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Behavior Changes After Stroke: Why They Happen & What It Means

doctor talking to stroke survivor about treatment for behavior changes after stroke

Behavior changes after stroke can be a normal part of the recovery process. Some changes, however, can indicate the presence of other medical complications that require treatment. This article will explain potential changes in behavior so that you know what to expect and can seek medical attention when necessary.

We’ve updated this guide to be as comprehensive as possible. To help make it easier to navigate, use the links below to jump straight to each behavior.

Types of behavior changes after stroke:

Why Do Personality and Behavior Changes Occur After Stroke?

Personality is defined as an individual’s unique pattern of thoughts, feelings, and behaviors. Although we tend to view personality as fixed, it often changes as we go through various stages in life.

After a stroke, however, these changes can occur suddenly. Stroke survivors may demonstrate completely new personality traits and behaviors, which can surprise their loved ones. Fortunately, there are ways to help survivors overcome unwanted behaviors. But why do they happen to begin with?

Sudden behavior changes after stroke can be caused by changes in the brain. A stroke is a medical event that impacts the brain, causing damage to varying amounts of some brain tissue. As a result, there could be changes in the brain that cause an abrupt change in behavior.

In fact, sudden behavior changes may correlate with the area of the brain affected by stroke. For instance, a frontal lobe stroke may result in impulsiveness because that area of the brain contributes to self-control.

Slow, progressive behavior changes after a stroke, on the other hand, could simply be a result of lifestyle changes. Many of us get our sense of personality and identity from things like our friends, occupation, and hobbies. When these factors change after a stroke, it could cause changes in behavior.

Up next you’ll learn about potential behavior changes in more detail. At the end, you’ll discover various resources for treatment and recovery.

Types of Behavior Changes After Stroke

It’s important to know that every stroke is different and therefore everyone experiences the effects differently too. Some survivors may not experience any behavior changes while others do.

Here’s an explanation of the most common behavior changes after stroke:

Mood Swings After Stroke

Sometimes, mood swings are an innocent byproduct of the intense challenges of stroke recovery. Everyday activities may require more energy than normal as the brain is still healing. This can result in post-stroke fatigue and mood swings as a complication of that fatigue.

Other times, mood swings can stem from damage to the emotion center of the brain, resulting in a condition known as emotional lability or pseudobulbar affect. This can cause uncontrollable emotional outbursts like laughter or crying, even if the situation isn’t funny or sad. This condition may improve on its own over time (spontaneous recovery) and it can also be treated with medication.

Depression

It’s estimated that one out of every three stroke survivors struggles with depression. While depression isn’t exactly a behavior, it can have a secondary impact on an individual’s behavior. For instance, an individual can become unmotivated during recovery due to post-stroke depression; and if this person was once an ambitious person, this can look like a change in behavior.

The good news is that studies show that depression tends to lift about one year after having a stroke. This could suggest that depression is a byproduct of the challenges of recovery and tends to improve as the survivor’s abilities improve and/or as they learn to adapt to a different lifestyle.

Strange Behavior

Some family members notice strange behavior in their loved ones after a stroke, such as disorganized thoughts and actions that don’t seem to make sense. Always talk to a doctor if you are worried by unusual changes in behavior because it could be a sign of post-stroke dementia. Be careful about jumping to conclusions, though.

Displays of strange behavior alone do not mean a person has dementia. Try to put yourself in the shoes of a survivor and imagine what it’s like to have your abilities change overnight. Although sometimes these changes are physical, there could also be cognitive and perceptual changes from stroke that could result in unusual behavior. Always start with compassion, and then talk to a doctor about any concerns, especially if you are worried about your loved one’s safety and well-being.

Irrational, Impulsive, or Inappropriate Behavior

woman looking at smartphone with surprise from inappropriate behavior

Some behavior changes are caused by damage to the brain’s executive functioning, which contributes to our memory, critical thinking, and self-control. When a stroke damages the areas of the brain that contribute to executive functioning, such as the frontal lobe, it can result in behavior changes such as irrational or inappropriate behavior.

Impulsiveness in particular is often associated with both frontal lobe strokes and a stroke in the temporal lobe, which plays a role in judgement and decision-making, particularly when the right side is affected.

Stubborn Behavior

Some caregivers notice stubborn behavior in their loved one after a stroke. To understand why this is happening, it helps to look at what the survivor is being stubborn about. Do they insist on doing things independently even though it’s more difficult? This stubbornness is actually helpful for recovery as it provides stimulation for the brain and encourages improvement, as long as they are engaging in activities safely.

However, if the survivor is being stubborn about the effects of their stroke and they express denial that anything is wrong, it could be a sign of a medical condition called anosognosia, or “lack of insight.” This condition causes a person to be in denial of their disability. It’s important to know that individuals with anosognosia are not being intentionally stubborn. Anosognosia is caused by changes in the brain that impair the person’s ability to be self-aware.

Aggressive and Combative Behavior After Stroke

Some survivors can demonstrate aggressive and even combative behavior after stroke. When this happens, you must seek help and talk to both a doctor and, if you experience any harm, call the domestic abuse hotline. Usually aggressive and combative behavior is the result of damage to the frontal lobe and impaired impulse control. Medication may help, and it’s imperative to talk to your loved one’s doctor while also protecting your safety.

Forgetfulness and Neglectfulness

stroke survivor gazing off into distance

Sometimes stroke affects memory and attention. This can cause a stroke survivor to act forgetful or neglectful. Forgetfulness is often the result of impaired cognitive function after stroke, and it can improve through time and cognitive rehabilitation.

Neglectfulness, however, could be a sign of hemineglect, a condition where a stroke survivor does not notice things in the environment on their affected side. For example, if you approach someone with left side neglect on their left side, they might not notice you. While this can seem like a change in behavior, it’s actually a cognitive deficit that should be formally diagnosed and addressed.

Childlike Behavior

Some survivors demonstrate childlike behavior after stroke. It’s important to understand that some people use this type of behavior as a coping mechanism. However, not all childlike behavior is a coping mechanism. Sometimes, when behavior becomes extreme, it’s a sign of vascular dementia or frontal lobe damage, so be sure to consult with a doctor.

Hypo- and Hypersexuality After Stroke

After a stroke, an individual’s libido can decrease or increase. When libido decreases, it’s called hyposexuality, which is common after a stroke. This could be the result of the challenges of recovery, insecurities about physical abilities, or changes in the brain. Also, some medications such as antidepressants are known to decrease a person’s sex drive.

On the other hand, some stroke survivors experience an increase in libido, which is known as hypersexuality. One very small study found that hypersexuality was associated with a stroke in the temporal lobe.

Diagnosis and Treatment for Behavior Changes After Stroke

stroke survivor sitting on yoga mat meditating outside

There are various types of behavior changes after stroke, each with their own variety of possible causes. Therefore, it’s critical to get a formal diagnosis from your doctor.

Here are some steps that can help your loved one with unwanted behavior changes after stroke:

  • Medication. If your doctor diagnoses your loved one with vascular dementia, pseudobulbar affect, or frontal lobe damage, they may recommend medication. Certain SSRIs may help improve a variety of behavior changes that stem from biological changes.
  • Psychotherapy. Another great step to help cope with behavior changes is therapy. When behavior changes are severe, therapy might not be enough treatment on its own, but it can certainly play a strong role in recovery.
  • Positive psychology. While psychotherapy attempts to address negativity, positive psychology aims to “enhance the good” by rewiring the brain for happiness. This practice is particularly helpful for post-stroke depression. The book Healing & Happiness After Stroke dives deeper into this concept.
  • Cognitive rehabilitation. When a stroke has impaired certain cognitive functions, such as critical thinking or memory, cognitive rehabilitation can help. It is frequently provided by a speech-language pathologist and involves practicing certain mental exercises to help encourage neuroplasticity and improve cognitive skills. Individuals that struggle with poor memory or dementia can particularly benefit from this therapy. We recommend the CT Speech & Cognitive Therapy App because it was created by experienced Speech-Language Pathologists.
  • Meditation. Don’t overlook this simple but powerful practice! Meditation has been shown to provide many benefits that may help with behavior changes after stroke, especially impulsiveness. When you practice being still and present in the moment, you build that skill. Recovery is all about neuroplasticity and practicing the skills that you want to improve.
  • Healthy food. Finally, the foods that you eat play a role in the way you think and behave. By eating foods that are known to help recovery after stroke, such as brain-boosting fatty acids, you can give yourself the best chance at feeling better.

As you can see, there are many ways to address unwanted behavior changes after stroke. Talk to your doctor to explore your options, and also consider starting some healthy habits like meditation and eating well.

Also, don’t forget that spontaneous recovery may also occur, where some conditions improve on their own, while also being proactive about talking to experts and taking matters into your own hands.

The Full Picture: Assessing Behavior Changes After Stroke

There are many different ways that behavior can be affected by stroke. Sometimes it’s the result of changes in the brain, and cognitive rehabilitation can help encourage recovery. Other times it’s a complication of the challenges of stroke recovery, which often improve over time as the survivor’s abilities also improve.

Always talk to a doctor if you are concerned about certain behaviors so that you can get a clear picture of what’s going on and the recommended course of action. We wish you good luck on the road to recovery and better behavioral health.

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