Let’s Talk About Personality Changes After Stroke

front page of the Let's Talk About Stroke: Personality Changes After Stroke resourceAfter a stroke, survivors often experience emotional, behavioral and cognitive changes. That’s because stroke affects the brain, which controls our emotions, behavior and thinking. These changes are common and vary greatly.

Stroke survivors can experience:

  • Impulsiveness
  • Apathy
  • Pseudobulbar affect
  • Depression
  • Anxiety
  • Anger, irritability and aggression
  • Confusion
  • Forgetfulness
  • Fatigue

Personality changes can be equally difficult for stroke survivors, caregivers and family members. They can be hard to identify and even unnoticed by health care professionals.

Types of Personality Changes

Pseudobulbar affect, or PBA, also known as emotional incontinence, causes sudden and unpredictable episodes of crying or laughing, often in socially inappropriate situations.

Depression is characterized by depressed mood, loss of interest, loss of energy, decreased concentration and mental, emotional and spiritual limitation.

Anxiety is characterized by extreme and unreasonable fear and difficulty managing daily tasks.

Anger, irritability and aggression occur in many people who get frustrated or lose their tempers more easily than before their stroke.

Impulsiveness is the inability to think ahead or understand consequences. It’s more common with right-side or frontal lobe strokes.

Confusion can be better controlled when caregivers and family members minimize clutter and distractions, as well as reduce visual and sound stimulation of TV or music.

Forgetfulness and memory loss is caused by the loss of nerve cells in the brain. Stroke can affect two types of memory:

  • Verbal: memory of names, stories and words
  • Visual: memory of faces, shapes, routes and things seen

Apathy is described as lack of motivation or loss of interest in life by not wanting to participate in everyday activities.

Fatigue in stroke survivors is early extreme tiredness developed during mental activity.


Neuropsychological assessments can evaluate cognitive impairment and memory loss. Screening for and identifying post-stroke depression is vital for treatment and management.


It’s not uncommon for survivors to experience all of these personality changes. The good news is that several therapy options are available:

Solution Focused: This goal-oriented therapy focuses on solutions instead of the problems.

Problem Solving: Problems are identified and the therapist teaches the survivor a structured approach to solving them.

Cognitive Behavioral: Looks at the relationships between thoughts, feelings and behavior.

Attitude and Commitment: The survivor is taught to accept and embrace their thoughts, feelings, sensations and memories rather than try to control them.

Interpersonal: Focuses on interpersonal relationships by improving how the survivor communicates and relates to express emotions in a healthy way.

Mindfulness: Helps individuals with depression and chronic unhappiness.

Cognitive Rehabilitation Therapies (CRT) work to restore functioning and independence after a stroke to improve survivors’ quality of life and to help them more fully participate in society.

Cognitive Behavioral Therapy (CBT) focuses on examining the relationships between thoughts, feelings and behavior, and may help survivors suffering from anxiety. 


How can I learn more?

  1. Call 1-888-4-STROKE (1-888-478-7653) or visit stroke.org to learn more about stroke or find local support groups.
  2. Sign up for our monthly Stroke Connection e-news for stroke survivors and caregivers at StrokeConnection.org.
  3. Connect with others who have also had an experience with stroke by joining our Support Network at stroke.org/SupportNetwork.

Do you have questions for your doctor or nurse?

Take a few minutes to write down your questions for the next time you see your health care professional. For example:

What can my family do to help me when I am emotional?
Will these personality changes improve over time?


We have many other fact sheets to help you make healthier choices, manage your condition or care for a loved one.
Visit stroke.org/LetsTalkAboutStroke to learn more


Nationally sponsored by: Encompass Health

© Copyright 2022 American Heart Association, Inc., a 501(c)(3) not-for-profit. All rights reserved. American Stroke Association and Together to End Stroke are registered trademarks of the AHA. Unauthorized use prohibited. DS19168 4/22

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