Treatments for cognitive problems focus on ways to cope with the problems, rather than ‘fix’ them.
Are there treatments that can help?
An occupational therapist can assess you and help you learn coping strategies as part of your rehabilitation. This may involve using aids to help you manage, such as writing in a diary or using labels and reminders. Or it may involve learning other techniques that can help you.
If your problems are quite specific or severe, you may be referred to a clinical neuropsychologist or clinical psychologist. These healthcare professionals specialise in the way the brain works.
Whether you receive treatment or not, your problems should continue to be monitored to make sure you get the support you need for them. Even if you do not need support straight away, you may once you’ve been discharged from hospital, so your doctor and stroke team should make sure that you get it.
Cognitive assessments
If you have signs of cognitive problems, or a cognitive screening test suggests you may have problems, it’s likely you’ll need to complete a cognitive assessment. An assessment will tell you more about the problems you’re having and how they’re impacting you.
The assessment is usually done by a doctor, occupational therapist or sometimes a psychologist. It involves a lot of questions. This can make you feel like you’re taking an exam, even though you are not.
The results of the assessment will help your stroke team decide the best way to help you. The findings should be explained to you and your family or carers.
What can I do about cognitive problems?
1. Get some help
If you think you may be experiencing cognitive problems, the first thing to do is to speak to your GP. They will check if there’s anything else that could be causing the problems, such as an infection or side effects of medication.
Depression, anxiety and sleep problems are common after stroke, and can make you perform less well on cognitive tasks. So if you feel depressed, anxious, or have difficulty sleeping, then let your GP or occupational therapist know.
It’s easy for people, including doctors, to forget there are effects of stroke you cannot see. So do not wait to be asked about them. If you’re finding it hard, tell someone. Make it clear how your problems are affecting you and ask what support you can get.
2. Do not be too hard on yourself
Having cognitive problems after a stroke is not something you can control. Be patient with yourself. You’re not stupid, even though you may feel that way.
Allow yourself more time to get things done and do not expect too much of yourself. Brain injury is a serious condition that needs diagnosis and rehabilitation, in the same way you need rehabilitation after another type of physical injury, like a broken leg.
3. Stay active
Being as active as you can may help with cognitive problems. It can also help with emotional problems like low mood and anxiety. If you can, try to aim for aerobic exercise that gets your heart beating faster and makes you slightly out of breath. This could be a sport like swimming or running, or you can try gardening or brisk walking.
4. Get enough rest
Fatigue is very common after a stroke. It can make it even harder to concentrate or remember things. Plan your day so that you balance activities with taking breaks and resting.
You’re not going to be able to take life at the same pace as you did before, at least not to begin with. Take breaks when you need to and make sure you get good quality sleep at night. It will help you to focus if you do.
Returning to work
Cognitive problems can take a long time to improve. If you go back to work too soon, you could find it more difficult than if you went back a little later. An occupational therapist can give you advice about the best time to go back to work. They can also talk to your employer about how they can support you when you do.
5. Look into aids and equipment
There are aids and equipment that you may find helpful, especially for problems with memory. Your occupational therapist should be able to suggest some to you.
6. Find ways to relax
Your mind needs to rest just as much as your body. Even small things like going for a short walk, listening to music or having a quiet moment to yourself can help to calm your mind. Some people find mindfulness or meditation really helpful. Relaxing can be difficult if you have a busy home life, but it’s important to find a way to rest your mind when you get tired or frustrated.
7. Tell people what’s going on
Cognitive problems are nothing to be embarrassed about. Tell people about them. Explaining how someone can help will make it easier for you both. This might include speaking more slowly or writing things down. It will also stop them getting offended if you forget something or get distracted.
8. Talk to someone who understands
Cognitive problems can affect your confidence and how you feel about yourself. Talking about it can really help. Many people find support groups useful, because you can talk about problems with people who are going through the same thing.
If you prefer, you could try talking to a friend or family member whom you feel comfortable with.
Tips for family and friends
Do:
- Be patient. Someone might need longer to respond or carry out a task. This can feel frustrating if you’re trying to help. Let the person do things in their own time. If there’s something bothering you, explain the problem calmly and focus on what you can both do to make it better.
- Be encouraging. Do therapy exercises with the person and think of ways to make them fun. Cooking a meal can be a good way to practise planning and problem solving, for example. If progress is slow, it can be easy to think things will never get better, so help them by celebrating all their successes, however small.
- Give information in the right way. If your friend or family member is finding it hard to concentrate or remember things, you can help by giving information in a way that suits them. This might include:
- Breaking down tasks into individual steps.
- Giving simple instructions or asking questions one at a time, rather than a list of things.
- Keeping it brief. They might not be able to follow a 20-minute update about your day. Just start with the main points. Allow the person time to process what you’re saying and to respond.
- Using a quiet room to talk if possible, without distractions like the TV.
- Help them get support. If someone needs more support, contact the GP or stroke team.
Don't:
- Do everything for them. It’s natural to want to help, but it’s better to help someone do things on their own rather than do it all for them. So if they ask you what day it is, suggest they look at the newspaper or their mobile phone to find out. You could help by preparing an activity, such as putting out the things they need. Tidy up and declutter the area. They may be able to dress themselves or make a sandwich, if they have the things they need and a clear space.