Recognizing Decline After a Stroke & What to Do
If you or a loved one has been through this kind of health event, you know that recovery can be a long journey. While many regain function over time with therapy and care, some may face unexpected setbacks. These challenges can be frustrating and even overwhelming, but recognizing the early warning signs and taking action can make a world of difference.
In this guide, we’ll break down the signs of decline, why they happen, and what you can do to slow or even reverse them. Whether you’re recovering, caring for someone, or just trying to stay informed, this article will give you a clear picture of what to watch for.
Understanding Recovery and Setbacks
Before diving into the warning signs, let’s talk about what happens after such an event. When it occurs, blood flow to a part of the brain is interrupted, leading to damage in brain cells. The extent of recovery depends on the severity of the incident, the specific area affected, and how quickly treatment was received.
For many individuals, the first few months are crucial for regaining lost abilities through rehabilitation. However, not everyone follows a straight path to recovery—some make progress, only to face unexpected setbacks.
Experiencing decline after such an event isn’t uncommon, but it’s important to determine whether it’s a temporary setback or a more serious issue.
1. Sudden or Gradual Loss of Mobility
One of the most noticeable signs of decline is trouble with movement. If someone who was previously able to walk short distances or move their arms starts struggling again, that’s a red flag.
Warning signs:
- Increased difficulty walking, even with assistance
- Weakness or stiffness in arms or legs that had improved
- More frequent falls or loss of balance
- Difficulty standing up from a chair or getting into bed
Why it happens:
- Muscle weakness from lack of use (known as learned non-use)
- Secondary strokes or other brain damage
- A buildup of spasticity (muscle stiffness)
What to do:
If you notice a sudden loss of mobility, call a doctor immediately—it could be a sign of another stroke. If the decline is gradual, increasing physical therapy and movement exercises can help prevent further muscle loss.
2. Worsening Speech and Communication Issues
After an event like this, many individuals struggle with aphasia (difficulty speaking or understanding language). If communication was improving but starts to decline, it could be a sign of cognitive or neurological issues.
Warning signs:
- Trouble finding words more often than before
- Increased slurring or difficulty forming sentences
- Struggling to understand spoken or written language
- Not responding to questions or conversations like before
Why it happens:
- Another stroke or mini-stroke (transient ischemic attack, or TIA)
- Fatigue or stress affecting brain function
- Dementia or other cognitive decline
What to do:
- Keep practicing speech therapy exercises
- Engage in conversation regularly to keep the brain active
- If symptoms suddenly worsen, seek medical attention immediately
3. Increased Fatigue and Low Energy Levels
Many individuals in recovery often feel fatigued, but if exhaustion worsens instead of improving, it’s worth addressing.
Warning signs:
- Sleeping more than usual
- Feeling exhausted even after minor activities
- Lack of motivation to engage in therapy or social activities
Why it happens:
- Depression (which is common after a stroke)
- Poor circulation or low oxygen levels
- Heart problems or other medical conditions
What to do:
- Rule out medical issues like heart disease
- Encourage gentle exercise to boost energy
- Address mental health concerns like depression
4. Cognitive Decline and Memory Loss
Cognitive issues can develop after an event like this, and for some, they worsen over time. Related dementia is a real concern, making early detection crucial.
Warning signs:
- Forgetting names, appointments, or important details
- Difficulty following instructions or conversations
- Confusion in familiar places
- Struggling with problem-solving or decision-making
Why it happens:
- Another stroke affecting cognitive areas of the brain
- Progressive neurological diseases (like vascular dementia)
- Medication side effects
What to do:
- Get a neurological evaluation to rule out other conditions
- Engage in brain-stimulating activities (puzzles, reading, socializing)
- Ensure medications are not causing cognitive side effects
5. Mood Changes, Depression, and Anxiety
Emotional changes are common after such an event, but if someone becomes more withdrawn, irritable, or shows signs of depression, it could indicate a deeper issue.
Warning signs:
- Increased irritability or mood swings
- Loss of interest in hobbies or socializing
- Frequent sadness, hopelessness, or crying
- Anxiety about daily activities or fear of falling
Why it happens:
- Chemical imbalances in the brain after a stroke
- Frustration with physical or cognitive limitations
- Social isolation and lack of engagement
What to do:
- Seek mental health support (counseling or medication if needed)
- Encourage social interaction and hobbies
- Provide a supportive and positive environment
6. Trouble with Swallowing and Eating
Many survivors experience dysphagia (difficulty swallowing). If swallowing problems return or worsen, it could lead to serious complications like aspiration pneumonia.
Warning signs:
- Choking or coughing while eating or drinking
- Feeling like food is stuck in the throat
- Sudden weight loss or dehydration
- Avoiding meals due to swallowing difficulties
Why it happens:
- Weakening of throat muscles over time
- New or worsening brain damage
- Lack of proper swallowing therapy
What to do:
- Consult a speech therapist for a swallowing assessment
- Adjust diet to include easier-to-swallow foods
- Monitor for signs of pneumonia, such as fever or chest congestion
7. Changes in Bowel and Bladder Control
Urinary incontinence or constipation can sometimes come back after the event, causing discomfort and frustration.
Warning signs:
- More frequent accidents or urgency
- Difficulty emptying the bladder completely
- Increased constipation or diarrhea
Why it happens:
- Nerve damage affecting bladder/bowel control
- Side effects from medications
- Lack of mobility leading to weakened pelvic muscles
What to do:
- Schedule regular bathroom breaks
- Consider pelvic floor therapy
- Stay hydrated and maintain a high-fiber diet
When to Seek Medical Help
If you notice any of these signs of decline, don’t ignore them. Some setbacks can be managed with therapy and lifestyle adjustments, but others require urgent medical attention.
Call 911 or seek emergency care if:
- Symptoms come on suddenly (could be another stroke)
- There’s a significant loss of mobility or speech
- Confusion or memory loss gets worse rapidly
- Swallowing issues lead to choking or weight loss
For gradual decline, schedule a check-up with a doctor to rule out medical causes and adjust treatment plans.
Can a survivor experience personality changes over time?
Yes, personality changes can develop after an event like this, even months or years later. These shifts might include increased irritability, impulsiveness, aggression, or even apathy. This occurs because the brain may have sustained damage in areas responsible for emotional regulation and decision-making.
Why it happens:
- Damage to the frontal lobe, which controls personality and emotions
- Difficulty coping with physical or cognitive limitations
- Depression or anxiety after a stroke
What to do:
- Be patient and understanding—many survivors are frustrated by these changes too
- Encourage counseling or therapy to help with emotional regulation
- Work with a neurologist to determine if medications or brain stimulation therapy might help
Final Thoughts
Experiencing a decline doesn’t mean all hope is lost. Recognizing the warning signs early and taking action can make a big difference. Whether it’s physical therapy, cognitive exercises, or medical intervention, the right steps can help maintain and even improve quality of life.
If you or someone close to you is experiencing signs of decline, don’t wait—seek the support needed to stay on track and improve well-being.
