Understanding cognitive issues after stroke 

Cognition refers to the process of thinking. It is about how your brain understands, organizes, stores and retrieves information. Difficulties with cognition may happen after a stroke. The type of cognitive issues you may experience will depend on the location of the brain damage from stroke.

How does a stroke affect my cognition?

1. Memory Problems

Many people complain of memory problems after suffering a stroke. You may notice that you need more time to process information or learn new things.
The memory process is broken down into 3 stages:

• Stage 1: learning the information
• Stage 2: Retention of information over time
• Stage 3: Retrieval of information

There are two broad categories of memory, short-term memory and long-term memory.
Here are some examples of problems with:

Some memory problems are caused by difficulty with concentration. You will not be able to remember / perform the things you were told if you cannot focus during a conversation or task.

Here are some examples of memory problems due to difficulty with concentration.

• Difficulty with multi-tasking.
• Taking a longer time to do things than usual.
• Difficulty returning to a task after being interrupted.

2. Problems with Executive Function

As well as being able to take in and store information, our brain performs a whole range of other thinking processes. Problems with executive function can affect a person’s ability to manage and organise themselves in achieving goals.
Here are some executive function processes:

Ability to control and think before acting	Ability to self-evaluate your performance or behaviour
Ability to plan all the steps or put the steps in correct order for a task	Ability to keep information in mind
Ability to start on a task	Ability to adapt to changes in situation and problem solving
Ability to manage your feelings	Ability to manage work or multiple tasks

3. Problems with Recognizing Things (Agnosia)

Your brain recognizes objects in 2 stages.

Stage 1: 

Receiving information from your senses about the way an object looks, feels and sounds.

Stage 2: 

• Comparing the information received with the information in your memory.
• It retrieves the information from your memory about what the object is called and what it does.

It is often difficult to differentiate between language difficulties and agnosia.
Agnosia may affect you in very specific ways. Using a cup as an example, people with agnosia may experience the following.

• Unable to recognise a cup by looking at it. However, he/she may be able to recognise it by the sense of touch.
• He/she may be able to describe the look or usage of a cup but unable to say that it is a cup.

How is Cognition Assessed?

Cognitive Screening

Cognitive screening is a simple tool that helps evaluate your memory and other thinking skills. It helps to indicate if a more detailed cognitive assessment is required.

Cognitive screening is not used for diagnosing any particular cognitive illness
and does not replace consultation with your doctor. If cognitive problem is indicated, you should follow up with your doctor for a more detailed cognitive assessment.

Full Cognitive Assessment

You may be referred for a detailed cognitive assessment. The assessment is usually done by a doctor, nurse, an occupational therapist (OT), or a psychologist. 

It is important to do the assessment as the results will help your stroke care team decide the best way to help you.

Will it get better?

For some people, cognitive problems may improve over time, either spontaneously or through rehabilitation. For others, it may remain stagnant and in some, it can deteriorate.

What may help me manage my cognitive problems?

Depending on the type and severity of the cognitive problem, treatment mainly focuses on ways either to improve or cope with the problems.

Rehabilitation Strategies

A neuropsychologist and/or an occupational therapist (OT) can teach you some cognitive exercises to improve your memory and problem-solving skills. An art or music therapist may also be involved in providing you cognitive exercises. 

These cognitive exercises may consist of games, puzzles and daily activities that have been found to improve cognition.

Compensatory Techniques

Compensatory techniques are strategies that meant to support you in coping with difficulties and not necessarily improve your cognition. 

This may involve using aids such as using a daily planner and memory notebook.

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For more information on how to better manage your stroke recovery journey, visit Stroke E-Resources.