Dealing with Cognitive Changes
For many months, my husband’s health has had expected changes due to the stroke and underlying health issues, but they have been manageable until now.
Over the last few months, as many have experienced, changes have occurred, and we as Care Partners need to adapt to keep our loved ones and others safe.
Over the next four weeks, I will be addressing cognitive changes, emotional changes, communication changes and physical changes such as driving.
This week, let’s start tackling cognitive changes you may see, when to address them with a health professional, how to discuss them with your friends and family, and tips for the care partner.
What is a cognitive change?
When your loved one starts to have problems with memory and thinking, this is considered a cognitive problem. Some of the most common problems are…
Concentration problems
Memory problems
Planning and Problem-solving
Problems moving or controlling your body (apraxia)
Problems with movement and finding your way around (visual perception)
Confusion and denial (anosognosia)
Problem recognizing things (agnosia)
Problem recognizing things on one side (spatial neglect)
Depending on the site of the stroke and residual damage, the above may be seen at the time of the stroke, and your loved one is receiving therapy to manage it.
The concern is when the above changes appear new for your loved one. We are 2 ½ years post-stroke and have begun to see cognitive changes. Numerous factors can cause the changes, so you must share what you have witnessed with your physician and neurologist.
With us, some of the changes have been subtle and I can see that the changes are part of the aging process. The concern is when the changes impact their activities of daily living and or become an unsafe situation.
When to contact your physician or need to call 911?
Your loved one has had a previous stroke, but a second stroke can occur. To quickly evaluate use the following acronym:
F — facial drooping: People should ask the individual to smile to see if it is uneven. They can also ask:
Is one side of the face drooping more than the other?
Is one side of the face numb?
A — arm weakness: People should ask the individual to raise both arms. If they are unable to raise one arm, or it lowers more than the other, it is a symptom of stroke.
S — speech difficulty: If a person has slurred speech, it could mean they are having a stroke.
T — time to call 911: If someone shows signs of the above, people should call the emergency services.
Once it is assessed that this is a non-emergency, follow the guide below on when to discuss changes with your physician.
Contact your MD when you first see a change. Document what you have observed, the time of day, and any precipitating factors such as travel or lack of sleep.
The American Heart Association provided the below information on their site - Cognitive impairment after stroke is common, and early diagnosis and treatment needed | American Heart Association
Statement Highlights:
More than half of people who survive a stroke develop cognitive impairment within the first year after their stroke, and as many as 1 in 3 may develop dementia within five years.
The high risk of cognitive impairment and dementia after a stroke suggests early screening is essential for determining initial treatment, such as multidisciplinary care, cognitive rehabilitation or increased physical activity. It’s also important to assess stroke survivors for cognitive changes over time to offer appropriate treatment modifications and support for longer-term care.
Cognitive impairment after a stroke may fluctuate, particularly during the first six months after the stroke.
More research is needed to help identify which stroke survivors are most likely to develop cognitive impairment and to help develop culturally relevant screening and management techniques.
How and what to share with family and friends?
Keeping family and friends in the loop is important as cognitive changes occur. Share what you are seeing and the plan for your loved one. Their support will be critical to you and your loved one’s health. Here are some tips on how they can assist you.
Ask them to share their observations. You are with your loved one daily, and so subtle changes can be missed or thought of as if that is just them.
Activities and mental stimulation are critical to cognitive impairment. Invite the loved one and allow them time to talk and share their thoughts. Please be patient; it can take several minutes for them to form their thoughts or to share their words.
Don’t assume they have nothing to say. They become embarrassed with the changes and may choose to watch the world go by versus engaging.
Topics of discussion that were so common to them may no longer be. For example, trivia for my husband was a go, but now he must think about it and gets embarrassed when he can’t remember the answer quickly.
Play board games or cards; this is a great activity and keeps their minds active. For me, winning is no longer the objective but that he can participate.
Tips for the Care Partner
As the Care Partner, the grief over your loved one’s changes is overwhelming. I want to think or pretend that it is all due to the aging process and we are all experiencing cognitive changes, but the fact is that these issues are above and beyond aging.
What helps me…
Share your grief with a support group. Family and friends love you both and deal with the changes they see in the loved one. It is important to find a group for you. Individuals who are in the same boat do not know your loved one. You may also consider contacting a carepartner advocate that can help guide you through this experience.
You feel responsible for them 100%, and sharing changes falls to you. These are tough conversations. Talk to your health provider alone and discuss with your loved one. This softens the anger and sadness that they project onto you.
Have a family meeting where everyone can share their observations with you; this will allow you not to feel so alone. Then, together, develop a plan to share with the loved one. The key is that they do not feel ganged up on. I recommend smaller conversations with one child or friend at a time.
For more information on what worked for us, check out “Stroke and the Spouse,” available on Amazon, or follow the code below to purchase.
Stroke Caregiver Connection…Because you care!