Problems with memory and thinking
Problems
with memory
and thinking
Together we can conquer stroke
A stroke can affect the way your brain
understands, organises and stores
information.
In this guide we talk about some common problems
that can happen because of this and what you can
do about them.
It’s aimed at people who have had a stroke but
there is information for family and friends as well.
We have information on all aspects of stroke.
If you have a question that is not answered in
this guide, visit stroke.org.uk or call our Stroke
Helpline on 0303 3033 100.
If you’re looking for more information on this topic
you may want to take a look at our Complete guide to
cognitive problems. Go to stroke.org.uk/publications
to find it.
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What’s in this guide?
Why has my memory and thinking changed? 4
What kinds of problems can this cause? 5
Will it get better? 7
What can I do about my memory and thinking? 8
Memory problems 12
Problems with concentration 14
Problems with planning and problem-solving 16
Other problems 18
Where to get help and information 19
Tips for family and friends 21
About our information 23
3
Why has my memory and thinking changed?
Every second you receive a huge amount of
information from the world around you, which your
brain has to understand, organise and store.
If the part of your brain that processes this
information is damaged by your stroke, this can
affect your thinking. So you may find it difficult to
concentrate or remember certain things. You may
also find it difficult to work out how to respond to
what’s going on around you.
Memory and thinking problems are also called
cognitive problems or a cognitive impairment.
They are very common after a stroke and many
people will have some difficulties.
Because so much goes on in hospital, you may
not realise that your memory or thinking has
been affected until you return home. Even then,
you may not notice until you go back to work or
start to do other things like driving.
4
What kinds of problems can this cause?
Memory problems
Many people have problems with their memory after
a stroke, especially in the first weeks and months.
This may not always be down to a problem with
your memory. Some memory problems are actually
caused by problems with concentration. If you can’t
focus on what you’re being told, you’re not going
to be able to remember it later. So if you’re having
problems with memory it may help to think about
ways to improve your concentration as well.
Problems with concentration
People often find that that their concentration is
affected after a stroke, especially in the early stages.
If you’re having problems with your concentration
you may get distracted easily, or find it difficult to do
more than one thing at a time.
Concentration is extremely important because we
rely on it for all of our other thinking processes.
5
Problems with planning and problem-solving
As well as being able to take in and store information,
our brain performs a whole range of other thinking
processes which enable us to plan and carry out
tasks. This is also known as executive function.
If a stroke affects your executive function, you may
not be able to work out how to do certain things,
like changing the channel on the TV remote or
making a meal. Or you may not know how to start or
finish a task on your own, and may find it difficult to
multitask (do more than one thing at the same time).
Other problems
A stroke can affect your thinking in other ways. This
can cause problems with:
• finding your way around
• being able to recognise things
• moving your body in the way you want to
• not noticing things on one side of you
• being confused about the effects of your stroke.
6
Will it get better?
Cognitive problems are usually worst in the first few
months after stroke, but they can and do get better.
They’re likely to improve very quickly over the
first few months. It’s still possible for problems to
improve after this, but you may find that it takes
longer. Recovery tends to slow down, especially
after six months.
Having cognitive problems does not mean that you
have dementia. Many people worry about this, but
dementia gets worse over time, whereas cognitive
problems after stroke often get better.
Even if your cognitive problems never go away
completely, they should not get any worse and do
get easier to live with.
If you think that your problems are getting
worse, make sure you speak to your GP about it.
For more information about dementia, you can
read our Complete guide to vascular dementia on
stroke.org.uk/publications.
7
What can I do about my memory and
thinking?
1 Get some help
If you’re having problems with your memory or
thinking, the first thing to do is to speak to your
GP. It’s easy for people, including doctors, to forget
that there are effects of stroke you can’t see. So
don’t wait to be asked. If you’re finding it hard, tell
someone.
Your GP can make sure that there isn’t anything
else that could be causing problems, such as an
infection or your medication. If there doesn’t
seem to be any other cause, you’ll need to have
a cognitive assessment with someone in your
stroke team – usually a doctor or an occupational
therapist, or sometimes a psychologist.
Some people can find these assessments
off-putting because the questions are often very
simple, which can seem pointless. Still, it’s important
that you answer them, as the results of the
assessment will help your team decide the best way
to help you.
8
Treatments for cognitive problems
Treatment and therapy you’re likely to be offered
will focus on ways to help you cope with your
cognitive problems, rather than ‘fix’ them.
Things that help you to do this are known as
compensation or coping strategies.
An occupational therapist can help you learn
coping strategies. This may involve using aids
(such as using labels and reminders) or learning
other techniques that can help you.
If your problems are quite severe, you may be
referred to a clinical neuropsychologist. This is
someone who specialises in the way the brain
works. They can carry out a detailed assessment
to understand the type of problems you’re
having and the best ways to manage them.
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2 Don’t be too hard on yourself
Having cognitive problems after a stroke is
nothing to feel bad about. A stroke is a major
injury to your brain, so it’s going to take time for
it to recover. You are still the same person even
though things have changed for you. Allow more
time to get things done and don’t expect too
much of yourself, too soon.
3 Take plenty of exercise
Being as active as you can may help with
cognitive problems and it can also help with
emotional problems. If you can, try to aim for
aerobic exercise that gets your heart beating and
makes you slightly out of breath.
4 Get enough rest
You’re not going to be able to take life at the
same pace as you did before, at least not to
begin with. When you’re tired it’s even harder to
concentrate or remember things. So rest when
you need to and make sure you get plenty of
sleep at night. It will help you to focus if you do.
10
5 Find ways to relax
Your mind needs to rest just as much as your body.
Even small things like listening to music or having
a quiet moment to yourself can help to calm your
mind. Relaxing can be difficult if you have a busy
home life, but it’s important that you find a way to
rest your mind when you get tired or frustrated.
6 Tell people what’s going on
Be up front about the problems you’re having.
People feel awkward when they don’t know what
to do, so tell them what will help (speaking slowly
or writing things down, for example). It will also
stop them from getting offended if you don’t
remember something from your last conversation,
or assuming that you’re bored if you get distracted.
“I’ve had to learn not to beat myself up
about not being able to remember.”
Mary
11
What can I do about memory problems?
1 Write things down
• Use calendars or diaries to keep track of
appointments and important dates. You can
also use them to record things that happen
every day.
• Make a note of small tasks as you do them, so
you know whether you’ve fed the cat or phoned
someone.
• Write down notes after a therapy session or
doctor’s appointment, so that next time you can
go back and remind yourself of what you talked
about.
• If writing is difficult you could use a dictaphone
or an app on your smartphone to record notes.
You could also take pictures or ask other people
to write things down for you.
Try using your phone. Smartphones have alarms,
calendars, address books and cameras that can
help you record things and set up alerts and
reminders.
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2 Use prompts
• Set your phone or a cooking timer to remind you
when you need to take your medication.
• Leave things like your keys or wallet near the
front door, so you’ll see them when you go out.
• A pill or dosette box can help you to organise the
medication you need to take each day, so you can
easily see whether you’ve taken it or not.
• Some people use acronyms or sayings to help
them remember things. One lady told us she
thinks of “SLAC” when she leaves the house, so
she knows she needs to Set the alarm, Lock the
door And Close the gate.
• Labels on cupboards and drawers will help you
know where things go. They don’t have to be
written labels, you could use pictures instead.
3 Put reminders where you won’t miss them
• Leave notes in noticeable places – buy a pen that
you can use to write on your bathroom mirror or
set up a white board somewhere obvious.
• You could put up signs in the kitchen to remind
you to turn the cooker off, or one on the front
door to remind you to lock it when you go out.
13
What can I do about problems with my
concentration?
1 Keep it simple
• Focus on completely finishing a task before
moving on to another one. So if you’re making
something to eat, don’t try to use the phone at
the same time.
• If someone’s giving you information, ask them
to break it down and go through it one step at a
time. Get them to write it down if it helps.
2 Remove distractions
• Ask yourself if there’s anything that may distract
you. Turn off the TV and radio or move to a quiet
room and ask other people not to disturb you.
• Try to remove clutter, so you won’t have any
visual distractions either. If you only keep the
kettle, cups and teabags on the kitchen counter,
this will help when you make a cup of tea.
“Balance being busy with taking rest.
My brain is definitely slower when I’m
overloaded, tired or run down.”
Jo
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3 Know your limits
• Remember that you’re not going to be able to
concentrate for long periods. So keep tasks to
half an hour, or however long you can manage. If
something is going to take longer than this, take
a break and come back to it later.
• If you find it hard to follow a TV programme,
think about what you’re watching. News, sports,
or cookery programmes will probably be easier
to keep up with than dramas or documentaries,
which rely on you watching the whole thing.
4 Plan your day
• If you know you’re going to an appointment or
expecting a visitor, or doing something else
where you’ll need to concentrate, then plan to
have a rest immediately before.
• It may help to write a ‘to do’ list the night before
and decide which tasks are the most important.
That way, if you find yourself having a bad day,
you’ll know what to focus on and what can be left
until another time.
15
What can I do about problems with planning
and problem-solving?
1 Practise, practise, practise
• Planning and problem solving can be improved,
but only with lots and lots of practice. Your
occupational therapist or neuropsychologist can
help you decide what activities to focus on, as it
will be different for everyone.
• Once you’ve mastered one task, like making
a sandwich, you can move on to more difficult
ones, like cooking a meal.
2 Keep to a routine
• Dressing yourself in the same way or order every
day will make it easier for you to relearn the steps
and spot when you miss one.
• Develop a weekly routine – if you know that
Tuesday is washing day or Wednesday is
shopping day it’ll prompt you to do these things.
“The best people to do things with were the
kids. We practised planning and sequencing
by baking fairy cakes.”
Cath
16
3 Use prompts and reminders
• Write out instructions or checklists for you to
follow when you do something.
• Or stick up notes around the house to remind
you of things that you may not think of on your
own, like brushing your teeth.
• You could use brightly coloured stickers on the
microwave or remote control to help remind you
which buttons to press.
• Prompts don’t have to be written, you can use
pictures or recordings instead. Some people
make up songs or acronyms to help them
remember how to do things in the right order.
4 Talk it through
• It can help to talk through a task with someone
before you do it, so that you can think of and sort
all the steps in your head before you do it.
• Also think about what could go wrong, so that
you know what you need to do in case it happens.
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What can I do about other problems?
1 Speak to your doctor
Other cognitive problems, like not being able to
recognise things, or finding your way around, will
often be picked up by your doctors or therapists
while you’re in hospital, or by your community team
when you’re back at home.
If they haven’t been, and you start to notice that
you may be having problems, then go back to your
GP to get them properly diagnosed and assessed.
You can find more information in A complete
guide to cognitive problems after stroke. Go to
stroke.org.uk/publications to download it.
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Where to get help and information
Talk to us
Our Stroke Helpline is for anyone affected by a
stroke, including family, friends and carers. The
Helpline can give you information and support on
any aspect of stroke. Call us on 0303 3033 100,
from a textphone 18001 0303 3033 100 or email
info@stroke.org.uk.
My Stroke Guide
My Stroke Guide is the stroke support tool and online
community from the Stroke Association. Log on at
mystrokeguide.com. Our Enquiry Line can support
you with using My Stroke Guide: call 0300 222 5707
or email mystrokeguide@stroke.org.uk.
Talk to others affected by stroke
There may be a stroke group in your local area
where you can meet other stroke survivors. You can
meet people on our My Stroke Guide online chat
forum at mystrokeguide.com, and our Facebook
page Facebook.com/TheStrokeAssociation.
Call our Helpline or visit stroke.org.uk/support for
more information on stroke groups and other face-
to-face support.
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Other sources of help and information
The following organisations can provide information, advice
and support. Contact our Stroke Helpline if you’d like to
know about others in your area.
Alzheimer’s Society
Website: www.alzheimers.org.uk
National dementia helpline: 0300 222 1122
Email: enquiries@alzheimers.org.uk
Provides information about dementia and living with
memory problems.
Disabled Living Foundation
Website: www.dlf.org.uk
Helpline: 0300 999 0004
Email: helpline@dlf.org.uk
Gives impartial advice about aids and equipment.
Headway
Website: www.headway.org.uk
Helpline: 0808 800 2244
Email: helpline@headway.org.uk
A charity for people who have had a brain injury. Publishes
guides about cognitive problems and how you can manage
them.
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Tips for family and friends
It can be difficult to know how to help someone
cope with cognitive problems. So here are some
tips to help you.
Be patient
None of us like to repeat ourselves or feel that
we’re not being listened to. But you need to
remember this isn’t something a stroke survivor
can control very easily. So let your friend or family
member do things in their own time. If there’s
something that’s frustrating you, explain the
problem calmly and focus on what you can do to
make it better.
Don’t make things too complicated
Help your friend or family member by giving
information in the right way:
• Break tasks down into individual steps.
• Give simple instructions, one at a time, rather
than a list of things to do.
• Get to the point – don’t expect them to keep up
with a 20-minute update about your day. Just
start with the headlines.
21
Be encouraging
Practise exercises with your friend or family
member 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 that things
will never get better, so help them by celebrating all
their successes, however small.
Don’t do everything for them
It’s normal to want to do as much as possible for
someone you love. But it will be better for your
friend or family member if you help them to do
things on their own, rather than do it for them. So
if they ask you what day it is, for example, suggest
they look at the newspaper to find out.
Get support
Cognitive problems are often missed by doctors
and sometimes it can be difficult to get them taken
seriously. So don’t be afraid to keep pushing to
get the support you need. If you don’t think you’re
getting the right support from your GP or stroke
team, then call our Stroke Helpline.
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About our information
We want to provide the best information for people
affected by stroke. That’s why we ask stroke
survivors and their families, as well as medical
experts, to help us put our publications together.
How did we do?
To tell us what you think of this guide, or to request
a list of the sources we used to create it, email us at
feedback@stroke.org.uk.
Accessible formats
Visit our website if you need this information in
audio, large print or braille.
Always get individual advice
Please be aware that this information is not intended
as a substitute for specialist professional advice
tailored to your situation. We strive to ensure that
the content we provide is accurate and up-to-date,
but information can change over time. So far as
is permitted by law, the Stroke Association does
not accept any liability in relation to the use of the
information in this publication, or any third-party
information or websites included or referred to.
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Contact us
We’re here for you. Contact us for expert information
and support by phone, email and online.
Stroke Helpline: 0303 3033 100
From a textphone: 18001 0303 3033 100
Email: info@stroke.org.uk
Website: stroke.org.uk
We are the Stroke Association
We believe in life after stroke. That’s why we support
stroke survivors to make the best recovery they can. It’s
why we campaign for better stroke care. And it’s why we
fund research to develop new treatments and ways of
preventing stroke.
We rely on your support to fund life-saving research
and vital services for people affected by stroke. Join the
fight against stroke now at stroke.org.uk/fundraising.
Together we can conquer stroke.
© Stroke Association 2018
Version 2. Published: April 2018
To be reviewed: April 2021.
Item code: A01F07
Stroke Association is registered as a charity in England and Wales (No 211015) and in Scotland (SC037789).
Also registered in Northern Ireland (XT33805), Isle of Man (No 945) and Jersey (NPO 369).
