Cognitive Remediation After a Stroke

Many patients recovering from a stroke experience some degree of emotional difficulties and/or cognitive changes. A therapy called cognitive remediation — also known as cognitive rehab or cognitive rehabilitation — can help.

Cognitive dysfunction is a frequent complication of a stroke. A stroke may cause physical changes to brain tissue and can lead to diffuse cognitive deficits, including problems with attention, memory, executive functioning, and information processing.  

Executive functioning problems include difficulty with executing “everyday actions,” such as carrying out a sequence of actions, planning a task, beginning a task, knowing when one has completed a task, or even becoming “lost” while in the middle of a task.  Executive functioning problems are highly related to problems carrying out everyday activities.

A stroke also affects mood and emotions, and this is not simply a reaction to a life-threatening event. The area of the brain in which a stroke occurs determines what functions are affected, which could be not only speech, motor control, or cognition, but even emotions. For example, damage to the left temporal lobe is associated with low mood, but damage on the right side can produce manic reactions. Damage in the frontal lobe will often modify emotional processing and behavior.

Cognitive remediation combined with cognitive behavioral therapy is a valuable treatment to help a patient overcome all of these difficulties. Cognitive remediation treatment can teach long-lasting skills that help restore everyday functioning and optimize quality of life.  Research has demonstrated that cognitive remediation interventions that incorporated elements of memory, information processing, and attention led to significant improvements in a number of cognitive areas.

The good news is that everyone, even after a stroke, has intact cognitive abilities and strengths. Cognitive remediation therapy teaches a patient to use those existing abilities to compensate for deficits in other areas. Cognitive remediation in combination with cognitive behavioral therapy incorporates all domains of functioning: emotional, behavioral, and cognitive.

Cognitive rehabilitation is based on the principle of experience-dependent neuroplasticity, meaning that the human brain is not a static organ but can be physically changed when exposed to challenges or exercises. These changes can occur within neural pathways and synapses after exposure to enriched environments. Cognitive remediation provides such an enriched environment.

What is cognitive remediation/cognitive rehabilitation?

• Cognitive remediation teaches compensatory strategies, such as using a memory notebook or daily planner, as well as using task analysis (the process of breaking down tasks into logically sequenced steps in order to better carry out important activities of daily living.  The central goal is to  apply these strategies to everyday life after brain tumor surgery. 
• Cognitive remediation incorporates attention-enhancing exercises that require a variety of neural networks. These attention exercises engage both visual and auditory skills, both of which are essential to many everyday tasks.  Attention and information-processing exercises are designed to enhance information retention and recall, contributing to improvements in memory. 
•  Attention, memory, and executive functions are interdependent, and impairments in these areas profoundly impact daily functioning.  Therefore, exercises that increase capacity for attention, working memory, and short-term memory will increase overall mental capacity.  Such exercises also increase an individual’s awareness of the mental effort required to process information. 
• Cognitive remediation is integrated with components of cognitive behavioral psychotherapy to help patients process and understand the emotional effects of a stroke. The neuropsychologist will help the patient identify negative thought patterns and teach the elements of thought modification and relaxation techniques.
• Cognitive remediation is a collaborative treatment in which the individual and provider set goals and then customize treatment in order to reach these goals.

Behavioral, emotional, and cognitive changes after a stroke can be stressful, but with quality rehabilitation a patient can achieve excellent results and a good quality of life.

The Weill Cornell Medicine neuropsychology service within Neurological Surgery is pleased to offer several services to assist patients after an intracerebral hemorrhage, including a comprehensive Cognitive Remediation Program that focuses on improving working memory, attention, and focus. The five-week program includes personal consultation and weekly tailored treatment using principles of cognitive remediation and cognitive behavioral therap, designed to improve performance in a wide range of cognitive tasks. Find out more about the Cognitive Remediation Program.