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Journal of Neurology, Neurosurgery, and Psychiatry logoLink to Journal of Neurology, Neurosurgery, and Psychiatry
. 2004 Dec;75(12):1708–1713. doi: 10.1136/jnnp.2004.037887

Personality change after stroke: some preliminary observations

J Stone 1, E Townend 1, J Kwan 1, K Haga 1, M Dennis 1, M Sharpe 1
PMCID: PMC1738868  PMID: 15548488

Abstract

Objectives: To describe changes in personality after stroke and effects on carers.

Methods: A consecutive series of patients was recruited from hospital admissions with stroke. A novel questionnaire was administered to the patients' main carer at nine months after the stroke to determine their perception of the patients' pre-stroke and post-stroke personality. Personality change was identified by changes in these ratings, and associations between personality change and the following variables explored: emotional disorder in patients and carers (measured using the hospital anxiety and depression scale and a structured psychiatric interview), stroke classification (Oxford community stroke classification), residual disability (Barthel index and Nottingham extended activities of daily living scale), and lesion characteristics on computed tomography (CT).

Results: Carers of 35 patients with stroke took part. Reported changes in personality after stroke included: reduced patience and increased frustration (both p<0.0001, t test of difference), reduced confidence, more dissatisfaction, and a less easy going nature (all p<0.005). Occasionally, aspects of personality change were seen as positive by carers. There were relations between greater personality change and interviewer rated patient depression or anxiety (p<0.001) but not when this was self rated; and between personality change and both emotional disorder in carers (p<0.005) and greater disability (p<0.01) but not CT lesion characteristics.

Conclusions: Carers commonly perceive personality change in stroke patients. This is associated with self rated emotional distress in the carer. More research is needed to understand what carers mean by "personality change" and what factors contribute to the perceived change.

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Selected References

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  1. Aben Ivo, Denollet Johan, Lousberg Richel, Verhey Frans, Wojciechowski Franz, Honig Adriaan. Personality and vulnerability to depression in stroke patients: a 1-year prospective follow-up study. Stroke. 2002 Oct;33(10):2391–2395. doi: 10.1161/01.str.0000029826.41672.2e. [DOI] [PubMed] [Google Scholar]
  2. Anderson C. S., Linto J., Stewart-Wynne E. G. A population-based assessment of the impact and burden of caregiving for long-term stroke survivors. Stroke. 1995 May;26(5):843–849. doi: 10.1161/01.str.26.5.843. [DOI] [PubMed] [Google Scholar]
  3. Bamford J., Sandercock P., Dennis M., Burn J., Warlow C. Classification and natural history of clinically identifiable subtypes of cerebral infarction. Lancet. 1991 Jun 22;337(8756):1521–1526. doi: 10.1016/0140-6736(91)93206-o. [DOI] [PubMed] [Google Scholar]
  4. Bjelland Ingvar, Dahl Alv A., Haug Tone Tangen, Neckelmann Dag. The validity of the Hospital Anxiety and Depression Scale. An updated literature review. J Psychosom Res. 2002 Feb;52(2):69–77. doi: 10.1016/s0022-3999(01)00296-3. [DOI] [PubMed] [Google Scholar]
  5. Bogousslavsky J. William Feinberg lecture 2002: emotions, mood, and behavior after stroke. Stroke. 2003 Mar 20;34(4):1046–1050. doi: 10.1161/01.STR.0000061887.33505.B9. [DOI] [PubMed] [Google Scholar]
  6. Brooks D. N., McKinlay W. Personality and behavioural change after severe blunt head injury--a relative's view. J Neurol Neurosurg Psychiatry. 1983 Apr;46(4):336–344. doi: 10.1136/jnnp.46.4.336. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Brott T., Adams H. P., Jr, Olinger C. P., Marler J. R., Barsan W. G., Biller J., Spilker J., Holleran R., Eberle R., Hertzberg V. Measurements of acute cerebral infarction: a clinical examination scale. Stroke. 1989 Jul;20(7):864–870. doi: 10.1161/01.str.20.7.864. [DOI] [PubMed] [Google Scholar]
  8. Bugge C., Alexander H., Hagen S. Stroke patients' informal caregivers. Patient, caregiver, and service factors that affect caregiver strain. Stroke. 1999 Aug;30(8):1517–1523. doi: 10.1161/01.str.30.8.1517. [DOI] [PubMed] [Google Scholar]
  9. Carnwath T. C., Johnson D. A. Psychiatric morbidity among spouses of patients with stroke. Br Med J (Clin Res Ed) 1987 Feb 14;294(6569):409–411. doi: 10.1136/bmj.294.6569.409. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Carson A. J., Ringbauer B., MacKenzie L., Warlow C., Sharpe M. Neurological disease, emotional disorder, and disability: they are related: a study of 300 consecutive new referrals to a neurology outpatient department. J Neurol Neurosurg Psychiatry. 2000 Feb;68(2):202–206. doi: 10.1136/jnnp.68.2.202. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Dawson D. V., Welsh-Bohmer K. A., Siegler I. C. Premorbid personality predicts level of rated personality change in patients with Alzheimer disease. Alzheimer Dis Assoc Disord. 2000 Jan-Mar;14(1):11–19. doi: 10.1097/00002093-200001000-00002. [DOI] [PubMed] [Google Scholar]
  12. Dennis M., O'Rourke S., Lewis S., Sharpe M., Warlow C. A quantitative study of the emotional outcome of people caring for stroke survivors. Stroke. 1998 Sep;29(9):1867–1872. doi: 10.1161/01.str.29.9.1867. [DOI] [PubMed] [Google Scholar]
  13. Draper B. M., Poulos C. J., Cole A. M., Poulos R. G., Ehrlich F. A comparison of caregivers for elderly stroke and dementia victims. J Am Geriatr Soc. 1992 Sep;40(9):896–901. doi: 10.1111/j.1532-5415.1992.tb01986.x. [DOI] [PubMed] [Google Scholar]
  14. Ellis-Hill C. S., Horn S. Change in identity and self-concept: a new theoretical approach to recovery following a stroke. Clin Rehabil. 2000 Jun;14(3):279–287. doi: 10.1191/026921500671231410. [DOI] [PubMed] [Google Scholar]
  15. Farmer Anne, Redman Kate, Harris Tanya, Mahmood Arshad, Sadler Stephanie, Pickering Andrea, McGuffin Peter. Neuroticism, extraversion, life events and depression. The Cardiff Depression Study. Br J Psychiatry. 2002 Aug;181:118–122. doi: 10.1017/s0007125000161823. [DOI] [PubMed] [Google Scholar]
  16. Forsberg-Wärleby G., Möller A., Blomstrand C. Spouses of first-ever stroke patients: psychological well-being in the first phase after stroke. Stroke. 2001 Jul;32(7):1646–1651. doi: 10.1161/01.str.32.7.1646. [DOI] [PubMed] [Google Scholar]
  17. Han B., Haley W. E. Family caregiving for patients with stroke. Review and analysis. Stroke. 1999 Jul;30(7):1478–1485. doi: 10.1161/01.str.30.7.1478. [DOI] [PubMed] [Google Scholar]
  18. Hodkinson H. M. Evaluation of a mental test score for assessment of mental impairment in the elderly. Age Ageing. 1972 Nov;1(4):233–238. doi: 10.1093/ageing/1.4.233. [DOI] [PubMed] [Google Scholar]
  19. House A., Dennis M., Molyneux A., Warlow C., Hawton K. Emotionalism after stroke. BMJ. 1989 Apr 15;298(6679):991–994. doi: 10.1136/bmj.298.6679.991. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Johnson G. A. Research into psychiatric disorder after stroke: the need for further studies. Aust N Z J Psychiatry. 1991 Sep;25(3):358–370. doi: 10.3109/00048679109062637. [DOI] [PubMed] [Google Scholar]
  21. Jones A. L., Charlesworth J. F., Hendra T. J. Patient mood and carer strain during stroke rehabilitation in the community following early hospital discharge. Disabil Rehabil. 2000 Jul 20;22(11):490–494. doi: 10.1080/096382800413970. [DOI] [PubMed] [Google Scholar]
  22. Kim J. S., Choi S., Kwon S. U., Seo Y. S. Inability to control anger or aggression after stroke. Neurology. 2002 Apr 9;58(7):1106–1108. doi: 10.1212/wnl.58.7.1106. [DOI] [PubMed] [Google Scholar]
  23. Kitze K., von Cramon D. Y., Wilz G. Psychische Belastungen bei Angehörigen von Schlaganfallpatienten. Rehabilitation (Stuttg) 2002 Dec;41(6):401–406. doi: 10.1055/s-2002-36283. [DOI] [PubMed] [Google Scholar]
  24. Kotila M., Numminen H., Waltimo O., Kaste M. Depression after stroke: results of the FINNSTROKE Study. Stroke. 1998 Feb;29(2):368–372. doi: 10.1161/01.str.29.2.368. [DOI] [PubMed] [Google Scholar]
  25. MAHONEY F. I., BARTHEL D. W. FUNCTIONAL EVALUATION: THE BARTHEL INDEX. Md State Med J. 1965 Feb;14:61–65. [PubMed] [Google Scholar]
  26. Martin Claudine, Dellatolas Georges, Viguier Delphine, Willadino-Braga Lucia, Deloche Gerard. Subjective experience after stroke. Appl Neuropsychol. 2002;9(3):148–158. doi: 10.1207/S15324826AN0903_3. [DOI] [PubMed] [Google Scholar]
  27. Paradiso S., Robinson R. G., Arndt S. Self-reported aggressive behavior in patients with stroke. J Nerv Ment Dis. 1996 Dec;184(12):746–753. doi: 10.1097/00005053-199612000-00005. [DOI] [PubMed] [Google Scholar]
  28. Schulz R., Tompkins C. A., Rau M. T. A longitudinal study of the psychosocial impact of stroke on primary support persons. Psychol Aging. 1988 Jun;3(2):131–141. doi: 10.1037//0882-7974.3.2.131. [DOI] [PubMed] [Google Scholar]
  29. Storey P. B. Brain damage and personality change after subarachnoid haemorrhage. Br J Psychiatry. 1970 Aug;117(537):129–142. [PubMed] [Google Scholar]
  30. Thommessen B., Wyller T. B., Bautz-Holter E., Laake K. Acute phase predictors of subsequent psychosocial burden in carers of elderly stroke patients. Cerebrovasc Dis. 2001;11(3):201–206. doi: 10.1159/000047639. [DOI] [PubMed] [Google Scholar]
  31. Thompson S. C., Sobolew-Shubin A., Graham M. A., Janigian A. S. Psychosocial adjustment following a stroke. Soc Sci Med. 1989;28(3):239–247. doi: 10.1016/0277-9536(89)90267-0. [DOI] [PubMed] [Google Scholar]
  32. Tyerman A., Humphrey M. Changes in self-concept following severe head injury. Int J Rehabil Res. 1984 Mar;7(1):11–23. doi: 10.1097/00004356-198403000-00002. [DOI] [PubMed] [Google Scholar]
  33. Wade D. T., Legh-Smith J., Hewer R. L. Effects of living with and looking after survivors of a stroke. Br Med J (Clin Res Ed) 1986 Aug 16;293(6544):418–420. doi: 10.1136/bmj.293.6544.418. [DOI] [PMC free article] [PubMed] [Google Scholar]
  34. Zigmond A. S., Snaith R. P. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983 Jun;67(6):361–370. doi: 10.1111/j.1600-0447.1983.tb09716.x. [DOI] [PubMed] [Google Scholar]

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