What are the long term effects of a stroke?

A stroke occurs when the blood supply to part of the brain is interrupted or reduced, causing brain cells to die from lack of oxygen. This can result in damage to the areas of the brain that control muscle movement, speech, memory, and more. The long-term effects of a stroke depend on the location and severity of the brain injury.

Table of Contents

What are the most common long-term effects of stroke?

Some of the most common long-term effects of stroke include:

Paralysis or weakness on one side of the body (hemiparesis) – This affects over 50% of stroke survivors and can range from mild clumsiness to complete paralysis on one side.
Difficulty with movement and coordination (ataxia) – Stroke survivors may have problems with balance, coordination, vertigo and unsteadiness.
Pain, numbness or strange sensations – Nerve damage from the stroke can cause ongoing pain, numbness, tingling or increased sensitivity.

Fatigue – Mental and physical fatigue are common after a stroke, and this lack of energy may persist.
Memory loss and thinking difficulties – Strokes affecting the brain’s memory centers can cause memory deficits. Many survivors experience problems with thinking, concentration, judgment, and problem solving.
Emotional problems – Conditions like depression, anxiety and emotional volatility are common after a stroke.

Swallowing difficulties (dysphagia) – This affects around 50% of patients and can make it difficult to swallow safely.
Communication problems (aphasia) – Stroke can affect areas involved in speech and language, making communication difficult.
Bladder and bowel issues – Incontinence is common, as strokes can damage the part of the brain that controls bladder and bowel function.

The type and severity of long-term effects depends on the location and extent of brain damage from the stroke. The brain controls so many facets of human function that almost any area damaged can lead to deficits.

What factors influence the long-term prognosis after stroke?

Some key factors that influence long-term prognosis following a stroke include:

Size of stroke – Larger strokes typically cause more extensive brain damage and more severe, persistent deficits.

Location of stroke – Brain areas affected and their functions impact deficits. Strokes in the brain stem, for example, are more likely to lead to death.
Type of stroke – Ischemic strokes tend to cause more focal damage, while hemorrhagic strokes cause more widespread effects.
Age – Younger people’s brains tend to recover better due to neuroplasticity.

Other medical conditions – Co-existing conditions like heart disease, diabetes, high cholesterol complicate recovery.
Rehabilitation – Early, intense therapy can help recovery and minimize long-term deficits.
Social support – Support from family and community aids coping and recovery.

Understanding the specifics of an individual’s stroke will help doctors estimate their prognosis and likely long-term outcome.

What are the long-term effects on motor function?

Stroke often leads to long-term issues with movement and motor function, including:

Paralysis – If stroke damages the motor cortex or the pathway to the muscles, it can cause paralysis or weakness on one side of the body.

Spasticity – Muscle spasms and stiff, tightly clenched muscles are common, making movement difficult.
Ataxia – Damage to coordination areas causes lack of balance and control over voluntary movements.
Tremor – Shaking or tremors in the hands and arms can occur.

Dysarthria – Motor speech problems make communication difficult.
Apraxia – Difficulty executing learned movements despite having motor function.

Physical and occupational therapy can help stroke survivors relearn motor skills and regain strength and coordination. However, deficits often persist long-term.

Arm and hand function

Over 50% of stroke survivors have persistent weakness or paralysis on one side of their body after stroke. This often impairs arm and hand function.

Poor arm and hand strength makes activities like dressing, writing, lifting objects difficult.
Loss of fine motor control makes tasks that require dexterity like buttoning shirts or tying shoes challenging.

Shoulder pain and frozen shoulder are common and can limit mobility.
Sensory loss in the arm and hand can cause problems with gripping objects.

Walking ability

Walking impairment is common after stroke.

Weakness or paralysis on one side leads to hemiplegic gait patterns.
Balance and coordination deficits make walking difficult.
Stooped, slow walking with short strides is typical.

Assistive devices like canes, walkers or braces may be required for safety.
Many survivors will regain walking ability with rehabilitation but it may remain slower and more unsteady.

What are the long-term cognitive effects?

In addition to motor effects, stroke often causes persistent cognitive deficits including:

Memory loss – Both short-term and long-term memory are often impaired after stroke.
Attention deficits – Reduced ability to concentrate and focus.
Slower information processing – Taking longer to understand and respond to information.

Executive dysfunction – Difficulties planning, reasoning, decision making, multitasking.
Aphasia – Inability to understand/express language if language centers damaged.
Apraxia – Impaired ability to complete familiar tasks.

Neglect – Reduced awareness of surroundings on one side.

Cognitive rehabilitation can help reduce deficits through remapping functions and compensatory strategy training. But these stroke effects often persist to some degree, interfering with work, activities of daily living, social interaction and quality of life.

Vision and perception

Strokes affecting the visual cortex or pathways to the brain can cause vision problems including:

Blurred vision or visual field cuts.
Double vision or inability to control eye movements.
Impaired depth perception, color vision and object recognition.

Inability to perceive one side of space (visual neglect).

Spatial awareness and neglect

Stroke survivors may experience one-sided neglect affecting their spatial awareness.

They may ignore or not respond to stimuli on one side of their body or environment.

For example, not eating food on one side of their plate or failing to dress one side of their body.
This stems from damage to the hemisphere opposite the neglected side.
Neglect increases risks of injury such as falls on the affected side.

What are the long-term effects on mood and personality?

Stroke can have profound effects on psychological health including:

Depression – Around 1/3 of survivors experience post-stroke depression, due to brain changes and coping with deficits.
Anxiety – Many survivors develop anxiety after a stroke.

Emotional lability – Fluctuations in emotions that are hard to control.
Personality changes – Strokes affecting the frontal lobe can inhibit judgment and emotional control.
Fatigue and apathy – Lack of energy and difficulty initiating activities.

Pain – Chronic pain after stroke increases risk of depression.
Self-esteem issues – Coping with disability can affect self-worth.

These effects may require medication, psychological therapy, and support groups for optimal recovery. But even with treatment, survivors may continue experiencing effects like sadness, anxiety, anger outbursts and fatigue.

What are the long-term effects on daily activities?

The physical, cognitive and psychological deficits caused by stroke can profoundly impact daily functioning and independence with activities like:

Self-care – Bathing, grooming, dressing, using the toilet can be impaired by weakness, coordination problems and memory loss.
Mobility – Walking, transferring to a chair, navigating stairs safely.

Homemaking – Cooking, cleaning, laundry, yardwork become more challenging.
Communication – Expressive and receptive language deficits affect conversing with others.
Shopping and finances – Math abilities, vision, planning may be compromised.

Driving – Most survivors do not regain the physical and cognitive skills needed to drive safely.
Work – Memory, fatigue, mobility issues affect ability to return to work, especially in jobs with high demands.
Leisure – Hobbies like sports, reading and social activities require adaptations.

Occupational therapy helps stroke survivors relearn daily living skills, use assistive devices and modify activities. This promotes greater independence long-term, though ongoing help from caregivers is often still needed.

What are the long-term effects on relationships and social life?

The effects of stroke can strain relationships with family, friends and caregivers due to:

Role changes – Spouses may need to take on more responsibility if their partner is disabled, affecting relationship dynamics.

Communication deficits – Aphasia can hinder conversations with loved ones.
Personality changes – Irritability, passivity, lack of interest can strain relationships.
Depression – Social withdrawal, loss of interest in activities can affect relationships.

Dependency – Needing more care from family members can be difficult for stroke survivors and caregivers.
Fatigue and mobility issues – Making it harder to participate in social occasions and enjoy shared interests.

Counseling and community services to give caregivers respite can help families adjust. Peer support groups also allow stroke survivors to connect with others facing similar challenges.

What are the long-term effects on returning to work?

Returning to work after stroke poses challenges due to:

Physical deficits – Weakness, coordination problems, fatigue limit capabilities.
Cognitive impairments – Memory, concentration issues affect performance.

Driving restrictions – Inability to drive to work if driving is unsafe.
Emotional issues – Depression, self-esteem problems interfere with motivation and working effectively.
Accommodation needs – Workplaces may need adjustments for disability: modified duties, part-time hours, assistive technology.

According to studies, only around 40% of working-age stroke survivors return to work. Those who do return take a median of 6 months to do so. The most successful return is for white-collar workers without severe disabilities. Heavy manual labor, service jobs and intellectually demanding fields are most challenging after stroke.

What are the long-term secondary complications of stroke?

Some common long-term health issues that can develop after stroke include:

Chronic pain – Especially shoulder pain, occurs in up to 1/3 of survivors due to spasticity and injury from falls.

Seizures – Stroke increases seizure risk from scar tissue or brain aneurysms.
Blood clots – Being immobile raises risks of potentially fatal clots.
Skin injury – Pressure sores from lack of movement require prevention.

Malnutrition – Trouble swallowing and poor appetite can cause malnutrition.
Infections – Pneumonia, urinary tract infections are more common after stroke.
Falls and fractures – Weakness, vision issues and poor balance increase risks.

Ongoing medical care including medication, therapy, diet modifications and assistive equipment helps prevent and manage these potential complications.

What is the long-term outlook for stroke disability and recovery?

The degree of long-term disability depends on the severity and location of the stroke. But general patterns include:

About 40% of survivors recover with only minor impairments.

15% recover almost completely or with minimal deficits.
25% have moderate to severe impairments requiring special care.
10% require care in a nursing home or long-term facility.

10% die shortly after stroke.

Overall, around 2/3 of stroke survivors have some residual disability. Complete recovery is rare. Maximum recovery tends to occur within the first year but more modest gains can continue for years with ongoing therapy. Supportive care and rehabilitation greatly aid functional recovery and quality of life.

What are the key takeaways on long-term stroke effects and prognosis?

Stroke can cause persistent motor, sensory, cognitive, visual, emotional and communication deficits.

Common effects include paralysis, pain, memory loss, depression, difficulty walking, self-care activities and returning to work.
Severity depends on size, location, type of stroke and age, along with access to rehabilitation.
Ongoing medical care and therapy can enhance recovery but some level of lasting disability is common.

Support from family and peers aids coping with these deficits.
The most significant effects tend to occur in the first year but recovery can continue for years with rehabilitation.

While stroke leads to lifelong changes, with proper treatment and support many people can adapt and regain a good quality of life. Being aware of the potential long-term effects allows survivors to seek appropriate help and work on new skills to maximize their capabilities.

Type of Deficit	Common Long-Term Effects
Motor	Paralysis, muscle weakness, coordination and balance problems, spasticity, dysarthria
Cognitive	Memory loss, attention deficits, aphasia, apraxia, slower information processing
Visual	Blurred or lost vision, visual field cuts, double vision, depth perception problems
Mood	Depression, anxiety, emotional lability, personality changes, apathy, pain, lowered self-esteem
Daily Living Skills	Impaired self-care, mobility, communication, homemaking, work capacity, driving, leisure participation

Conclusion

Stroke can lead to a wide array of long-term deficits that profoundly impact survivors. However, recovery is still possible, especially with early rehabilitation and support. Being informed allows survivors to access the full range of treatment options to adapt and work towards regaining function. With time, perseverance and appropriate help, quality of life can be improved even when disabilities persist. While the road to recovery after stroke is challenging, many people find they can still live fulfilling and independent lives.