Current Concepts of Cerebrovascular Disease — Stroke Emotional Problems After Stroke

EMOTIONAL distress, especially anxiety, frustration, and depression, are common problems after stroke and other chronic, disabling illnesses. Estimates of the prevalence of clinically significant levels of depression after stroke range from 26 to 60%.'" Other common difficulties include overdependence on others, inflexible and rigid thinking, impatience, irritability, impulsivity, denial and lack of awareness of problems, insensitivity to others, and poor social perception. Occasionally, suicidal ideation and paranoid delusions occur. The emotional reaction to the sensory and motor symptoms is complicated and compounded by the cognitive deficits caused by the lesion: in language, reading, writing, memory, visual perception, planning, judgment, logic, initiative, etc. These cognitive problems can contribute to emotional problems in a number of ways. For example, brain-damaged patients may jump to conclusions after considering only part of the relevant data. Such behavior often leads to misinterpretation of emotions of others and erroneous conclusions. One man observed his wife talking with his roommate in a nursing home and reasoned that they were having an affair and that his roommate wanted to kill him. Impaired initiative and lack of empathy can contribute to insensitive, demanding behavior and a resulting breakdown in interpersonal relationships.