Complete Personality Change at Wit's end.

by Angie S.
(Michigan)

Question: My mom had a stroke in August 2013 it affected her right side. She has all her mobility back but tires easily, this is nothing new. On the other hand, she has become this other person mentally, not changing her clothes or showering for days. This is a person who could not stand to go 8 hours with out a shower. She is totally wrapped up in her self-pity and treats my dad terribly. That's putting it kindly. I have been telling her that she needs to stay active and keep moving so that she doesn't become immobile. She says she can't do anything and it's like she has given up on life. She is only 67 not 90! Her very dear and close friends call me and ask if she is okay noticing a total change in her personality... If we try to say something to her or get her to do something then she blows up and all progress is lost. I am a married mother of 2 and 2 step-children. My older brother is handicapped with Parkinson's disease in an assisted living home and I am so afraid my mom is going to put my dad in an early grave. Help me please. She has alienated everyone who cares!

Answer: It's hard to help someone when they don't feel as if they have a problem or don't want to be helped. If she is open to it, she could see a neuropsychologist who specializes in emotional issues after stroke. You could also post your question on a caregiver support group forum and see what other people have done in this situation that was helpful. Many people who have strokes want to maintain control of their own lives and may not respond well to being told what to do. Maybe you could include her in activities that would allow her to be more active without making it obvious that is what you are doing. Kids are a great way to help older people become more active (e.g. throwing a ball with the kids, going shopping with them, coming to watch their sporting events, etc.) If she doesn't have enough stamina to go out in the community then choose something easier at home. If the kids come up and ask her to do something, she may be more apt to say yes. I assume you have probably talked to her about her personality changes, but if you haven't, then sit down and have a heart to heart discussion when she is in a good/receptive mood. It doesn't have to be a long or accusing conversation. You can just let her know that her friends and you are worried because she seems more stressed/anxious and that you would like to help.

Mood Swings

Question: My mother had a stroke in 2010. Her right side was affected. With rehab, she has regained most mobility. Her personality has always been controlling, negative, critical and combative but she seems unbearably worse since her stroke. Outbursts come more often. She throws tantrums. She is in assisted living and hates it. She won't eat food that is offered in the dining room, take meds, let them do housekeeping or laundry. She is 88 and the last living of her friends, siblings and parents. She feels she has no one.

We 4 kids are at our wits end. Her doctor is having her tested by a geriatric psych. She is in such denial that anything is wrong with her. She says it's everyeone else. Her memory is above average for a stroke victim but her RAGE is more than we can take.

Is there anything we can show her that indicates a stroke can affect her personality and/or mood changes?

We are dealing with a Jekyl and Hyde

Answer: Stroke can definitely change personality and behavior. These changes may occur because of having a serious, frightening illness that changes one's living circumstances. Stroke victims who were previously independent may feel everyone else is trying to control them and their decisions.

Another reason that mood disorders or personality changes can occur is due to the brain damage caused by the stroke. This damage can cause irritability, mood swings, and loss of emotional control. Unfortunately, the stroke patient may be unaware of the effect they are having on family and caregivers. You can visit www.stroke-rehab.com/personality-changes.html for more information.

There is plenty of other information on the internet regarding stroke and mood changes or irritability. I suggest you do a search and print out some information that you could give to your mother. Of course, this will not change her behavior especially if it's a result of brain damage. My suggestions would be to have a neuropsychiatrist consult with your mom and to get her involved in some type of stroke survivor support group so she could relate to others who have been through the same thing. It would also be a good idea for your siblings and you to go to a support group and hear from other caregivers.
A stroke support group can really have a positive impact on both patients and caregivers.

Apathy and Depression After Stroke

by Deborah L
(Denver)

Question Since my mother has come home from the hospital she does not want to do anything, she does not want to change her clothes,take a shower,put shoes on, she just sits and does not say much...the dr told us that we need to give her books to read but she will not read them, when you ask her how she feels she always say fine whether she feels fine or not.

Answer: Two conditions that are not uncommon after stroke are apathy and depression. Apathy is characterized by indifference, lack of emotion, loss of interest in activities, lack of initiation, loss of motivation, and decreased participation in social activity. Depression may have some of the same symptoms but is also accompanied with a sad mood and hopelessness. Other symptoms that might be present with depression are self criticism, changes in sleep, changes in appetite, and suicidal ideation.

I recommend having your mother see a neuropsychiatrist who can help determine if she is experiencing one of the above conditions and the best course of treatment which can include medication in some cases. Some tips to help with apathy include:

1) Help your mother initiate a task but don't do the task for her (for example hand your mother a brush and tell her to brush her hair instead of brushing it for her)
2) Encourage her to do what she can.
3) Break large tasks down into smaller tasks (for example have her read a paragraph rather than trying to read a page or a book in one sitting)
4) Involve your mother in social activities that you know she enjoys (maybe visiting with friends/family, looking at old photos, playing with a grandchild, church, getting her hair done, listening to her genre of music)
5) Keep activites short in duration
6) Follow a schedule that will help her know what to expect - i.e. bath days are Monday, Wednesday, Friday
7) Make sure caregivers and other family members are on the same page and using the same strategies as well

Stroke recovery

Question My mother had a left frontal lobe stroke Aug 2010 and she recovered very well except some problems with memory. Then about 2 weeks ago she had another stroke and while working on recovery she will have a day where her mind is clear and she can stand and even take a few steps then the next day she is completely confused and dead weight unable to do anything at all or even aware of where she is or who the people around her are. Then the very next day she is back to knowing things and doing things again. We have had this good day bad day every other day for just over two weeks. Is this something that will continue or is this what we can expect? After her first stroke we didn't have this everyday different. On the days when she is weak and confused she is also very mean. On her good days she is sweet and easy to care for.

Answer Some patients have post stroke delirium that will often improve with time. Other factors that could cause increased confusion could be having small strokes called TIAs, having an infection (such as a urinary tract infection), or medication that is being administered.

It's important to rule out what might be leading to the increased confusion. Watch out for urinary tract infections especially if there is an indwelling catheter. Symptoms would be cloudy or smelly urine or a complaint of burning during urination. Ask the MD if all bloodwork is normal and make sure there are no underlying infections.
Observe your mom after taking medications. If you notice an increase in confusion after medication, then notify the physician.

If all seems well in the areas noted above, then the confusion may simply be a result of the stroke. Only time will tell if the confusion will get better. Strokes that occur in the frontal lobe can cause confusion and changes in personality. Having a set schedule can help with confusion.

Mental Issues After Stroke

by David
(New Jersey)

It has been 3.5 months since my father's stroke which was categorized as a mild stroke. He has been displaying the below behaviour, and I wonder if he needs some sort of mental therapy?

- He keeps insisting that he needs to pull his shorts and underwear up together, and that the underwear needs to be aligned straight.

- He told us to turn on the engine of the car so that aircon could cool it first. We did that, but just a minute later, he insisted to get in the car.

- We decided to leave the house at 4.30pm for a massage session. At 4pm, he put on his shoes and sit near the car porch. We told him it was still early, but he wouldn't listen. He kept wanting to "go now".

- He wants to go back to the company to do his work. A staff member prepared some documents categorized properly according to different company names sorted into separate envelopes. My father insisted to check and re-arrange according to the document's running number (like invoice number). We told him it is easier and logical to sort according to companies and that it had already been prepared properly. He didn't listen, insisted on emptying the envelopes, doing it his way and messed up everything.

- Once we were out and he wanted to look for a nail clipper to buy. He saw a pedicure shop and wanted to go in. I told him they don't sell nail clippers. He wanted to ask them if they knew where we could buy the nail clippers. We bought some after this. Days later, he wanted to buy another one because he wasn't satisfied with the new one.

We have been to 1 or 2 sessions with a doctor for a psychology assessment. Unfortunately, I did not get to go. But what I heard from my mother was that this doctor asked some very simple questions like, "How are you?" etc, and if my father could answer, he was deemed ok. My mum has stopped going for this because she saw no point and from this concluded that my father is ok.

Should we get a second opinion from somewhere else or am I worrying about unnecessary issues as it is only 3.5 months after the stroke? He can walk about at home and go for strolls, although he walks with a bit of limp for now.

Answer: Strokes can effect individuals in various ways. Though your father may physically be doing well, it sounds as if he has some cognitive deficits and could benefit from cognitive retraining. Cognitive retraining aims to improve a person's problem solving, memory, attention, organization, decision making, reasoning, and higher level thinking skills.

I suggest having your father's physician write a prescription for speech therapy. The speech therapist will help your father work on all the cognitive skills listed above. I suggest that you go with your father to the speech therapy evaluation and explain what has been happening (or you could send a letter with your mother). This would give a the therapist a better idea of which deficits are interfering with your father's daily life. Speech therapy is normally performed 2-3x/week and can be helpful with the issues you describe.

I don't know if your dad saw a psychologist or a neuropsychologist, but there is a difference. A neuropsychologist specializes in the study of brain-behavior relationship and addresses issues such as learning, memory, and cognition in individuals who have a neurologic injury or disease such as stroke. A clinical psychologist on the other hand treats behavior and emotional disorders such as depression, schizophrenia, etc. If you get your dad started with speech therapy, the therapist could most likely refer your dad to a neuropsychologist if needed or you could go ahead and schedule an appointment with a neuropsychologist in addition to a speech therapy evaluation.

Mental Problems & Imagining Things after Stroke

by Marcel
(Jericho New York)

Question:My brother-in-law had a stroke about 2.5 years ago in 2009. It was a mild stroke and he had no real physical damage, but after the stroke, his whole personality changed and he became unengaging, sometimes seemed in a daze for hours, confused, mumbling his words, etc. He also seemed tired, dragging his feet when he walked.

Right after the stroke he started accusing his wife of having an affair. This is so ludicrous, but he really believes it and he is conjuring up scenarios of how and where this is happening. He says she disappears on the weekend and that's when it is happening. Meanwhile, she does her errands, goes food shopping, etc. Their grandkids come over most weekends. He seems to not remember this but says I have no idea what my sister is doing. This is insane and something is really wrong with him. He is in complete denial that any damage could have happened with his stroke. His doctors just asked him basic questions and they say he is fine. He has been saying he needs to get out of his financial mess and then he will have to get a divorce from my sister even though he still loves her because she is out chasing men.

This man was previously a happily married,self-employed businessman. In the business arena, he hasn't been able to put any deals together and he says he is all mixed up because of what my sister is doing to him as well as because of the economy.
Do many people start hallucinating or dreaming things up after a stroke? His neurologist said it could be due to normal aging of the brain since he is 69 yrs old.

There is too much detail to write but looking for some way to help him. Any help is appreciated. Thank you

Answer: Stroke most definitely can change a person's personality as well as cause psychological issues. I recommend that he see a neuropsychiatrist. A neuropsychiatrist specializes in addressing cognitive or behavior problems caused by neurological injury such as a stroke.

Maybe your sister can sit down with her husband and have a heart to heart talk letting him know that she is not having an affair and asking him to visit the neuropsychiatrist since issues like this can arise after stroke or tell him it is counseling for them. If he is not open to talking to her, maybe she can let his physician know about issues that her husband is having and see if the physician will refer him to a neuropsychiatrist during his next doctor appointment. She could also ask a close relative who her husband respects to try and convince him to go.

I do not agree that this is normal aging of the brain. There can be age-related dementia, but that is definitely not the norm for a 69 year old. If there are changes in the brain, whether it be from aging or neurological issue, they can be identified through imaging studies and even addressed medically in some cases.

Impulse Control

by Ellen
(Jefferson)

Question: My brother’s stroke occurred 8 years ago. He is now 69. He did not have rehab following the stroke. He has impulse control problems(when in public places or other people’s homes, he picks up things and opens doors, drawers and cabinets), apathy about appearance, urinary and fecal incontinence. His speech was never affected but there is repetition of movement on his right side (specifically extending right arm behind him and squeezing his hand). He is quiet but will respond in conversation with wit and reason. He takes Zoloft and blood pressure meds, but his wife will not take him to a cardiologist or rehab therapist. He sees only their internist twice a year. There are balance problems due to being 75 pounds overweight, concentrated mostly in the gut area. Is there any course of treatment that might improve his quality of life? ellen@fashionrevival.com

Answer: My biggest question for you would be is your brother's wife willing to work with him at home on rehabilitation? From your submission, it sounds like she may not be open to doing rehab with your brother. Unfortunately, your brother has several issues going on, and I think he would benefit most from having evaluations by a physical therapist (for balance), occupational therapist(for daily care skills), and a speech therapist (for impulse control or cognitive issues) who could then assign him with home exercises to do if there is no interest in setting up continuous therapy sessions outside of the home. If you have a good relationship with your brother and wife, maybe you could encourage them to at least ask for therapy referrals from a physician and go for at least one appointment even if it's only to get home exercises. Maybe after going to one session, his wife might be open to having him attend more sessions. Otherwise, unless you are involved in the direct care of your brother, I don't know that there is much more that you can do.

Behavior Problems and Stroke

by Jan
(Lakemont, GA)

Question: My Dad had a right side stroke 2 yrs. ago. He was doing pretty well until he started having seizures from the scar tissue (he didn't get medical help the day of the stroke for 10 hours). He has depression which is finally, after several meds, being treated with Lexapro which has helped a lot. He is very negative, worried about money (which is not a problem for him) and doesn't want to be with other people.

I have been his sole caregiver, and he has become agitated with me. He does not want to eat or take his meds even though he does. He was always a math wiz and now has difficulty dealing with paying bills, etc. I help him, but he feels like he has to pay the bill the day it comes or he panics. He's constantly worried about things that are months away from happening, like tax time.

Should I take these responsibilities away from him (I was trying to let him feel he's still able to take care of some things himself) or am I setting him up for feelings of failure? I need to hire help, but he has fought that idea, though he still wants to stay at home. I can't be there all the time and worry that he's alone too much. I don't know where to go from here. Do I insist on hiring help or leave him alone? He wants his life to be over, and I understand why he feels that way, but God was not ready for him yet. What can I do?

Answer: As a caregiver, finding the right balance between keeping your dad safe and allowing him to have dignity is difficult. Safety should always come first. Some things to ask yourself:

1) Is he safe at home alone all the time? If not, then you should hire someone to help.
2) Can he accurately pay his bills and manage his finances? If not, then you should take it over.

You should get a Durable Power of Attorney (one for health and one for financial) if your dad is agreeable and cognitively able to agree to this. Once a person has dementia or does not have the mental faculties to make decisions for themselves, you cannot get these legal documents signed but instead would have to go to court and try to obtain "guardianship" over the person. It would be much better to have those documents in place now in case your dad's health and cognitive abilities deteriorate later.

If you have to make changes, include your dad. Have him help in deciding on who to hire. If he doesn't like the idea of someone watching over him, maybe change it around to I am going to have someone come cook and clean for you (while at the same time, they are actually keeping an eye on him). If taking over the bills, let your dad know that you don't want the stress to affect his health and that you will take care of it.

I actually think if you can hire someone to help your dad that it may improve your relationship as he won't feel like you are there in his business all the time. One warning though - make sure you hire someone reputable with references you can check. There are many out there who will take advantage of the elderly, stealing from them or spending their money without the person's knowledge. Others can be verbally and physically abusive so do your homework before hiring someone to help.

If on the other hand, you feel your dad is safe at home by himself and has the mental faculties to pay his bills, then let him. You cannot control is attitude or negativity outside of making sure he has received medical attention for any personality disorders or depression. I would still look into a Durable Power of Attorney either way as this will be important as your dad ages.

stroke recovery

by Lisa
(NY)

My husband had an MCA, with bleeding which they werent sure would have a shift- no one can give me hope or prognosis- i guess i am not looking for either but i want to know what is percentage level recovery for others that have had this- ie: 50% of people with this type of stroke gain 40% of their recovery back...

Answer Unfortunately, there is no clear cut answer to your question. The middle cerebral artery is the most common area of infarct, and each person is different in their recovery. You could look at various studies, but you will get varying information. The best solution for you is to talk to the physician who has seen the physical data on your husband and ask his opinion on the type of recovery to expect. He or she should be able to give you some idea of the severity of the stroke. Also, if the stroke is recent, your husband will need time to begin making gains. What you see during the first few weeks or months after stroke can and often does change drastically so don't make any determinations about prognosis until some time has passed. I suggest joining an online support group so that you can receive encouragement and hope from other's experiences.

Emotional Issues from a Stroke

by Beth Canton
(Thomasville, AL)

Question: My 48 yr old bro-in-law had a stroke during a heart valve replacement March 1, 2012. He has vision and speech problems as well as his right leg does not follow like his left does. He has all the clinical symptoms like talking all the time, hollers when he thinks someone is talking about him, poor eating habits, crying etc. He has not had any type of therapy except for a few sessions of speech. His wife cries as much as he does and they both keep saying that he is not getting any better. He is working but is always tired as well. I feel that they all need psychological counseling so they all know how to cope with the situation. How important or urgent is this at this time?

Answer: I would recommend seeing a neuropsychiatrist who has dealt with stroke patients. It definitely sounds like the family is not functioning well, and I believe a psych consult could be helpful. I would also advise to seek out support via a support group or through online support groups for both your brother-in-law and his wife. It is most likely difficult for them to listen to family memers who are not in the same situation. The advice that other stroke patients and caregivers can give them could be invaluable and may allow them to see that they need to seek help.

Lack of motivation, inspiration and initiation

by Rose
(Ohio)

Question Hello, my name is Rose and I have been a caregiver for two years now. My husband is 42 and had a stroke during an emergency open heart surgery. We were told that he would never walk, talk, feed himself, etc. He does all of the above and I am so grateful that he has surpassed all of the doctors expectations. I believe there is more progress to be made. The issue being, his motivation and initiative. He has none. His left hemisphere is essentially gone. I am currently reading "The Brain That Changes Itself" and feeling very hopeful about neuroplasticity but am wondering what exercises will benefit the part of the brain that effects motivation and initiation. Or, do I need to have the attitude that this progress will be based solely on my desire, my motivation, my beliefs? Is that even possible? Thank you in advance for your response.

Answer: Hi Rose. This is indeed a tough question. I have found this to be a problem with many of my stroke patients. It seems to be especially true when they are at home with their caregivers. I found this great article that might be helpful, Finding Motivation After Stroke or Brain Damage. Just click on the link to read it. It basically talks about how motivating factors for each individual is different and gives some ideas for trying to motivate your loved one such as hobbies, work, and social relations. The article also discusses when depression or frontal lobe damage may be causing initiation problems. Hopefully, you will find it helpful. If you don't find that any of the tips work for your husband, you may want to have him visit a neuropsychiatrist and see if there are medications or counseling that might help.

Short term memory

by Amy Walsh-Kuenneke
(Cincinnati, Ohio)

Question: My right brain stroke was more than 5 years ago. It seems that my memory and ability to "solve" problems have gotten worse as time goes by. Since my stroke I have not been able to hold a job for very long. I had a neuro psych evaluation earlier this year. The test showed "lack of effort" which I was told means depression. I have been seeing a psychiatrist who has diagnosed me with anxiety no depression. What do they mean by lack of effort. This is really driving me crazy. My medical bills have already drained my husband's 401k and retirement.

Answer: I would not be able to interpret what is meant by "lack of effort" without seeing test results. Stroke can have many effects on a person's emotional well being as well as the brain's processes. If you haven't already tried it in the past, I would contact your state's vocational rehabilitation department. I am not familiar with the process in Ohio, but when I did a quick online search, it gave me this website: http://ood.ohio.gov/. You can also contact the local Bureau of Vocational Rehabilitation in Cincinnati. They might be able to help you locate a job more suited to your post-stroke needs.

I would try not to worry about labels/test results and focus more on coming up with solutions to help you gain functional employment (if you want to continue to work). This would include talking with your MD and determining if you need meds to help emotional conditions such as depression and working with vocational rehabilitation services to find work more suited to you. I would also suggest making sure you participate in regular exercise which can often help improve emotional conditions such as depression or apathy.

Can a Stroke Patient Change Their Will?

by Lisa
(NC)

Question: Can a stroke patient change their will?

Answer: If the patient's mental capacity has not been affected or their mental capacity is such that the stroke patient understands the nature, scope and effect of the document, then yes, a stroke patient can change their will. If, however, their cognitive status has changed to the point where they are not capable of this understanding or are not mentally competent, then the will could not be changed by the person while in this condition (in the U.S. - I do not know in other countries).

It's also important to remember that when a person first has a stroke, he or she may be confused but later recover cognitively so it's possible that a person might not be able to make decisions regarding a will immediately after a stroke but then later be able as they recover. The best advice is to consult your attorney and be upfront about the stroke patient's mental/cognitive status. I personally would not have my loved one change a will immediately after a stroke especially if there were cognitive and mental/emotional changes. I would wait until my loved one stabilized in their recovery. Stroke can be overwhelming so what a person is feeling immediately after a stroke may change later, and cognitively, the person will most likely be much clearer after the healing process has taken place.

I encourage everyone to have a current will and living will in place because if you have a stroke and do not have a current will, it can become very complicated for family members, and your wishes may not be carried out.

Recurring UTIs & confusion with a 75 yr. old, 6 year post stroke survivor.

by Rebecca
(Hoover, AL, USA)

Question: My 75 yr old Mom suffered a right side stroke 6 years ago. UTIs & confusion are increasing. What could be happening?

Answer: I'm not sure why your mother would be having more frequent UTIs, but I do know that UTIs can make elderly patients very confused. I can't tell you how many patients (especially females) I have seen come in that are totally disoriented and weak and the only thing wrong is that they have a UTI. I would definitely recommend getting the UTIs under control which may in turn help with the confusion. UTIs are more common in patients who have had a stroke. Make sure she is cleaning herself properly after bowel movements (front to back) to avoid having bacteria enter the urinary tract.

There are other factors that can cause confusion so obviously you should have a physician examine your mother when there is cognitive decline. Just be aware that UTIs can cause serious changes in mental status of the elderly, and make sure her MD checks for UTIs and treats them accordingly. You might want to have her visit a urologist to determine why she is having recurrent UTIs.

Explaining to Stroke Patient That They Have Diabetes

Question: The stroke patient has aphasia and doesn't understand that he has diabetes. How can I explain?

Answer: Some strategies you can use to communicate with patients who have receptive aphasia are:

1. Speak slowly and clear.
2. Simplify your message and sentences - rephrase it to be more concise with simple phrases.
3. Use pictures to help explain what you are trying to say.
4. Use gestures, writing, or objects to help you communicate.
5. Minimize any distractions such as TV/Radio.
6. Confirm that they understand. Give them time to talk and don't speak for him/her.

In an attempt to explain diabetes, you might search online for simple ways to explain diabetes including videos, charts, or graphics that might help you. Sometimes aphasia can be so severe that explaining a medical condition may not be possible. You could also seek the help of a speech pathologist to help with communication strategies and explaining diabetes to the patient.

emotional issues

Question: Ever since the stroke I feel like my emotions are gone. I don't cry or ever really feel happy, excited, etc.

When my parents died, there were no tears. When my son graduated, there were some tears of joy.

Is here any way to get back my emotions? Most survivors are crying all the time. i don't want that, but it's a bit embarrassing when you're at your parent's funeral with a blank stare on your face.

Answer: I suggest you visit with a neuropsychiatrist. Stroke can have the effect of making someone overly emotional, but there are many stroke patients who become less emotional and /or apathetic. Neuropsychiatrists will have experience in working with patients that have mood disorders due to neurological conditions and would be best suited to helping you.

Emotions

by Eileen Lippold
(Pgh. Pa)

Question: I notice when we tell my mother somebody is sick or they have passed she don't seem to get emotional, In the past before she had a massive stroke 3 yrs. ago, she would get so emotional and cry. She is paralyzed on her right side. Does that mean she doesn't comprehend it?

Answer: If her cognition was affected or her ability to comprehend language is impaired (receptive aphasia), then it's possible she doesn't comprehend it. It could also be that a part of her brain that controls emotions has been effected. Stroke can change how people express emotions. Some people's emotions may become heightened and they get upset more and others may demonstrate muted emotions with very little reaction because of the area of the brain damaged.

Anger and Lashing Out

Question: My mother in law recently had a stroke. She has been suffering from a major loss of mobility for some time due to other health issues not directly related to, but probably contributing to, this stroke. Most notably, she has a benign brain tumor and she is on P. Dialysis for kidney failure. Since the stroke, she has become very angry at my father-in-law. He might be the most patient person I know, he loves her deeply, and has been her 24 hour/care giver for several years. She has always been a bit irritable, but it has gotten worse since coming home from the hospital. She is accusing him of things that have not happened and she is unwilling to participate in any kind of physical therapy, stating that none of the doctors mentioned it, when they had in fact done just the opposite. We are very worried about this development. She is absolutely sure that everyone is wrong and she is right. Can you offer some advice on how best to deal with her? It is killing my father-in-law and my wife.

Answer: If your father-in-law has medical power of attorney, he could ask the MD to prescribe home health therapy. Once the therapist came out, he or she could let your mother-in-law know that the MD requested therapy and talk to her about why she needs it. Often stroke patients are more willing to cooperate with medical staff over their loved ones. If he doesn't have medical power of attorney, he could still take your mother-in-law to see the MD and see if the doctor would talk to her about therapy and possibly seeing a neuropsychologist to help her deal with her emotions.

If she is not willing to cooperate, there may not be a lot that can be done. I would suggest that the family give breaks to your father-in-law so that he can have some time away from caregiving each week. I would also suggest a stroke caregiver support group for him or if your mother-in-law is able, then a stroke support group that they both could attend would be nice. I would also suggest trying to find an activity that your mother-in-law could be involved in or have friends come and visit her so that she has a social outlet. It's important to note that stroke can affect one's personality/emotions so she may not have full control of her actions. It sounds like she has a very supportive husband that loves her, and I would encourage the family to support both of them in this trying time. You could also visit some of the online stroke support groups and pose your question as others in your position may have some good advice.

Mental

by Marge
(Ocala FL)

Question: My husband, Bill, spent 3 days in the hospital for a stroke. He has recovered wonderfully physically. However, he does not want to visit with anyone or go to church. Out to eat seems to be the only social thing he wants to do. Is this normal? Do I push for more? Going to church by my self did not seem to work, especially since I do not drive very well. Thought this would work, but no. Any suggestions?

Answer: You might try to get him out to a stroke support group that has both patients and their caregivers. I think stroke patients enjoy talking to each other and often can provide encouragement and tips to each other. This is true for the caregivers as well. The stroke support groups seems to be well attended and enjoyed at our facility. You can find out more about stroke support groups by going to www.stroke-rehab.com/stroke-support-groups.html.

Mental Issues

by Ralph
(Delaware)

Question: I am a 47 year old man who had a stroke in June 2014. I Have recovered and returned to work in August 2014, however, I am afraid of everything. I fear something else is going to go wrong. I worry that I will have another stroke, I worry about getting angioplasty, I worry about about my sleep apnea. Is this normal?

Answer: It is not unusual to be fearful after having a stroke or any life event that threatens one's life. I suspect that with time this fear will fade, but if it is interfering with your daily life, you could talk to a neuro-psychologist which is a specialist that is experienced at addressing psychological issues with those who have had neurological injury. You also might benefit from visiting online forums/support groups and talk to (or just read about) others who have gone through a similar experience. It has not been that long since you had your stroke, and you need to give yourself time to recover not only physically but emotionally. It is important to make lifestyle changes though to help prevent future strokes. These include maintaining a healthy weight, eating nutritiously, not smoking, avoiding excessive alcohol intake, monitoring your blood pressure/cholesterol and exercising.

Mood swings for two weeks

by David W
(Running springs, CA)

Question: Two and a half years ago my wife of 36 had a bleed on the left side. While in the ER she had another one but much smaller on the right side. She is now paralyzed on her left side. It happened two weeks after she gave birth to our son. Today our son is 2 1/2 years old and our daughter is 5.

Having kids and dealing with a stroke victim is more of a challenge than I can handle! She can talk rather well and can get around somewhat. This is a blessing after reading other stories.
However, she has changed into a completely different person and the worst of it lasts about a week to a week and a half. She lays into me like I'm suddenly the enemy! She actually looks for things she can bring up just to pick at me. She is a cold person during this time of the month. She curses in front of the kids, is unfair with them, has little patience with the all of us. Yells at them, and is very unfair at times etc. She has even begun throwing things at our daughter as a punishment because she can't simply catch her when she is being naughty. She flicks our son In the face as a punishment instead of timeouts. She says this is her new method because timeouts don't seem to work! I'm just about done in and our kids shouldn't have to suffer for her being handicapped? What can I do to calm her down and prepare for her ugly part of the month that seems to always be on time?

Dave

Answer Though you didn't mention it, I wonder if her mood swings are corresponding with her monthly menstrual cycle. Hormones can wreak havoc on a woman during this time of the month and it may be magnified due to her stroke. You could try to have a heart to heart talk to her when she is not in one of these moods and see if she will consult with her doctor. There are various medicines to help with mood stabilization or depression. She could talk with her ob-gyn if the moods are occurring during or close to her menstrual cycle or she could also talk to a neuropsychiatrist who deals with mood and emotional disorders that are related to neurological injury such as stroke.

In your wife's defense, she may not be able to control her emotions as she did before the stroke and may not have insight into the fact that she is behaving differently. She will need a lot of support from those around her and you both may need extra help with the kids. I encourage you to try a caregiver support group that can help you deal with your emotions and let off a little steam. You might try parenting classes together which might help her realize that she is not handling the children in a healthy fashion.

I am a mother of three plus three stepkids, and I have to say that raising kids is trying on a marriage especially when children are young. It is not uncommon for the worst to come out in people when dealing with young children who can be exasperating, and it is especially hard when someone has gone through a stroke as is the case with your wife. I encourage you to find good supportive friends and family that can give you and your wife a break from the kids. This of course isn't advice about stroke but just advice for marriages in general (not my expertise but just an opinion from experience). You'd be surprise by how many husbands might describe their wives' mood swings as similar to your's but without the stroke. I know that I am grumpier and shorter tempered now than when I was younger, and I am not very pleasant to my kids when I have PMS. Good luck to you! You will have to put some effort into the situation to get the results you are looking for.

My Dad, mind difficulties

by Sue
(Warwickshire)

Question: My dad (76)had three strokes the end of last year. The x-ray shows a triangle of damage. He thinks nothing is wrong with him. He cannot do processes, fixing things, closing things, turning things off.

His hygiene has become poor. My mum (76)asks him if he's had a bath and he just says yes to everything. When we check something, it's not done so I don't think he is having a bath. I was wondering if he has forgot how to mix the hot and cold water to the right temperature so he just doesn't bother.

He is a private man and won't even let Mum in the bathroom. I told Mum to do the bath for him to just get in and that he may not remember how to use the soap. It's worth a try.

Has this happened to other stroke victims?
How can I find out what the problem is if he can't tell me?

Answer: It might be beneficial to request home therapy and have an occupational therapist come out to evaluate what he can or cannot do for himself. The therapist could then pass the information on to you. I would pay attention to other general activities that he does. Can he feed himself? Is he shaving himself? If he can do these activities, then he can probably wash himself too. Sometimes patients have apraxia where they don't know how to use an item correctly or can't coordinate their arms to do the correct movement but think they are doing the right thing. Examples would be someone trying to brush their hair with a toothbrush, putting lotion on their hair, or holding the phone upside down when talking into it. If your dad has apraxia, this is a condition that would warrant treatment by a therapist (one experienced in working with apraxia). I would also suggest going to caregiver forums and asking others who are in similar circumstances what has worked for them.

How to help with Dysphagia/No mobility

by Sandy
(New york)

Question: My father suffered a stroke back in February 2014. He was in a rehab facility for 4 months and is now home. However, since the stroke he has lost all mobility of his left side, slight impaired speech and developed dysphagia (difficulty swallowing) and is on a pureed diet and thickened fluids. PT/Speech and OT all have given up on him both at the rehab center and now at home due to lack of progress. He only wants to be in bed, hardly wants to sit even on the bed. He is irritable and on most days his voice is less stronger. He has lost over 60 lbs since February and now he is anemic. With 24 hour aides and my daily visits still nothing motivates him and my biggest concern is he eats like a bird 3 or 4 bites of soups/pureed foods. I've done everything (protein shakes, veggie smoothies, pureeing foods from his past favorite restaurants etc). He says he's tired of mashed foods and wants his regular foods but that is not possible. I don't want to lose my dad but I feel like I'm losing this battle.

My question...How do I help if he's shutting down?

Answer: I would suggest that you consult with a neuro-psychiatrist or neuro-psychologist to help you figure out how to best deal with your father. These specialists are trained in working with psychological issues of patients that have neurological disorders. Even if your father can't go with you, I would suggest going for a consult on your own (you might have to do private pay since you would not actually be the patient). I also would encourage you to look online for a stroke support group or a caregiver website and pose your question as their are others that will have been in your position and may have some suggestions. You can find out more about stroke support groups and caregiver websites at https://www.stroke-rehab.com/stroke-support-groups.html and https://www.stroke-rehab.com/caregiver-assistance.html.

Overt financial generosity after stroke

Question: Is it normal that stroke victims are over generous after a stroke?

3 months on after a frontal lobe mild stroke my mother leaps to pay for any item one suggests.

This is worrying because living independently she could easily be taken advantage by trades people.

Answer: The frontal lobe is involved in planning, organizing, and problem solving so yes her judgement could be affected. You should have a discussion with her about it. If she doesn't seem to respond, you can always look into legal options to see if there is anything you can do to protect her, but if she is high functioning, there may not be anything you can do.

2 yr old stroke victim; Now i am 35

by Bill G
(Bordentown Nj)

Questiom: I had ACUTE INFANTILE HEMIPLEGIA OF THE LEFT HEMISPHERE when I was 2.

I have 95% functionality in my body. My right hand has very minimal fine motor control loss.

My question is about the growth of the brain. I always thought something was off. I am missing that long term drive and accomplishment. I felt that way all my life. My parents and sisters are very accomplished in what they do throughout out their life. But in my case I have never finished anything productive ever to further myself. I do not know if this is an excuse for my life or it has to do with the growth of my brain since the incident.. I have made radical decision through out. I am 35, I have been to 2 different college programs and I have started a third. I want to finish them but something is holding me back from doing so. I feel like there is a part of me that is not plugged in.
Does the brain alter its growth so it would be harder for me to function in life?

Answer: I don't know if your brain growth could be altered, but damage to certain areas of your brain could have had long term effect that affected your motivation, attention, personality, etc. Many people with traumatic brain injuries (including those from stroke) will have long term effects such as these.

Personality Change

by Michele
(Phila, PA)

Question: My mother had a brain bleed a month ago which subsequently lead to two strokes. She still has symmetry and most of the dementia is cleared. She will at times ask me if I've seen my grandmother outside (she's been dead for about 10 years now).

The question I have is this....she just seems so disengaged. She answers your questions and will listen to you, but there's very little interaction. Is there a term for this? Is this common? I'm told a lot of recovery happens in the first couple of weeks. Will this be something that is permanent for the most part or can this be rehabilitated?

Thanks so much for any input!

Answer: She is still early in the recovery process at a month out so you may see quite a bit of change over the next few months. One term that might describe the behavior you are describing is apathy. Apathy presents as a lack of enthusiasm or interest. Characteristics may include being passive, lacking motivation, loss of one's usual expression, and indifference. Feelings may appear muted. Apathy can occur as a result of the brain damage and may or may not improve, but you will need to give it time as it is still early in the recovery process. Many times individuals with apathy will still participate when prompted to do so by others but will have a flat affect. Don't think of it as your mother not being engaged. It's more like her emotional response to situations has been diminished so even though she may actually be engaged, her emotions/behavioral response to the situation may not demonstrate it. There may be problems with initiation as well. If you know what area of her brain was damaged, you can read up on the effects and get a better idea of what is going on as certain parts of the brain control different aspects of our emotions and behavior.

Mental Health & Aging After Stroke

by Loving Daughter
(Philadelphia, PA)

Question:I'm wondering if there have been any studies about mental health aging studies in a people who suffered a major stroke when they were young?

My mother had a major stroke when she was 23 years old (1983). She had completely lost the ability to do anything for herself and actually had recovered after about 5 years of therapy and actually was able to return to her job. But then with the advancement of computers in the 90's, she was no longer able to perform her job and went on disability. Since then, she is pretty much home all day and has isolated herself. I seem to be her only connection to the outside world.

Within the last 5 years, she started to hear voices. I would describe her as paranoid and unwilling to accept reality. I've tried to convince her she needs to see a doctor, but she has no faith in the medical community because they never could determine the cause of her stroke and over the years, have tried to tell her she is exaggerating her condition. (If you looked at my mom, she doesn't look like she had a stroke. She's is slim and strong, very pretty - People have often told me she looks like my sister, not my mother. But any sort of long conversation with my mom proves to be very frustrating for most people.)

She is now aged 55. She is convinced people are hacking her computer (a constant source of frustration for her and me since I'm her 'go to' for everything. She thought there were cameras in the house spying on her and ripped the house apart looking for said cameras. And her language is worse than ever. She cannot stay on topic; She throws random thoughts into a conversation; She will not listen when I say I am concerned. She is married but I think he is too close to the situation to see the truth that something is seriously wrong. I've also tried speaking with my grandmother (her mother) as well as her brothers, about my concerns but everyone just relates everything back to her stroke from '83. (She has also isolated herself from her family over the last few years and I think some are just tired of dealing with her mood swings and judgments she places on people.) While the stroke may be the initial cause of her deteriorating brain, I think she is showing signs of something else. I don't know if this is normal part of aging after suffering a major stroke or if there is something else taking a hold of her brain.

Either way, I'm in a pickle because she refuses help and everyone else explains it away from her '83 stroke.

Answer: It would not be uncommon after a brain injury to have problems with organizing information or learning new tasks which might be why your mother had problems when computers were introduced in her job. It would also not be abnormal to see deterioration in mental status because of fatigue or lack of sleep in someone who has experienced a stroke/brain injury. What would not be expected though is a noticeable decline in mental status years after the original stroke. The effects of a stroke would have occurred when she had it. Unless there are new changes that have occurred in her brain, you would not expect her to have new symptoms such as seeing things or paranoia. I personally think you should encourage her to see a neurologist to see if there have been any changes in her brain function. If she is unwilling to cooperate, then I would encourage you to enlist family support. Ask family members to take note of her different behavior and to take your observations seriously. Maybe as a family, you can talk her into seeing a MD.

depression

by Jennifer
(Nj)

Question: What to do for my husbands depression post stroke after 1 yr . He takes cymbalta 2xs a day already . What else can he take and what else can I say to make him feel better / normal :(

Answer: As an occupational therapist, I don't treat depression so I would have to refer you to a different profession. I would have him consult with a neuropsychologist, and if he is not already, I would have him join a stroke support group. Being able to interact with other stroke survivors can allow for a release of emotions and provide some needed support/understanding that may help give him a boost. I can't say enough about support groups. It can be inspiring to see what others are capable of achieving after stroke. You want to make sure it is an interactive group where patients talk to each other (versus going and listening to a medical professional talk about stroke related topics).

Lacking Determination

Question: It has been a year since my mom had her 2nd attack, and until now she is still unable to walk and talk. My mom has some other issues as well. She is not cooperating well with the therapist, and I feel that she is not determined to walk. Because of that, her therapist decided that instead of having a 3 times a week session it would be just once a week. It is an hour and a half for every session. My question is, is it still possible for my mom to be able to walk, and for her to be able to walk again, how many hours per week would you recommend considering that she's not cooperative and undetermined? Thank you for reading my story.

Answer: I can't really predict whether your mother will walk again especially since I've never seen or worked with her. Many stroke patients can learn to walk or at least take a few steps but not all. There is no set amount of hours that one must practice to learn to walk again, but obviously more practice at trying to stand and walk is more beneficial than less practice. With that said, however, a therapist cannot make someone work with them if the patient does not wish to participate.

If it can be done safely, I would encourage you to have the therapist train you or other caregivers on how to work on standing and or taking steps with your mom so that she can practice with caregivers on other days when the therapist is not there. Many caregivers can learn to assist patients with therapy if trained. Ask her therapist to do some training sessions with you - I'm sure the therapist would be more than happy to oblige. Even if it wasn't safe to stand, the therapist could show you other exercises/strengthening activities that your mom could do with your assistance.

Spouse Treatment after Stroke.

by Diane

Question After having two ischemic strokes in 2013 and 2014, my husband of 51 years told me he know about the affair I was having because my vagina was so big he could put his fist in me. (Disgusting, I Know)/ I cannot believe he said this to me. I am heart broken knowing full well this affair has not happened ever- he said he has been thinking about it for a year. He can hardly remember meals he has eaten. Actually his attitude changed abut a week before my 70th birthday a week ago.

I have heard of dementia patients and very sick people accusing spouses of this but I am sickened that he said this to me. I can't stop crying. Is THIS SOMETHING that is normal for stroke victims? I don't know what to do. I know he isn't well but I don't know where this came from. (WE haven't had sex in probably 15 years) He was very heavy 317 for many years. He has had "sleeve" surgery 2 years ago Sept. He is now 165lbs. Memory a problem, slow movement because of diabetes. He has a man exercise him 4 hrs a week. He comes to work very seldom (we have a business).

I am trying to keep the business running, take care of his dad's estate since he died in 2014, take care of his messes when he has an accident, prepare food sometimes 3 times a day- An Affair - Really! I need some insight please.

Answer: Unfortunately, you never know what thought may develop in someone with dementia or someone who has had a brain injury such as a stroke, and sometimes they can fixate on these thoughts. I would just let it pass. He most likely will forget the accusation. I know it is very hurtful to you, but you must realize that this is an effect of the damage to his brain not who he truly is. If the accusation does not pass over time, you could try to enroll the help of a neuropsychologist. Even if they end up not being able to help/change him, they might be able to give you strategies/ideas on managing his behavior and help you understand that this is a symptom of disability/injury and not a true reflection of how he feels for you. I know it's tough , and it doesn't seem fair. It takes a lot of resilience and sometimes tough skin to be a caregiver of someone with dementia/brain injury.

MENTAL ISSUES

by Janet
(Huntsville, Al)

Sis is 60 years old and had a stroke 6 weeks ago. She is mobile and has most normal body functions, but weak and slurs her speech and might use the word "quarter" as a "fill in the gap" word or thought. What she does not have is short term memory, or long term memory. She does not know her family and when she talks, we think it might be about events from 30 -40 years ago. She uses 5 or 6 words to make a sentence, but we don't know what she is talking about. Any suggestions on how to help her and us to "connect the dots"?

How to deal with Crying after a strike

by Carolyn Cooper
(Carson City)

Question: Is there something I can do to keep my mother who has had two strokes left side for crying all the time?

My mother has had two strokes in 5 years on the left side of her brain, I almost the same spot. The first stroke actually caused her to die and was revived at hospital. She recovered very well physically EXCEPT for her short term memory which is Totally gone.

She had her second stroke five years later, three weeks after my dad died; of which they had been married for 65 years.

This stroke was much more dibilitating needing rehabilitation to walk, talk, and basic skills. She Now needs full time care and hates it. I find her crying over events she would normally never cry over.

Is there something I can do to help her with the crying?

Answer: If the crying is excessive, I would recommend consulting with her MD as their may be medicines that can help decrease her propensity to cry.

Not wanting to do his rehab/therapy

by Michelle
(Marysville WA)

Question: My father in law had 2 strokes in a few weeks starting in mid July. The 2nd one has his whole left side paralyzed. Both kids live out of state, we flew in & have gotten him settled in the nursing home of his choice in his home town (he will not move to either state), but the nurses are calling us because he is refusing to do his rehab. He was recently put on depression medication due to not wanting to get out of bed. If we can't get him to do any therapy he will never be able to go home-which he says he wants to. Any idea how to get him engaged to want to do the rehab?

Answer: Sometimes apathy or lack of interest in participating in therapy may be as a direct result of injury to specific portions of the brain. Facilities have to respect the wishes of their patients, but you also have to take into consideration their injury and if their behavior is a result of the injury. In this case, you have to sometimes be more creative in getting patients to participate. Without knowing how the facility is run that he is in, it's hard to say how to help. If therapists or nurses walk in and say let's go to therapy, and he says no, and they walk back out with little effort, then it may be more of a facility problem than a problem with your father-in-law. On the other hand, if you see they are trying different tactics and working hard to try to get him to participate, but he is obstinate, then that is a different problem. I would not rely on their report as far as their efforts to get him to participate but would rely more on your direct observations.

Since his family is in different states, this makes things more difficult, but I would say it would be in his best interest if a family member could be present for a week or two to see if they can help him overcome this issue (it does not have to be the same family member over the two weeks). Usually with coaxing from family and the facility knowing that the family expects them to have the patient participate, results can be made. I would also involve the help of a neuro psychologist or neuro psychiatrist as well. If family along with medical professionals are unable to get your father-in-law to participate, there may not be much you can do. It may be helpful to get him in a stroke support group too if they have one at the facility so he can interact with peers in the same situation.

Emotions long after stroke?

by John Decker
(Orange County, CA)

Question: I had a stroke 4 years ago almost to the day. I am more emotional now than ever. It seems to be a good thing, but I find myself crying at the thought of how much I love my family, and it is weird. I am a 55 year old male who has always been tough. I wouldn't cry over anything. Now I am weeping just thinking of life's normal things. No dementia, fully recovered physically, I think. I work out every day, walk 2 miles a day and keep a full time job. What is up?

Answer: It is not uncommon for a stroke to affect one's emotions causing lability, crying spells, anger, or even indifference. Emotions are controlled by our brain as well as hormonal changes. Not only did you have a stroke, but you are also at an age where it is not uncommon to have changes in hormones. As a therapist, I do not know a lot about hormone changes and the natural aging process, but I do know it happens, and it might be something you want to investigate further to see if it is affecting you.

Depressed Mother of a 26 year old.

by Liliana
(Clifton NJ USA )

Question: My daughter suffered a brain aneurysm 4 years ago the worst time in my life. From one min of being a normal 21 year old working, driving living a normal life to hours later the doctor telling us she had a 90% chance of living. I have to say I never prayed so hard in my life. Thank God that the only thing that she had happen was memory loss and some speech impairment at the time, but now 4 years later she is ok.

The problem is that her attitude has gotten worse. The entire family has noticed in the past year she has been angry. She talks back to everyone and she is disrespectful especially to me. I've cried and cried because of the the things she says to me. She does not seem to realize that she says things and really hurts people. She has gotten fired and we all know its because of her attitude. I want to get her help and the entire family all agree that she is just getting worse. Her father and I are divorced, and it's like she is living back in that time. She can't accept certain things that have gone on in my life, and I do believe she hates me.

I need help. I want to help her. I need to help her... She doesn't think anything is wrong with her.... But I need to reach out to her or find someone that can help my daughter. I want her to be happy and stop being so angry at life. I don't know if its the medication or what but she is slipping away and it breaks my heart.

Please Please tell me what I should do... My child is my life and I don't want her going thru life angry or alone....

A concerned Mother in tears....

Liliana T..

Answer: The biggest obstacle to getting her help is that she doesn't believe she needs help. I think she should see a neuropsychologist who deals with emotional and cognitive problems of those who have suffered neurological injury. However, you may not be able to get her to see one if she is not willing. You could speak to a neuropsychologist on your own to get an idea of what you could do to get your daughter help. If your daughter is willing, maybe you could go in together and talk to a neuropsychologist. If your daughter won't go, definitely contact one on your own, and see what ideas they have for helping you to get your daughter to realize she needs help.

Stroke on Right Side of Brain and Personality Change

by Mrs W
(Montana)

Question:I have a friend who is 47 and suffered a massive hemorrhagic stroke to the right side of his brain. He is currently recovering and I have noticed that he is saying a lot of sexually explicit things, which is very much not his personality. He has said sexual things to his therapists and nurses. Otherwise he seems quite the same. Is this normal?

Answer: Unfortunately, there can be changes such as this with a stroke. I have seen it happen in several patients. I don't know how long it has been since his stroke, but if it is still early on, maybe it will improve with time. If not, hopefully he can work with a speech therapist or neuropsychologist and learn what is and what's not appropriate.

Apathy - How To Treat?

by Jim
(Jacksonville, FL USA)

Question: My wife had her 2nd left side stroke 2 1/2 years ago. She has lost about 50 lbs and has almost no interest in eating. She is content to sit and watch TV her waking hours. She doesn't get out of bed till afternoon where she lays and watches TV and then gets up and sits in the living room watching TV. She has no interest in walking, which we used to do or any type of exercise. She used to take good care of her looks but now could care less (used to go to beauty salon regularly but now doesn't want to go) I would like to know what type doctor would deal with this? I need to "make" her go so I want to make sure I get the right kind of doctor the first time. Thank you.

Answer: I would have her see a neuropsychiatrist. A neuropsychiatrist deals with emotional and cognitive issues in those who have had neurological injury such as stroke.

uninhibited

Question My mother-in-law had a stroke over a year ago, and we, her children, have all taken turns watching her. The problem is that she has turned vulgar. She publicly says horrible sexual comments about people around her. What causes this? Many times this is in front of children. We aren't sure what to do! She also seems to like to walk around naked.

Answer She most likely had damage to the part of her brain that would regulate this type of behavior. As a result she is impulsive and uninhibited. Due to the damage to the brain, she probably is unable to control her actions as we would normally be able to. You could have her consult with a neuro-psychologist to see if the issue could be addressed. You could try making her aware of how the stroke has adversely affected her and at least try to educate her about what is going on, but it may be futile if she can't self regulate or retain the information. You could also try posting reminders that help her remember to watch what she says. I think the best option though is to see the neuro-psychologist.

possible mental issues

by Jasmina
(Ohrid, Macedonia)

Question: Ten days ago my father had a brain stroke. Three days after the stroke he opened his eyes. Five days after the stroke he began moving his left hand and his left leg. He is not able to walk but he is progressing well. His speaking skills improve day by day. He remembers everything and everyone. However I am afraid that he will have some changes in his personality. For example he wants to get up. He says he wants to go back to work. He talks about sex (he never did that before). He asks for certain kinds of food. He doesn't want do eat the hospital's meals. He gets mad when we need to leave. HE covers his head with a blanket and refuses to talk. He says that we don't love him. He is happy when he see us, but sad when we leave. He often cries. Is it possible that he will have some mental disorder? I appreciate your answer. Thank you.

Answer: When an individual has a stroke, the brain is damaged. This can lead to personality changes and cognitive changes. Only ten days after a stroke though is too early to determine what lasting changes will occur. Many patients are confused or emotionally labile in the early weeks or months after a stroke but with time will improve.

Remember problem after mild stroke

Question: Recently my mother had a mild stroke. She recovered soon after the stroke. She was paralyzed on her left side which was cured by physiotherapy(80%), but recently we found she forgets things or names. Please tell me is this dangerous or a sign of another stroke? What is the remedy?

Answer: If she began forgetting things after the first stroke, it may just have been a result of that stroke. If the loss of memory did not coincide with the first stroke but occurred later, then I would check with her physician to makes sure she hasn't had any new issues. A new stroke of course could be dangerous so it's best to check with a physician if you notice a loved one exhibiting any new symptoms that weren't previously present.

In dealing with short term memory loss, you could try a memory journal so the patient can write down names and important information. You can also use a calendar to help with dates and appointments. The patient would use these to help compensate for deficits. The patient could also participate in cognitive or speech therapy and work on improving memory or using adaptive techniques to deal with memory loss.

Drug & Alcohol abuse after Stroke

by Alisa Duca
(Sparks nv)

Question: My friend had a stroke In April of 2013. She did not attend therapy or rehab after stroke. She got back into drinking, smoking and doing Meth. She can walk, drags left leg. but can not use her left arm. My question is..What kind of program should I look into for her?

Answer: I assume you are asking about what type of stroke rehabilitation program would be best. Once someone is out of the hospital and functioning at home, outpatient clinics or a day program would be most appropriate. Outpatient clinics will have PTs and OTs, and usually they schedule 2-3 visits a week (visits usually last 45 minutes to 1 hour). Another option is a day program. These usually last several hours a day, but I am not sure if one of these are available in your area. I did find the website below about a program in northern Nevada that has information about services available. I would contact them and see if they have anything that would be appropriate for your friend or know of programs/clinics. The website is:

http://nncil.org/programs-services/

Question: Anger stroke victim after 7 yrs

by Antoinette
(New jersey)

Question: My BF had a stroke 7 yrs ago, at 42 from a pin hole in his heart that never closed completely He did recover fine but had a little numbness in the right arm. Appeared fine, but he has come more and more angry over the years. He has had a loss of interest in sex, speaks badly to me and to others. Calls me the "B" word for no reason. He's just a new person. You would think after having a stroke 7 yrs ago, things would change but no it's just getting worse. He has no sexual desire and laughs at people for no reason. We had a good relationship until the stroke. But I guess I have to move on. I can't take it any more. He's nice to everyone else. During stroke he was hospitalized for 5 days then transferred to another hospital for 7 days, I never left his side stayed ever night and second of the day. It's just so frustrating how a person can change in a blink of and eye. I still love him very much, but just tired of the verbal abuse.it has just wore me down. The best part is that we don't live together, but we have a 9 yr old daughter together. I dont want her to grow up thinking this is the way a man is to speak to a girlfriend/wife or anyone. It's just very confusing. He won't talk about anything so that's very hard too, No possible way we can discuss seeing a doctor. If anyone have any advice please comment.

Answer: I'm sorry to hear you are having such a rough time. Many times, stroke patients can have a change of personality, and it can be very difficult for loved ones to deal with. However, what concerns me in your case is that you mention he is nice to others. The fact that he is able to act differently around others might indicate that his actions are not simply a result of his stroke. The change in personality may be a result of the stroke, but obviously he has learned some self-control if he controls his behavior around others. Most of the time, I encourage family members to work with stroke patients and the emotional disturbances they experience after stroke, however, it sends up red flags in my opinion if he is manipulating and being verbally abusive to you yet can control it around others. Only you can decide what is best for your daughter and you. Maybe some others have had a similar experience and can share more insight.

senior had stroke end of January

by Sara
(Canada)

Question: Hi my dad just turned 85 and had a stroke January 21, 2018. He wasn't treated right away at the hospital and was left in ER for 13 hours. He was in hospital for 2 weeks then transferred to rehab center and was there 1 month and went home with therapy coming to his house.

He did make a lot of improvement since the day of the stroke. We can now understand him. He talks well but still lost some memory and words slur. He never lost his ability to walk or move hands so he gets around himself great without help and dresses and eats.

He had some anger issues in hospital and went home and was doing good but just recently started yelling at my poor mom for no reason and yelling at us also. He usually realizes what he did and says sorry but these past 3 days he is yelling for no reason thinking we want him to die and don't care about him which is not right. We have been with him from day one and still all day and night. He gets really upset because he can't drive. What can we do for his anger I am so worried my mom will be next in hospital she is so weak and upset. Does this get better? Is the anger another sign of stroke?

Answer: Stroke can cause emotional changes such as anger. I would recommend that you take your dad to see a neuropsychologist that deals with emotional disorders for those who have had neurological injury.

4 years after stroke

Question: My husband had a stroke 4 yrs ago. It affected his right side and he has aphasia. He has done really good up until 3 months ago. He has become very angry, accused me of cheating and selling drugs, which I have done neither. He is demanding a divorce, talks horrible to me. We have been together for 24 yrs. Is this normal for this to happen that long after a stroke? There is absolutely no reasoning with him. I am scared and I have no desire to leave him.

Answer: Changes in mental status that occur 4 years after a stroke (especially abrupt changes) are most likely not due to the stroke. He needs to be seen by a neurologist to see if he has had other brain changes. There are multiple conditions that could affect the brain including stroke, traumatic brain injury, drugs, dementia, alcohol, tumors, swelling around the brain, and metabolic disorders just to name a few. Hopefully, you can convince him to see a physician. If not, maybe you can get a family member to convince him.

Physical abuse

by Krista
(U.S.)

Question: My husband had 2 small strokes sometime over the last year. (We don't know exactly when). I think i missed the symptoms because I blamed them on side effects of pain medication he was given for a back problem. Anyway, he is in his 50s, and I am younger (40 soon). We have a 6 year old. He has been very verbally abusive in this time, has a huge problem with confabulation (or lying, I'm not sure which or if he is aware of it), blames people for taking things he has misplaced, and spends money we don't have. Yesterday, he woke me at 5 am grabbing me in a sexual way. I sat up angry as I had been awoken from a sound sleep (he does this to me often now). He proceeded to strangle me and hit me upside the head with an open hand then strangle me again. He told me he was going to kill me. After he stopped he told me to get out. We have never legally married and my name is not on the title to the house. He told me to go to a shelter with our daughter. I do not know what to do. His strokes were very minor (ha) and he only shows the worst affects at home. I have no legal recourse. He did not leave visible marks on me which makes me think it was premeditated because he was careful. I am afraid of what he will do next. I'm scared.

Answer Find a women's shelter in your area, and take your child with you. They should have services available and will be able to help you find answers to your questions such as legal recourse. If you have a child together and have lived together, there will be property and child custody and support issues that need to be addressed legally. I would also ask the shelter about getting a restraining order against your husband and options that you have. Since they deal with issues such as this, they will be able to point you in the right direction as who to contact. I would record any dates and incidents that you can recall where verbal (especially threats of endangerment) or physical abuse has occurred and anything that would be detrimental to your child. If someone has a stroke and is verbally abusive, I might advise their loved one to have them seen by a neuro-psychologist, but once anything escalates to violence or physical abuse, I would advise the person living with them to leave if they felt unsafe or were threatened as you have been. The stroke is irrelevant at this point as your safety is much more important.

Cognitive impairment

by Alison Robins
(Woodford Green)

Question: My mother had a couple of mini strokes about 35 years ago and recently has had at least two strokes. The consultant thinks probably more that weren't so noticeable. She has now got a very poor memory and is confused and sometimes thinks things have happened when they haven't at all. I can't seem to find any help with this? Many thanks and kind regards.

Answer: Vascular or multi-infarct dementia is a type of dementia that is caused by multiple small (or large) strokes in the brain. I would begin researching this type of dementia and treatment. First and foremost, if your mother does have this, it is best to control any lifestyle factors that contribute to it. This means controlling blood pressure (I would have her or someone else if she is not able to monitor her blood pressure daily), controlling diabetes if she has it, not smoking, keeping cholesterol down, and I would add getting some type of cardiovascular exercise if approved by her doctor. Also, I would check with her doctors about the blood pressure range they would like her to say within. Some studies have shown detriment with lower blood pressures in those with vascular dementia as well, so I would check with her doctor to know the exact range recommended for her rather than relying on norms recommended for the healthy population. High blood pressure is definitely a big risk factor, but what is considered high for her may be different depending on her health conditions.

There are several medicines being used in clinical trials to help with vascular dementia, and though I'm not sure that any have been approved for use, I would definitely do some research on it and talk to her doctor about possible medications that might help.

Lastly, if she is at home, I would recommend having home health occupational and speech therapy. They can evaluate her safety in the home and recommend adaptations, determine what activities of daily living she is having trouble with and how much help she should have, issue a home exercise program, and help her with memory aids or notebooks and other suggestions. IF she also has physical limitations, then physical therapy may be needed as well. I once had a patient with multi infarct dementia who stayed at home by herself during the day. Her family did not realize how impaired she truly had become. Her vision and cognition had been affected, and she truly had trouble with even the simplest of tasks. It was very deceiving, however, that she had no physical deficits and could walk and move without issue. I think a thorough cognitive (and visual) examination should always be done so families have a better idea of their loved one's limitations.

Here are some articles that might help you learn more about multi-infarct dementia (the second one has good resources for those in the UK):

https://www.caregiver.org/vascular-dementia

https://www.physio-pedia.com/Carers_Guide_to_Dementia.

Problems with frustration and with losing temper

by Cynthia
(Ontario, Canada)

Question: My partner had a stroke almost one year ago. He used to be a real go-getter, very active physically, and went non-stop. Now he has a hard time finding the energy let alone the physical abilities to do a lot that he previously could do quite easily. I try to listen to what he says and encourage him. It is draining me. I also find that he tends to not rest when needed. Some days are spent mostly sleeping. And his balance is quite off. But he keeps trying. Previous to the stroke, he lived alone for some time. And divorced a long time ago. He was quite obsessed with having things around his house a certain way. Now he loses his temper more easily. I confront him and say what I will not tolerate. He cannot compromise much. And after he says unkind things or bosses me, he acts a few minutes later like nothing happened. I tell him this is verbally abusive and intolerable. He seems to believe it is not. Any advice? I am also a Registered Nurse so I am used to dealing with people in recovery, but, I must confess, this situation is difficult. I maintain my own space and I pursue my own interests. I understand his frustration, but I also know what is wrong. I would appreciate any thoughts. Thank you.

Answer: As a nurse, you most likely understand the effects of stroke and his symptoms. I think we as healthcare professionals understand the physical and emotional problems that stroke patients have, however, we don't often realize the real toll on the significant other or caregiver until we are put in that situation. Honestly, only you can decide what you want to do. Some people have a great amount of compassion and patience to deal with partners who have undergone brain injury and emotional changes. Others have compassion but just can't tolerate the situation and circumstances. It sounds like you are upfront with him, and I would suggest that he work with a neuro-psychologist. One way to look at it would be to consider what you would want him to do if the roles were reversed and you had been the one who had a stroke and personality changes. It's really a tough situation. I definitely think you are making the right decision to enjoy things outside of the relationship and your own interests. Perhaps if you can get him to a neuro-psychologist or neuro-psychiatrist, they could suggest something to help.

Combative 5 weeks after ischemic stroke

Question: My dad had an ischemic stroke 5 weeks ago now today he is combative and doesn't know who I am. We're at a facility now and an ambulance is coming. What has or could have happened? I appreciate any help. Sorry to bother you, I feel helpless.

Answer: Of course he will need to be examined by a physician to see what is going on. Some things that could change mental status in a stroke patient would include another stroke or mini strokes, some type of infection (many stroke patients with urinary problems are put on catheters, so UTIs are not uncommon and can cause serious mental changes especially in the elderly), effects of medication (always monitor cognition after starting any new medicine), and dehydration to name a few. Getting your father to the hospital for a thorough examination will help you determine the cause of his change in mental status.

Boyfriend had a stroke 2yr ago won't do anything I'm just done being a mad

by Beverly
(Punta Gorda Fl)

Question My boyfriend had a stroke 2 yrs ago and will not try to do anything for his self. I feel like I'm just a maid. I work in a nursing home, and I don't need to do it at home. I want to leave him. I'm not happy anymore. I need help, I'm just done, and I want my freedom. I'm 63 and he is 61. He just sits in front of the TV. We go somewhere, and he sits in the car. I have no life with him. All he does is stare at the floor like he's mad at the world. He's not happy.

Answer: Unfortunately, stroke can cause personality changes that make it difficult for others to understand or deal with. It can also cause emotional changes. If you haven't expressed your feelings to your boyfriend, I would encourage you to do so and suggest to him that he see a neuropsychologist or neuropsychiatrist that helps patients deal with emotional and psychological changes after stroke. Even if you don't decide to stay with your boyfriend, you could maybe guide him toward some help. He may not listen, but at least you will have offered him some valuable advice.

Physically a vegetable

by Geri
(Erie Pennsylvania)

Question: My husband who is 61 years old has many, many health problems. Heart disease, kidney, liver disease, server brain atrophy, vascular issues, diabetic, cancer (MDS), strokes amputated left leg above knee and doesn't carry on a conversation anymore. One word answers, etc. and is living in a nursing home.
The other day I was visiting and I asked him what he was doing and he said he was trying to put this watch together. I then asked whim whose watch it was and he said mine and I asked where he got it from and he said I gave it to him. Weird, I am wondering if in his mind it's keeping him doing things making him feel like he's still living a life. He can't move at all including his hands or arms. He can't even sit up on his own. He's physically a vegetable. Just wondering if you have any insight on why his mind would think like this?

Answer: Hi Geri. With all of the vascular changes and brain atrophy, your husband may not be aware that he is unable to move. You didn't mention whether he had insight into his physical deficits or not, but I have worked with individuals who just don't realize that they can't move their body or think they are moving when they are not. It's usually related to the area of the brain that is damaged. On the other hand, it would not be unreasonable for someone to come up with a coping mechanism for being physically unable to move by imagining that they were able to move. Or there may be some other reason he thinks like this. Since the brain is complex, it's hard to give a definitive answer.

Weird sex

Question: My husband didn’t have sex with me for 23 years. When he took a mild stroke he has become obsessed with sex, weird sex etc. It was nice to finally have sex but not always to my liking. I tell him some of this is not normal, talk to someone but he says nothing wrong with him. He has always been an SOB, but now he is so hateful I fight with him. I’m broad minded but even his fantasies are hard to believe. He doesn’t ejaculate as he is 73 and only get aroused every so often, but he is trying constantly and is always playing with himself and watching porn. He never gambled in his life and I found out he spent $2000 at the slots recently and he can not afford that. I am flabbergasted.

Answer: Stroke can affect parts of the brain that control libido and self-control. In this case someone may show changes in sex drive and also in responsible decision making. If you feel he is making rash/dangerous decisions or may deplete bank accounts, it may be best to secure money requiring both of your approval to remove funds or talk to your attorney about what options you have if your husband is not able to make financial decisions due to cognitive deficits from stroke.

Fronto temporal stroke changed Mom's head

by Jennifer
(Canada)

Question: Mom had a massive frontotemporal stroke last week. She is on the stroke unit now but they have to restrain her because she gets really angry and tries to leave. Her best friend cried when she saw her and Mom said, "get yourself together!" I say I love you when I leave, and she says, "OK. See you." She has no impulse control. Sometimes she knows me sometimes she doesn't but she is not my Mom, the way she was. What can I expect in the short and long term? She had a stroke several years ago with weakness, and really worked to make it better, which she did. How will she work on this? How can I help her?

Answer: Having a stroke in this area of the brain will affect emotions, impulsivity, attention, motivation, executive function and more. If the Broca's area was affected, this can affect speech including the ability to come up with words and the tendency to speak in simple, short phrases and incomplete sentences. Usually behavior changes are involved and their can be depression. Just like physical issues can improve after stroke, emotional issues can improve as well. This is often dependent on the damaged area, amount of damage, a person's age, etc. No one can predict the amount of recovery that may occur. It will be important for family and caregivers to be patient and understand that emotional changes are due to the stroke and should not be taken personally. A neuropsychologist or neuropsychiatrist can be helpful with a patient's recovery. I know it is heartbreaking to see your mom's personality change, and you may want to seek a caregiver support group or even counseling yourself to help you cope. Hopefully with time, your mom's emotional and mental status will improve.

Stroke

by Diogo
(Milton Keynes )

Question: My mother suffered a stroke in 2014 and since then she is affected in her left side , she refuses to eat , drink , take a shower , don’t want to change clothes , throw them in the bin, curses to everyone included me and my sister , and even her husband... I don’t know what to do , I’ve taken her to the hospital but seems like nothing is going on , says the doctor... please reply , I’m desperate... I’m only 19 and never been so heartbroken

Answer: You need to take her to a neuropsychologist or neuropsychiatrist that deals in working with emotional and behavioral issues due to neurological causes such as stroke. You can find a neuropsychologist by visiting https://theaacn.org/directory/

Shouting, Confusion, and Anger After Stroke

by Stacey
(Zimbabwe)

Question from reader: My mom had a stroke about a month ago. Physically she is improving, but she has bouts of anger, confusion (says weird things), and times when she just shouts and screams. Her stroke was on the right side of the brain. Is this normal?

Answer from Stroke-Rehab.com: It's not uncommon for individuals who have experienced a stroke, especially on the right side of the brain, to experience emotional and behavioral changes including anger, confusion, emotional outbursts, and difficulty with communication. Emotional lability or exaggerated changes in mood are often observed by caregivers.

The right side of the brain is responsible for many aspects of social and emotional functioning, as well as understanding and processing nonverbal cues. When the right side of the brain is affected by a stroke, it can disrupt these functions, leading to a range of emotional and behavioral symptoms.

Each person's experience can be unique, and the extent and type of emotional and behavioral changes can vary widely. These symptoms may or may not be permanent and can improve over time as the brain heals.

You will need to have patience with your mother, and you can gently remind her that a stroke can cause one to become overly emotional. You might suggest some remedies to help her manage her emotions and promote relaxation. These may not all be appropriate for your mother (you can check with her physician), but some techniques include:


Deep Breathing Exercises: Inhaling slowly through the nose and exhaling through the mouth can help calm the nervous system and reduce emotional distress.

Progressive Muscle Relaxation: This technique involves tensing and then relaxing different muscle groups to promote physical and mental relaxation. It can help reduce tension and anxiety associated with emotional lability.

Guided Imagery: Guided imagery involves visualizing peaceful and calming scenes. This exercise can help redirect the focus away from overwhelming emotions and towards positive mental imagery.

Chair Yoga or Gentle Stretches

Walking: Taking regular walks outdoors can have a positive impact on mood and emotional well-being. Walking can help reduce stress and anxiety while promoting physical activity.

Art Therapy: Engaging in creative activities like drawing, coloring, or painting can provide a therapeutic outlet for emotional expression and help alleviate distress.

Listening to Music: Playing calming music or soothing sounds can promote relaxation and shift focus away from intense emotions.

Journaling: Writing down thoughts and feelings in a journal can provide an outlet for emotional expression and help one gain insight into their emotions.

Social Support: Engaging in conversations with supportive friends, family members, or support groups can provide emotional comfort and an outlet for sharing feelings.

Aromatherapy: Certain scents, like lavender or chamomile, are known for their calming effects. Using essential oils or scented candles during relaxation exercises can enhance their effectiveness.

Remember that the exercises should be adapted to your mom's abilities and preferences. It's also important to consult with a healthcare professional before starting any new exercise routine to ensure that the activities are safe and appropriate for their specific condition and stage of recovery.

If her symptoms persist or are interfering with her daily life, I would suggest consulting with her MD or a neuropsychologist.

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