Thinking skills
- Libby Cunningham, Clinical Occupational Therapist
- 5 minute read
- Last updated: September 2023
Strokes can affect your cognitive (thinking) skills, which can have a big impact on your ability to live independently and complete everyday tasks. With time and therapy, your thinking skills can improve and so can your ability to live with any changes to them. If you or your family notice any changes to your thinking skills, such as difficulties concentrating, paying attention, remembering, organising or problem solving, be sure to mention them to your stroke team before you leave hospital. If you only notice these changes once you are home, it is important to mention them to your GP (family doctor) or stroke nurse who can refer you to get help.
How stroke affects the brain
Thinking skills (cognition) refer to how the brain understands, processes, stores and uses information. Our thinking skills underpin everything that we do.
How can a stroke affect thinking skills?
Up to three-quarters of all stroke survivors experience changes to their thinking skills. These changes can be mild and not that noticeable or more obvious and severe. They may be short-lived or long-lasting.
A stroke can weaken a person’s thinking skills in a number of ways. For example, some stroke survivors may experience mental fatigue and brain fog or have problems with attention and concentration. Below is a list of some of other thinking skills that can be affected:
- Memory for recent events, learning new information and remembering to do important tasks like taking medication correctly and attending healthcare appointments
- Information processing – the amount of information that can be processed and how quickly it can be processed
- Apraxia – our knowledge of how to complete a familiar task or use familiar objects
- Self-awareness – our understanding of how the stroke is affecting us
- Executive functions – complex thinking tasks like problem solving, planning and making decisions
It is very important for you to get help if you experience changes to your thinking skills (even mild changes). Changes to your thinking can damage your ability to get back to your everyday life. They can affect your ability to perform daily tasks, such as following a conversation or a movie, managing your medications, cooking a meal, handling family and household responsibilities or returning to driving or work.
Getting help
Hospital stay
You will be screened by the medical team and occupational therapist for any changes to your thinking skills during your hospital stay. If any cognitive changes that may be related to your stroke are noted, you will be referred for further rehabilitation. You may get this rehab while you are in hospital or it may take place in your home with the early supported discharge (ESD) therapy team. Your stroke team will discuss the best options with you and your family.
Don’t be afraid to ask
If you have any concerns about your ability to think or express yourself during your hospital stay, speak to your occupational therapist (OT) or stroke nurse.
If you notice changes to your thinking skills when you are back at home, contact your GP.
Other information
Top tips
Stick to your programme
Follow the therapy programme your occupational therapist has given you. It has been designed to uniquely target your cognitive concerns in the context of your stroke presentation and your life-after-stroke goals.
Libby Cunningham | clinical occupational therapist |
Time for self-compassion
Tasks and activities may be harder to complete now. Listen to your mind and body. Stop if you feel overwhelmed or fatigued and discuss these feelings with your occupational therapist.
Libby Cunningham | clinical occupational therapist |
Make your needs known
Remind family and friends that it is very important for you and your recovery that you are given time and space to complete the tasks and activities that you can do and wish to do yourself.
Libby Cunningham | clinical occupational therapist |
Frequently asked questions
Yes, thinking skills can improve in the same way that physical and speech impairments can improve. Intensity of therapy is important. There are also strategies that your occupational therapist may recommend to compensate for your cognitive changes. Your OT will advise you on your specific therapy programme, as this will be unique to you, on the effects of your stroke and on your specific life-after-stroke goals.
Honesty is the best policy. Remember that changes to thinking skills are often invisible to people around you. Stroke survivors with cognitive changes and minimal physical impairments can be especially disadvantaged by friends, family and work colleagues expecting them to be able to do more than they can. Educate those around you that even “mild” cognitive changes like mental fatigue and impaired information processing are very common, invisible and disabling.
Driving and working are two of the most cognitively demanding activities humans can do. Changes to cognition can affect how well we can carry out these tasks. Recovery is possible. Your stroke team can advise you on how to support your recovery, and your stroke OT will provide you with therapy to improve your specific cognitive needs so you can achieve your goals. You may require an onward referral to a vocational rehabilitation service or be referred to have an on-road driving assessment. Your medical practitioner will be involved in making decisions about your returning to work and driving.
Cognitive changes after a stroke are not the same as dementia. Cognitive changes after a stroke can and often do improve, whereas dementia worsens over time.
Website: irishheart.ie
Email: referrals@irishheart.ie
Phone: 01 668 5001
