty” mood
• Depressed mood; loss of interest/pleasure
• Sleeping problems
• Decreased motivation
• Responding with little or no emotion
• Feelings of hopelessness • Feelings of guilt, worthlessness, helplessness (feeling like a burden)
• Decreased energy, fatigue, being “slowed down”
• Difficulty focusing, remembering, making decisions
• Appetite changes
• Thoughts of death or suicide
When five or more of the above symptoms last for two or more weeks, a survivor may be having PSD.
Anxiety
Anxiety
Changes related to stroke can lead to worry and anxiety. Getting around may be harder. There may be financial strains. Other sources of anxiety after stroke may be fear of falling because of balance problems or being anxious about speaking because of aphasia. Counseling can be helpful for anxiety. Sometimes anxiety and depression are both in play. If you’re anxious, talk with your health care team about potential treatments.
Pseudobulbar affect (PBA)
When parts of the brain that control emotions are injured, PBA (also called emotional lability or reflex crying) occurs. Most often, people cry easily. Some may laugh uncontrollably or have sudden mood swings. These are physical effects of the stroke. Telling the person not to cry won’t help. Instead, ask them how they want to be treated during an episode. Many people prefer that it be treated as a reflex, such as hiccups, and that conversation continue. Lability often lessens over time. If PBA is a problem for you, ask your health care provider about available treatments.
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