What cognitive symptoms can occur after an acquired brain injury (ABI)?
Due to the large number of potential causes of ABI, the symptoms vary from person to person depending on the location and extent of injury to the brain, and several other factors that can affect recovery. Cognitive changes can be widespread and severe across many thinking abilities or specific and mild. Some cognitive symptoms are also more common than others due to the vulnerability of their supporting brain networks, for instance proximity to bony structures, blood vessels or sensitivity to oxygen deprivation.
Memory difficulties are the most common cognitive symptoms following an ABI. Memory changes can range from a greater frequency in misplacing important items, like keys, wallet and glasses or in forgetting the details of conversations, to severe memory impairment such as forgetting entire conversations, recent events or what happened a few minutes ago. Executive functions, also often affected by ABI, are made up of a diverse set of cognitive abilities including reasoning, mental flexibility, organization, problem solving, multi-tasking, prioritizing, planning, sustaining attention, goal attainment, as well as motivation, impulse-control (not doing or saying the first thing that comes to mind), judgment, social appropriateness, self-awareness and empathy. Other potential cognitive challenges can include slowed mental speed, difficulties interpreting visual information, and speaking or understanding language. Cognitive challenges further interact, such that difficulties in one area (e.g., organization) can create challenges in other areas (e.g., learning and recalling new information, planning, goal attainment).
What psychological conditions can occur after an ABI?
An ABI is a major life event. It is normal to feel sad, down, angry, anxious and/or worried about what happened to you and what it means for your future. Adjusting to the changes you are experiencing as well as future uncertainties can be difficult to cope with. Many people describe their lives as “who I was before ABI” and “who I am after ABI”. The change to self-image, which may be due to changed employment status, physical abilities, and family and social roles, can be significant and have a negative effect on self-esteem. Many people benefit from supportive therapy to process these changes, the loss of their old life and to develop a new sense of identity and purpose.
Psychological disorders are common following an ABI. The most common conditions include depression, anxiety and anger. Often when psychological conditions are diagnosed, there is a pre-existing history of issues or risk factors (such as family history), but this is not always the case. Damage to certain brain structures resulting from ABI can also reduce emotional control which can exacerbate anxiety, anger and the ability to cope with day-to-day stressors. People who have experienced an episode of depression before ABI are at a greater risk following ABI of becoming depressed. Other risk factor for depression often experienced by individuals following ABI include reduced social contact, sense of purpose, meaning and engagement in activities they once enjoyed. Depending on how the ABI happened, a subset of people go on to develop post-traumatic stress disorder. Fortunately, cognitive behavioural therapy approaches have proven effectiveness with the above psychological conditions. As people with ABI may also have cognitive symptoms that interfere with traditional therapy administration (e.g., changes in memory, attention span), in many cases we may be able to adapt therapy to enhance treatment benefit.
Will I make a full recovery?
This is one of the most common questions asked following an ABI and one of the most difficult questions to answer, which can be very frustrating in planning your future. Many factors influence recovery. These can include the location and extent of brain injury, complications, the responsible medical condition(s) causing cognitive and/or emotional symptoms, the severity and nature of symptoms early on in recovery, age, intelligence and educational attainment, motivation, family and social support, availability of comprehensive brain injury rehabilitation, psychological health, continued mental and physical activity, alcohol or drug use, sleep and nutrition.
Will I be able to return to work after an ABI?
The type of injury, resulting symptoms, degree of recovery, in combination with your motivation, the nature of your job, flexibility at work and support of your employer can determine whether returning to work will be successful. Being aware of your challenges and learning strategies to effectively compensate, can also determine whether you will sink or swim at work.