Thinking challenges


After stroke, some people will experience vascular cognitive impairment (VCI). VCI is a condition where damage to the blood vessels of the brain leads to injury of brain tissue. VCI may be caused by stroke, tiny clots that block small blood vessels in the brain, bleeding from small blood vessels in the brain, or blood vessel wall disease, resulting in a lack of oxygen and damage to brain cells. 

VCI can cause symptoms that range from mild forgetfulness to more serious challenges with awareness, thinking, attention, memory, language, and executive functions like problem solving. The most serious form of VCI is called vascular dementia (VaD). Vascular dementia can cause difficulty with everyday activities like getting dressed and bathing. Vascular dementia and Alzheimer’s disease can share some similar signs and symptoms, can exist separately or together, but they are not the same condition. 

Areas of cognition that can be affected by stroke

Attention: Being able to concentrate for the time needed. You become easily distracted when performing a task – like getting dressed or eating take longer.  

Tips and strategies

  • Find a quiet space when you are trying to do something.
  • Turn off all distractions, such as radio or TV.
  • Keep clutter to a minimum.
  • Take your time and do a task one step at a time.

Orientation: Being aware of time, place and who you are. You may think it is time for bed right after breakfast. You may not be able to tell someone how old you are. You may not get lost in familiar surroundings.

Tips and strategies

  • Keep a calendar and cross off the days as they go by.
  • List the times for your daily activities and check them off once you finish.
  • Try to establish a routine, doing the same thing at the same time of day.

Memory: Being able to recall and remember experiences, information and skills. Stroke can affect your ability to learn new things or remember old information to help you with everyday tasks. You may forget the names of commonly used things. Or you might forget the exercise instructions you get from your physiotherapist.

Tips and strategies

  • Writing down important information in a journal can be helpful.
  • Put signs and labels on things you keep forgetting or want to remember.
  • Store items in the same place every time you use them.
  • Try memorizing the words to songs or poems you like.
  • Use on-line memory games.
  • Repeat information that you want to remember.

Sequencing: Being able to arrange things or perform actions in the right order. It may be hard to get a task started or remember what the next step is. This can cause trouble with things like getting dressed — for instance, forgetting to put socks on before shoes.

Tips and strategies

  • Break down a task into very short, numbered steps.
  • Follow the steps every time you need to do the task.
  • Write the steps down and keep them where you can see them.

Problem solving: Recognizing a problem and finding a reasonable solution. You may not realize that you are having trouble putting toothpaste on your brush because you have forgotten to take the cap off. Solving this problem requires memory skills, sequencing skills and insight.

Tips and strategies

  • Break the problem into small parts.
  • Brainstorm possible solutions.
  • Get family and friends to help if needed.
  • Practice solving problems with word and number puzzles. 

Insight and judgment: Knowing what we can do and understanding our limits; making good choices based on our understanding. You may not understand that you have poor balance and should ask for help when getting up. You may try to get up on your own and risk falling.

Tips and strategies

  • Discuss safety concerns with your healthcare team.
  • Make your home environment as safe as possible.
  • Post reminders such as: "Don’t stand up without help" and "Put on your coat when you go outside".

Impulsivity: Acting quickly, without thinking things through. You may get up quickly without locking the brakes on your mobility aid.

Tips and strategies

  • Slow down and take your time.
  • Ask for clear, specific instructions.
  • Divide tasks into smaller steps and take one step at a time.
Where to get support

Occupational therapists can help you adapt tasks to your abilities and share more tips and strategies to make them easier.

Talk to your healthcare team and your family and friends about your thinking skills. Let them know if you think you are having difficulties.

Related information

Stroke Engine: Cognitive Rehabilitation

Social and peer support

Attention impairments after stroke (video)

Organizing, planning and processing after stroke (video)

Memory impairments after stroke (video)

To find useful services to help you on your stroke journey, see our services and resources listing.