Problems with memory and thinking

Why has my memory and thinking changed?

Every second you receive a huge amount of information from the world around you, which your brain has to understand, organise and keep. This is called cognition.

Cognitive problems happen because of damage to your brain. Different parts of your brain control different things. If one of the parts of your brain that control cognition is damaged by a stroke, then this can affect your ability to do certain things.

Cognitive problems are very common after a stroke.

What kinds of problems can this cause?

Memory problems

We store all kinds of information in our memory. Your short-term memory is like a temporary storehouse for information. It allows you to remember things just long enough for you to use them. If you need to remember something for longer than this, it moves to your long-term memory. This lets you recall events and feelings from the past.

Some memory problems are actually caused by problems with concentration. If you can’t focus on what you’re being told, you’re not going to be able to remember it later. Emotional problems like anxiety can also make it hard to concentrate.

Problems with concentration

Problems with concentration can affect you in different ways, as we rely on it for all of our other thinking processes. If you find it hard to focus on something, then you’re not going to know how to respond to it or be able to remember it later.

Other effects of stroke can make your concentration worse too. Tiredness, pain or emotional problems like depression can all affect your ability to take information in and stay focused.

Problems with planning and problem-solving

As well as being able to take in and store information, our brain performs a whole range of other thinking processes. Many of these happen without us being aware of them, known as automatic processes. Together, many of these automatic processes are known as executive function.

If a stroke affects your executive function, you may not be able to work out how to do certain things, like changing the channel on the TV remote or making a meal. Or you may not know how to start or finish a task on your own, and may find it difficult to multitask (do more than one thing at the same time).

Problems noticing things on one side (spatial neglect)

A stroke can damage your brain so that it no longer receives information from one side of your body. If this happens, you may not be aware of anything on one side, usually the side where you’ve lost movement (your affected side). This is called neglect or inattention.

Problems moving or controlling your body (apraxia)

If you have apraxia you’ll find it difficult to move when you’re asked to, even though you understand exactly what you’re being asked to do and know how to do it. This is because apraxia is a problem with planning movements – so even though you can’t wave properly to someone when they ask you to, you may wave without any problem when they go to leave, because you’re doing it without thinking.

Problems with movement and finding your way around (visual perception)

We use information from our eyes to determine the size, shape and position of the objects we see. Our brain uses this to work out how far away they are from us and where they are in relation to other things. This is called visual or spatial perception.

If a stroke affects your visual perception you may not be able to judge depths or distances or tell the difference between foreground and background.

Confusion and denial (anosognosia)

Sometimes after a stroke, people are not able to recognise the effect that it has on them. So you may not know that you’ve lost movement in your arm or leg, for example. This is called anosognosia.

If you experience this kind of confusion, it’s more likely to be with movement or visual problems, although it can apply to other problems too. People who have neglect are more likely to experience anosognosia.

Problems recognising things (agnosia)

There are two stages to recognising something. The first stage uses the information you get from your senses about the way it looks, feels and sounds, to develop a picture of what it is. The second stage compares this to the information in your memory so that you can remember what it’s called and what it does. A stroke can affect both of these stages.

If your stroke affects how your brain processes the information you receive about an object, then this is apperceptive agnosia. If it affects the way you remember information about objects, this is associative agnosia.

Agnosia may only affect you in very specific ways. Some people, for example, find that although they can’t recognise an actual object, they can recognise a picture of it. Some people have agnosia for colour or faces. Having trouble recognising faces is known as prosopagnosia, sometimes called face-blindness.

Getting help

If you’re having problems with your memory or thinking, the first thing to do is to speak to your GP.

It’s easy for people, including doctors, to forget that there are effects of stroke you can’t see. So don’t wait to be asked. If you’re finding it hard, tell someone. Make it clear how your problems are affecting you and ask what support you can get.

Are there treatments that can help?

Treatments for cognitive problems focus on ways to cope with the problems, rather than ‘fix’ them.

Once your difficulties have been assessed, you can learn compensation or coping strategies, often with the help of a therapist or doctor.

An occupational therapist can help you learn coping strategies. This may involve using aids (such as writing in a diary or using labels and reminders) that can help you manage. Or it may involve learning other techniques that can help you.

If your problems are quite specific or severe, you may be referred to a clinical neuropsychologist.

Will it get better?

Cognitive problems are likely to improve most quickly over the first three months after stroke, as this is when your brain is at its most active, trying to repair itself. It’s still possible for problems to improve after this, but you may find that it takes longer. Recovery tends to slow down, especially after six months.

Even if your cognitive problems never go away completely, they should not get any worse and do get easier to live with.

What can I do about my cognitive problems?

Don’t be too hard on yourself

Having cognitive problems after a stroke is nothing to feel bad about. A stroke is a major injury to your brain, so it’s going to take time for it to recover. You are still the same person even though things have changed for you. Allow more time to get things done and don’t expect too much of yourself, too soon.

Take plenty of exercise

Being as active as you can may help with cognitive problems and it can also help with emotional problems. If you can, try to aim for aerobic exercise that gets your heart beating and makes you slightly out of breath.

Get enough rest

You’re not going to be able to take life at the same pace as you did before, at least not to begin with. When you’re tired it’s even harder to concentrate or remember things. So rest when you need to and make sure you get plenty of sleep at night. It will help you to focus if you do.

Find ways to relax

Your mind needs to rest just as much as your body. Even small things like listening to music or having a quiet moment to yourself can help to calm your mind. Relaxing can be difficult if you have a busy home life, but it’s important that you find a way to rest your mind when you get tired or frustrated.

Look into aids and equipment

There are aids and equipment that you may find helpful, especially for problems with memory. Your occupational therapist will be able to suggest some to you. There are also Disabled Living Centres all over the UK, where you can get advice on aids and equipment.

Tell people what’s going on

Be up front about the problems you’re having. People feel awkward when they don’t know what to do, so tell them what will help (speaking slowly or writing things down, for example). It will also stop them from getting offended if you don’t remember something from your last conversation, or assuming that you’re bored if you get distracted.

Many people find support groups useful, because you can talk about problems with people who are going through the same thing.

Information guides

• Download A complete guide to cognitive problems after stroke (PDF)
• Download Problems with memory and thinking guide (PDF)

Where to get help and information from the Stroke Association

Helpline
Call us on 0303 3033 100,from a textphone 1800 0303 3033 100
Email: helpline@stroke.org.uk
Our Helpline offers information and support for anyone affected by stroke, including family, friends and carers.

Read our information
Call the Helpline to ask for printed copies of our guides.

Other sources of help and information

Age UK
Phone: 0800 169 6565
Provides information for older people on a wide range of issues.

Alzheimer's Society
Phone: 0845 3000 336
Gives information about memory loss, memory aids, and the mini-mental state examination (MMSE).

Brain & Spine Foundation
Phone: 0808 808 1000
Provides information about stroke and memory problems. Their helpline is run by neuroscience nurses and other health professionals.

Headway – the brain injury association
Phone: 0808 800 2244
Provides information about memory problems, cognition and decision-making.

Apps from MyTherappy
NHS approved and recommended, there are stroke apps for survivors and carers ranging from communication, eating and drinking, healthy lifestyle, vision and more.

_{Disclaimer: The Stroke Association provides the details of other organisations for information only. Inclusion on My Stroke Guide does not constitute a recommendation or endorsement.}