Thinking challenges

 Cognitive (thinking) problems

Areas of cognition that can be affected by stroke

1. Attention: Being able to concentrate on one thing for the time needed.

Example: 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.

2. Orientation: Being aware of time, place and who you are.

Example: You may think it is time for lunch soon after breakfast.

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.

3. Memory: Being able to remember personal experience, information and skills. Stroke can affect your ability to learn new things or remember old information to help you with everyday tasks. 

Examples: You may forget the names of ordinary 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.
  • Read anything that interests you.

4. Sequencing: Being able to arrange things or perform actions in the right order.

Examples: 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.

5. Problem solving: Figuring out how to solve a problem takes many parts of cognition.

Example: 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. 

6. Insight and judgment: Knowing what we can do and understanding our limits; making good choices based on our understanding.

Examples: 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

  • Post reminders such as:
    • Don’t stand up without help.
    • Put on your coat when you go outside.
Where to get support:

Occupational therapists can help you adapt tasks to your abilities.

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