Cognitive effects of brain injury Cognitive effects of brain injury are often not visible to others so can be difficult to recognise and understand.

The word ‘cognition’ refers to the mental processes that take place in our brains that allow us to think and learn. A brain injury can affect any of our cognitive skills, causing difficulties with our ability to think, learn and remember.

While some people can make a good recovery after brain injury, many have long-term cognitive effects, with effects such as memory problems being particularly common. Using things such as diaries, alarms, timers, organisers, and other such aids can help to deal with the cognitive effects of brain injury.

Living with the cognitive effects of brain injury can cause many people to feel like they are ‘living life in the slow lane’ and this can be upsetting or difficult to adjust to. Quality of life or sense of identity can be affected by the cognitive effects of brain injury. Speak to your GP, neurologist, or rehabilitation team about any cognitive effects of brain injury that you are struggling with, as they may be able to provide a referral to a specialist who can help, such as a clinical neuropsychologist.

Explore the sections below to find out more details about the cognitive effects of brain injury.

What are the cognitive effects of brain injury?

Click through the list below for information on some of the common cognitive effects of brain injury.

Difficulties with attention and concentration

Brain injury survivors may struggle with attending to information, especially when there are multiple distractions in the environment. For instance, they may struggle with focusing on a conversation they are having with someone if there is a lot of background noise.

Difficulties with making decisions

Being able to make decisions may be more difficult for a brain injury survivor. This may relate to simple decisions such as what to wear or have for dinner, or more complex matters such as decisions relating to finances. It may be difficult for the survivor to consider different options and possible outcomes, or to identify risks associated with decisions. Difficulties with making decisions can make some brain injury survivors quite vulnerable. There may be legal issues to consider if the person lacks capacity to make decisions in their own best interests.

Memory problems

There are many different types of memory, any of which can be affected by a brain injury. After brain injury, many people struggle with remembering day-to-day information such as conversations had, or appointments made – this is known as anterograde amnesia. Loss of memories from before the injury is known as retrograde amnesia, and can affect people’s ability to remember significant life events such as their wedding day or holidays.

Memory problems are one of the most common effects of brain injury because there are several different structures within the brain that are involved in this skill. It can also be one of the most problematic effects of brain injury for people to cope with.

Executive dysfunction

Executive function is a name for a collection of thinking skills that we use when solving problems, making decisions, planning, and completing tasks, and reflecting on our activity.

It involves skills such as planning, motivation, multi-tasking, flexible thinking, monitoring performance, memory, self-awareness, and detecting and correcting mistakes.

We rely on many of these executive function skills on a daily basis, such as cooking a meal, following a conversation, interacting with others, working, studying and planning our day, among other activities. When these skills are affected by brain injury, this is called executive dysfunction. Executive dysfunction can cause problems with aspects of day-to-day functioning, such as:

  • Starting or finishing tasks
  • Planning ahead
  • Making decisions
  • Thinking through problems and forming solutions
  • Using alternative solutions if needed
  • Behaving appropriately and controlling emotions such as anger
  • Interacting with others

As these effects are not visible, it is sometimes difficult for others to recognise or understand them. This can be upsetting, frustrating, or embarrassing for some brain injury survivors. On the other hand, some brain injury survivors may themselves be unaware of their executive dysfunction. Returning to work or education may be particularly difficult for survivors with executive dysfunction, as we rely on many of our executive function skills for working and studying, such as multi-tasking, organisation, and motivation. Struggling to prioritise, make decisions and complete tasks can also cause challenges.

As well as having difficulties with managing day-to-day life, brain injury survivors with executive dysfunction may find themselves in difficult situations. For example, they may encounter financial problems if they have impulsively spent more money than they ought to have, or they may accidentally get into trouble with the police.

Difficulties with processing information

Information may be difficult for brain injury survivors to focus on or process, which may cause them to take longer to answer questions or react to the environment. This can be particularly challenging if there are distractions such as lots of noise, bright lights, or crowds, for example in a supermarket.

Problems with feeling motivated

Brain injury can cause people to lose their sense of ‘get up and go’. They may struggle to begin tasks or finish tasks that have already been started. Other people may misinterpret this behaviour as ‘laziness’ without realising that it can be an effect of brain injury.

Problems with language

Difficulties with language or speech are known as aphasia. After a brain injury, there may be problems with ‘finding’ the right word or using language to communicate effectively. While this can be due to physical problems interfering with speech production, there can also be difficulties with the cognitive processes involved in word retrieval and language use.

Problems with reasoning

Being able to think information through, weigh up possible consequences and make decisions accordingly can be affected after brain injury. Survivors may be unable to account for their behaviour or explain the steps they have taken to come to a decision.

Problems with insight (self-awareness)

Brain injury can result in a range of changes. However, sometimes a brain injury survivor may be unaware that these changes have taken place, and they may not recognise or seem to deny them even if they are pointed out - this is referred to as ‘lacking insight’. Issues with insight can make brain injury survivors vulnerable as they may be unable to recognise situations that could put them at risk.

Mental capacity issues

Mental capacity refers to the ability to take information in, weigh it up, and make decisions for ourselves. After a brain injury, some of the core skills that being able to do this relies on (such as memory, decision making and information processing), may be affected so that a survivor lacks capacity to make decisions in their own best interests, possibly putting them in risky situations.

Where can I get help with the cognitive effects of brain injury?

It is a good idea to start by speaking to your GP about any issues you are having as they may be able to refer you to an appropriate service or professional that can help. If you are under the care of a neurologist or rehabilitation team, they may be able to help with managing some of the cognitive effects of brain injury.

Clinical neuropsychologists and clinical psychologists with experience in brain injury can often help with the cognitive effects of brain injury. They will often begin by interviewing brain injury survivors and their families to get an understanding of what issues the survivor is experiencing. They may then complete specialist tests known as neuropsychological tests or assessments to assess areas of cognitive impairment. Coping strategies, cognitive techniques and lifestyle changes can be recommended to help cope with the cognitive effects of brain injury.

Other professionals with experience in brain injury may also be able to help you cope with the cognitive effects of brain injury.

Living with any of the effects of brain injury can cause a range of emotions. Feelings such as frustration, sadness and worry are all normal emotional reactions to the changes that living life with a brain injury can bring. Professionals such as clinical psychologists, clinical neuropsychologists, or counsellors with experience in brain injury can help with managing the emotions related to living with the effects of brain injury.

How do I cope with the cognitive effects of brain injury?

Coping with the cognitive effects of brain injury will depend on the types of effects you have. For some types of cognitive effects, using aids such as diaries, organisers, calendars, alarm clocks etc can help.

There may be techniques that professionals can recommend and help you work through to redevelop cognitive skills.

It is a good idea to start by speaking to your GP about any issues you are having as they may be able to refer you to an appropriate service that can help.

Our series of publications cover many of the effects of brain injury and can offer detailed information on coping tips. For more information, visit the Information Library.

It can help to cope with the changes of living life with a brain injury if you feel well supported by friends and family. Share information from Headway with your loved ones to help them with understanding the effects of brain injury and how best to support you.

Remember you can get support for living with the effects of brain injury in the following ways:

When will I recover from the cognitive effects of brain injury?

The cognitive effects of brain injury may not be as obvious in the early days of injury and may be more apparent once the brain injury survivor has returned home or attempted a return to work. They may therefore take longer to understand and adjust to than some of the other effects of brain injury.

While cognitive rehabilitation can sometimes help, cognitive effects can last for weeks, months, or even years, or be lifelong and may require adaptations or equipment to cope.

No two experiences of brain injury are the same, so there are no rules about when you will recover from the cognitive effects of brain injury. Receiving support from suitably qualified professionals can help with the recovery process while using adaptive aids and learning new ways of coping can help to readjust.

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