Personality Changes That Can Be Caused by a Stroke

After a stroke, you may have significant personality changes in addition to the obvious physical effects. These behavioral changes can take you and your loved ones by surprise if you suddenly do not act like “yourself” anymore.

You can get some reassurance by realizing that personality changes sometimes happen after a stroke. It helps explain why you or your loved one might be acting a little differently.

Acknowledging personality changes can be a huge step in changing unwanted behavior. With that knowledge, you can work towards getting back some of the personality traits that make you feel more like “you.”

This article gives an overview of some common personality changes after a stroke. It also discusses the causes, treatments, and how to manage.

Depression

Depression is a very common personality change occurring after a stroke, with up to 33% of survivors experiencing post-stroke depression. The exact numbers of people are hard to nail down, but evidence certainly suggests people who have had a stroke are more likely to report depression than those who have not.

Causes of Post-Stroke Depression

Post-stroke depression has a number of causes:

• Physical limitations: The limitations caused by a stroke, such as weakness, vision loss, and coordination problems, may make you feel disempowered or handicapped.
• Health worries: After a stroke, you might worry about your health or experience anxiety about your own mortality. The resulting feelings of helplessness or hopelessness can contribute to post-stroke depression.
• Brain changes: Stroke-induced damage can produce changes in how the brain functions, resulting in altered biological activity that leads to depression.
• Delays in treatment: Many people are reluctant to seek treatment for depression. Some stroke survivors are concerned about what other people will think. Other survivors may not believe that treatment can help.

Management

If you or your loved one has lingering feelings of sadness or hopelessness, you can get effective help for this problem. By recognizing that depression is not your fault or a sign of weakness, you can empower yourself to get the right medical treatment.

Post-stroke depression is usually treatable with a combination approach that includes prescription antidepressant medication and counseling.

Social Avoidance

It’s common for stroke survivors to experience social anxiety. In a 2018 study of stroke and TIA (transient ischemic attack) patients, one-fifth had an anxiety disorder. Most of those involved avoiding certain situations, including social gatherings.

Causes of Post-Stroke Social Avoidance

Anxiety, including social avoidance, may be caused by changes in your brain from the stroke. You may also be more likely to have anxiety if you’re experiencing health challenges.

Some stroke survivors have severe disabilities that make it difficult to drive, leave the house, or even get out of bed. An extreme disability may necessitate moving into a new living environment to get assistance with daily living.

All of these factors can lead to anxiety and avoiding social situations. This can make loneliness even worse, creating a cycle that is difficult to escape without a deliberate plan of action.

Management

Let your doctor know if anxiety is making it hard to interact socially. They can help you find the right treatment, which may include medication or counseling.

A counselor can help with different techniques to ease anxiety. One method is applied relaxation, a specific way of relaxing the muscles to help let go of tension and anxiety.

Cognitive behavioral therapy may also help with anxiety. For social situations, this can involve putting yourself in a situation that helps you face your fears.

Loss of Cognitive Skills

Changes in cognitive skills include trouble with language, problem-solving, reading, and simple mathematical calculations. Some stroke survivors become forgetful, forgetting names, losing things, or neglecting important tasks.

Cognitive deficits can also cause confusion or may make it difficult to understand concepts that a stroke survivor would have previously been able to understand.

The loss of cognitive skills can be distressing, and many people make excuses for frequent mistakes. They may even lie about errors to avoid embarrassment.

Causes of Cognitive Changes

A loss of cognitive skills can happen after a stroke in almost any region of the brain. It occurs most often with strokes that affect the frontal lobe, the parietal lobe, or the temporal lobe.

Management

Restoring cognitive skills is a challenge. But just as physical disability can sometimes improve with physical therapy, therapy may also help cognitive skills.

Brain retraining techniques, either in person or through computer programs, may help with cognitive skills after a stroke. Researchers are studying these programs to find out how effective they are.

Some memory issues can improve over time. Taking medication for other issues, like sleeping problems, can sometimes help with memory as well.

If you’re dealing with memory loss, some ways to help manage it include:

• Designating specific places for things you use frequently, such as keys and your coat.
• Using memory cues to remember things. For example, you could try remembering a name by thinking of a song.
• Keeping a notebook with important information organized into sections. It could include phone numbers, medications, and directions for appliances.
• Breaking down complex tasks into simple steps.

Practicing conversations can sometimes help those with communication and language issues. You can practice in a quiet environment that’s free of distractions. As you become comfortable talking with family and close friends, you can expand to talking with others as well.

Emotional Instability

Stroke survivors may find themselves becoming unusually emotional or inappropriately crying or laughing. Some experience a condition called pseudobulbar affect, which is characterized by mood changes and uncontrollable expressions of emotion.

Causes of Emotional Instability

A stroke can damage parts of the brain that control emotional responses. This likely happens along a neural (nerve) pathway in your brain. The pathway includes the cerebellum, which helps us monitor our expression of emotions. A stroke may disrupt that pathway and lead to difficulties controlling emotions.

Management

Medications are available to help control this problem. These include antidepressants as well as Nuedexta (dextromethorphan/quinidine sulfate), the first FDA-approved medication for pseudobulbar affect.

Cognitive therapy and social support can also help you cope. Some other tips to help gain control of your emotions include:

• Take slow, deep breaths.
• Relax your face muscles.
• Try to focus your attention on something different.

If possible, let people know about your condition so that they understand and know what to expect.

Lack of Motivation 

A stroke can lead to a lack of motivation, which is described as apathy. Apathy can occur after most types of brain injury. You may have less interest in seeing friends and family and doing things you normally like to do. Research has shown apathy has a negative effect on your health and quality of life.

Causes of Post-Stroke Apathy

There are several reasons for post-stroke apathy.

• The decline in cognitive abilities after a stroke can make many tasks seem too challenging and unsolvable. 
• It can be caused by post-stroke depression, having less responsibility after the stroke, and the feeling that “nobody will notice” what you do. 
• Apathy may also occur due to changes in the structure and function of the brain because of the stroke.

Management

Doctors may prescribe antidepressants to help with apathy. However, while there’s evidence that antidepressants can lower the risk of apathy, there’s less evidence to show that they can treat it.

One study of stroke patients without apathy found that those who took Lexapro (escitalopram) were 3.5 times less likely to develop it.

Behavioral therapies may also help those with apathy. These include planning future goals and problem-solving with enjoyable activities to help increase motivation.

Aggression 

Some stroke survivors become unexpectedly hostile and angry, behaving in ways that are mean or physically aggressive.

Causes of Aggression

Aggression, like the other behavioral and personality-related stroke changes, is often a result of both the emotional feelings about the stroke and the stroke-induced brain injury.

Aggression is particularly noticeable in stroke survivors who have had a large stroke or who have a stroke pattern that produces vascular dementia.

Vascular dementia occurs when many small strokes happen over time, leading to a buildup of injuries throughout the brain. It’s characterized by a decline in memory and thinking skills, confusion, trouble finding things, trouble with directions, and changes in behavior.

Management

Antidepressant medications such as Prozac (fluoxetine) and Celexa (citalopram) may help people with aggression who have dementia. In one study, fluoxetine helped reduce anger scores for stroke survivors. However, more research is needed to confirm the results.

If you or someone you care for has problems with aggression, seek medical help right away. Call 911 if you feel that you or someone else is in immediate danger.

Lack of Stroke Awareness (Anosognosia) 

Anosognosia is a mental health condition in which people are unable to accept their diagnosis. For stroke survivors, anosognosia can mean overconfidence and a lack of awareness that anything is wrong after a stroke. A person who has anosognosia may be surprised at the fact that there is any medical care being given at all.

Stroke survivors who have anosognosia present a challenging problem for loved ones and caregivers who try to offer assistance. The care they provide is often met with no cooperation. Sometimes stroke survivors who have anosognosia treat those who are trying to help them with dismissal or rejection.

Causes of Anosognosia

Anosognosia in stroke survivors may be related to several different factors. Some studies have found that damage to the right hemisphere of the brain is linked to anosognosia. Other risk factors may include older age, previous strokes, and other mental health conditions.

Management

Cognitive therapy can help people better understand their condition. There isn’t a well-established therapy for managing anosognosia, though occupational therapy and various psychological therapies have been reportedly helpful.

If you’re caring for someone who’s experiencing anosognosia, try to acknowledge what they’re feeling, whether it’s frustration or sadness. Avoid getting into arguments to convince them about their condition.

Reach out to your medical team for help if the lack of awareness is causing them to make decisions that are unsafe.

Lack of Empathy

After a stroke, a person may sometimes become less empathetic to others. Empathy means being able to see something from another person’s point of view. Without empathy, someone may say or do things that are hurtful to others.

A lack of empathy after a stroke is usually upsetting for friends and loved ones but is typically unnoticed by the stroke survivor. It can result in self-centered behavior and damaged relationships.

Causes of Lack of Empathy

Lack of empathy after a stroke is typically caused by brain damage in regions of the right side of the brain. This damage can affect their perceptions of other people’s emotions and facial expressions.

Management

It is not easy to predict whether a lack of empathy will improve after a stroke. Some stroke survivors can show improvement, while others do not.

If you’re a caregiver, try not to take their lack of empathy personally. Keep in mind that the change in personality is caused by changes in the brain.

If the person is having trouble reading facial expressions, talk to them about the emotions you’re feeling.

Counseling or therapy may also help with improving communication between stroke survivors and caregivers.

Loss of Sense of Humor 

A sense of humor requires insight and quick thinking. Humor is often based on the recognition that dissimilar ideas that do not belong together are funny and amusing when placed together.

Many types of strokes can diminish a stroke survivor’s sense of humor. A stroke survivor who was previously funny might not be able to construct jokes. Someone who would have been able to recognize and laugh at jokes might not be able to do so anymore.

Causes of Loss of Sense of Humor

The frontal and temporal lobes appear to play an important part in humor. For instance, a study from University College London found that people with damage in the frontotemporal region had difficulty determining whether or not non-verbal cartoons had a humorous intent.

Management

A loss of sense of humor can be difficult to recover from because this stroke effect is caused by a loss of cognitive skills.

Understanding that the lack of humor is the result of a stroke and not a personal rejection can help in preventing hurt feelings.

Loss of Social Inhibitions

Some stroke survivors may behave in ways that are considered socially inappropriate. Behaviors can include taking food from a stranger’s plate, insulting people out loud, or even undressing or urinating in public.

Generally, stroke survivors who display socially unacceptable behavior do not have the insight to understand that the actions are not acceptable. They are unlikely to apologize or try to correct the behavior.

It can pose challenges for the caregivers and family members who take responsibility for the safety and care of a stroke survivor.

Causes of Loss of Social Inhibitions

This socially inappropriate behavior is most commonly associated with a stroke of the frontal lobe. This area allows you to make predictions about what will happen and adjust your behavior when necessary.

Management

When someone has had a frontal lobe stroke, their behaviors probably don’t fit their “normal” personality. It is very important to be aware that mean statements are not reflective of what a stroke survivor “really feels, deep down inside,” but are more likely to be phrases that he or she heard in a completely unrelated setting, such as on a television show.

The loss of social inhibition can be somewhat better controlled when the stroke survivor is comfortable, in a familiar environment, and under as little stress as possible.

If you’re caring for someone with impulsive behavior, try giving them consistent reminders on appropriate behavior. If possible, you might use interventions to help, such as using a lap belt on a chair if they keep jumping out of it.

Jealousy 

Some stroke survivors may experience intense, unreasonable jealousy that’s out of character for them. A rare type of stroke causes a condition called Othello syndrome, named after the character of a Shakespearean play.

Othello syndrome is characterized by irrational and illogical jealousy, particularly in the context of romantic relationships.

Causes of Jealousy

Othello syndrome can affect stroke survivors with a brain injury in the right cerebral cortex. In case studies, this area of the brain was affected in patients who had become unreasonably jealous, accusing their partners of infidelity.

Management

Othello syndrome may be treated with antipsychotic medications, such as Seroquel (quetiapine), along with antidepressants.

Do These Personality Changes Go Away?

It depends on the person and their specific condition. Some changes may go away on their own. Others require treatment, including medications or therapy.

Check with your doctor about any personality or change you’re experiencing. They can help you know what to expect and work with you on treatment.

Summary

Personality changes can be common after a stroke. Some changes may be due to damage in the brain. Others may be caused by the stress of dealing with life changes and physical limitations from the stroke.

Some personality changes may get better on their own while others require medication or therapy. Your health care team can work with you or your loved one to find a treatment or learn to manage symptoms.

A Word From Verywell

A stroke can cause major personality changes that can make you feel as if you have lost yourself or that you’ve lost the loved one you used to know so well. Personality changes after a stroke can be emotionally draining for everyone involved.

It can be reassuring to know that the behavior comes from stroke-induced brain damage. The unpleasant behavior isn’t premeditated or intended to be insulting.

Depending on their condition, some stroke survivors can recognize these personality changes. That allows them to work on improving them, which can result in more satisfying interpersonal relationships.