Personality Changes After Stroke

While some emotional and behavior changes after a stroke occur due to brain damage, others can be caused by the stress of coping with a “new normal.”

You’re probably familiar with the noticeable physical effects after someone has a stroke. But personality and behavioral changes after stroke are common, too. It’s not surprising: A stroke is a significant medical event that disrupts blood flow to the brain — the seat of our emotions and behaviors.

These personality and behavioral changes can vary quite a bit from one person to the next, depending on which part of the brain the stroke affected.

“A stroke on one side or portion of the brain will cause different problems than a stroke on the other side,” explains Clemens Schirmer, MD, PhD, a cerebrovascular neurosurgeon and director of the comprehensive stroke centers at Geisinger.

“For example, if a stroke caused damage to the frontal lobe, which controls personality, concentration, organization and problem-solving, a formerly cautious person may become impulsive and disorganized," Dr. Schirmer says. "If damage occurred to the temporal lobe, which controls the ability to understand language, hearing and memory, a formerly outgoing person may have trouble communicating and remembering names, and shy away from socializing.”

But besides resulting from the physical effects of brain damage, further personality changes after a stroke may arise from the trauma of the event itself — and from new physical limitations and life changes that result.

Personality changes after a stroke

Because they can manifest in various ways, personality changes after a stroke might be surprising when the survivor suddenly acts differently and not quite like themselves.

Anger, irritability and aggression

Many stroke survivors show signs of increased irritability. They may get frustrated more easily or be quick to anger over trivial matters. They may lose their temper and throw things, scream or curse. They also may become more physical in expressing their anger, such as hitting, kicking, grabbing or pushing others, even loved ones.

Increased irritability could be a result of the emotional feelings about the stroke, as well as the stroke-induced brain injury to the frontal lobe, which controls emotions.

Anxiety and excessive worry

Anxiety is common for many stroke survivors and can be made worse by new physical limitations. They might feel excessively worried, nervous or uneasy, or have irrational fears that disrupt daily life. Survivors with anxiety may withdraw and avoid certain activities and social situations. Physical symptoms due to anxiety can surface as well, including shortness of breath and heart palpitations.

Depression and feelings of sadness

According to the American Stroke Association, about 30% of survivors will develop depression after a stroke. They might have fatigue, apathy and decreased concentration, or lose interest in activities they once enjoyed.

Depression can develop from brain damage after a stroke or because of the stress of a survivor’s “new normal” — or both. A survivor may worry about their health and an uncertain future. They may feel depressed due to physical limitations caused by the stroke, such as weakness or coordination issues. Stroke-caused abnormalities in brain chemical levels can lead to depression, too.

Cognitive and behavior changes after a stroke

Cognitive and behavioral changes can occur from strokes that happen in almost any region of the brain. But they most often result from damage to the frontal, parietal or temporal lobes.

Impulsiveness and poor decision-making

Stroke survivors may suddenly act without thinking or become unable to think ahead or consider the consequences of their actions. Because of this, they may behave in ways that are socially inappropriate, such as taking food from a stranger’s plate or insulting people out loud. Impulsiveness could also include overindulgence, oversharing of personal matters or ignoring signs of danger.

Forgetfulness, memory loss or confusion

Damage to nerve cells in the part of the brain that controls storing and retrieving information may lead to forgetfulness or memory loss. When memory loss is so severe that it affects daily functioning, it becomes dementia. Depending on which side of the brain was affected, memory loss can be verbal or visual.

Verbal memory loss involves forgetting:

Names
Information
Stories

Visual memory loss involves forgetting:

Faces
Shapes
Routes

This brain damage can also affect a person’s thinking ability, causing a general sense of confusion. Cognitive deficits make it difficult for the survivor to understand concepts they once did. They might have trouble concentrating, problem-solving, following directions, multitasking or recalling specific words.

Pseudobulbar affect

Emotional instability, also called pseudobulbar affect (PBA), is a more common sign in women. PBA is characterized by often inappropriate, uncontrollable displays of emotion that don’t reflect how the survivor actually feels. Someone with PBA may appear to lack situational awareness. They may suddenly laugh at a funeral or upon seeing someone hurt — or cry in response to a joke. Fatigue, excessive noise or crowded, highly stimulating situations can worsen PBA.

Lack of motivation and initiative or apathy

Apathy is a common behavioral change in stroke survivors. Suddenly, survivors might lack the interest and drive to achieve daily tasks they once had. They may have less interest in seeing loved ones or doing things they previously enjoyed. The decline in cognitive ability can make tasks seem too difficult to achieve, so survivors give up, or apathy can be caused by post-stroke depression.

Stroke aphasia

A stroke that affects the pathways, which control speech and language, can result in aphasia or dysphasia, a language disorder that affects a person’s ability to communicate. Survivors’ speech may be jumbled, fragmented or difficult to understand. They might have trouble finding or getting the right words out, speaking in complete sentences or understanding what others say. Stroke aphasia can also impact the way survivors write and understand written language.

“There are several types of aphasia, and the severity depends on the extent of brain damage caused by a stroke,” says Dr. Schirmer. “Many times, it can lead to depression because survivors often feel frustrated by the difficulties to communicate.”

Coping with emotional and behavior changes after a stroke

Recognizing new symptoms, behaviors or emotions and seeking help from a doctor are vital to living well after a stroke.

“Rehabilitation and therapy are crucial aspects of managing personality and behavior changes after a stroke,” says Dr. Schirmer. “These interventions not only focus on physical recovery and regaining independence, but they also address cognitive and emotional changes to help survivors feel more like themselves again.”

If personality and behavioral changes affect survivors’ everyday lives, their doctor can assess the extent of the changes, identify underlying causes and recommend suitable interventions, such as:

Physical and occupational therapy help people relearn daily functioning skills and decrease physical limitations — so they can regain independence.
Cognitive behavioral therapy examines the relationship between thoughts, feelings and behaviors. Survivors develop problem-solving skills and can change unhealthy thought patterns and behaviors.
Speech therapy and practicing conversational skills help survivors with aphasia and other communication and language problems.
Medication, such as antidepressants, can improve anxiety or depression, as well as apathy and aggression.
Brain-training techniques help with cognitive issues or memory loss. Practicing skills repeatedly is critical, like playing memory games, doing Sudoku puzzles and word searches or finding the difference between two similar pictures.
Special devices, such as those that assist with speech, alarms to regain attention or memory tools, help survivors manage after brain injuries.

Developing coping strategies and routines is also essential for recovery. Structured routines lend a sense of control and stability, while minimizing stress. Examples include setting specific goals, using a reminder app, breaking tasks into simple steps and doing activities promoting emotional well-being.

“No two stroke survivors are the same,” says Dr. Schirmer. “That’s why working with a doctor to develop a personalized approach to management and coping with a ‘new normal’ is so important to getting your life back on track and maximizing the potential to recover from this traumatic event.”