GRADUAL behavior changes after stroke?

[the_quest]

My mother had a stroke about three months ago (blood cloth coming from the heart) at the young age of 56 and since this moment she had some changes in her behavior. Some of these changes were immediate, like being very impulsive and pushy, being hyperactive and talking slowly. Also, she began to spend more money than usual from these moment, mostly on things she did not plan to buy in advance. I know these are common effects of a stroke, but in my mother's case it's not completely sure whether they really are caused by the stroke.

Before the stroke she was having her second big depression. After a while, she was sleeping almost the whole day, being very passive in general, just like in her first depression. And then she developed sleeping problems, which, of course, made it all worse. She restarted taking antidepressants on advice of her psychiatrist. Three days before her stroke, as a coincidence, her depression seemed to be over. She was again getting more active, more focused and she slept less.

The first weeks after the stroke, her behavior seemed quite normal and the behavior changes described above were considered to be rather small. She still was able to think clearly, nevertheless this thinking was obviously much slower than before. The neurologist of the hospital even said she was able to drive a car again (other doctors disagreed though).

Now, three months after her stroke, she is taken into a mental institution. Her behavior has changed gradually during these past three months. Slowly, she became more aggressive, telling my father he did not care about her anymore, calling my sister an ego-tripper,... things she would never do before. She developed serious compulsive hoarding: in order to "structure all her papers and books" (in the middle of the night btw), she puts them all around the house, on the sofa, on the bed,... Also, she began cutting out letters on milk boxes and brings them one by one to the neighbors, to show how they make together the name of their grand-son. Every day she bought more and more stuff she does not need and which fill the house even more. Not difficult to understand my father is getting crazy as well in this situation. She became more demanding every day, telling that it all about her now and everything has to be done the way she wants. Not only she commands my father and sister all the time that they have to go to a shop for her, she also commands the neighbors now. And, what worries me even more, last week, she was getting out the house in her pyjamas, ran on the street and stopped some cars there for unknown reason. She is not aware anymore of all she does, as she can not remember those things.

And now comes the really weird thing: I recognize most of all those actions and behavior, as they were already there BEFORE her stroke, after her first depression. However, of course, to a much smaller degree. After her first depression, she also became impulsive, pushy, slow, confused and began forgetting things. She is diagnosed recently with bipolar disorder, something we expected her to have already for a long time. For her father also had this bipolar disorder and my mother began more and more to behave like him.

Therefore, I came to the following questions:
- Is it common that people after a stroke change their behavior in such a gradual way? In all stories I read about strokes, most behavior changes are sudden at the moment of the stroke, not thereafter.
- Could this be multiple-infarct dementia?
- And what looks the most likely: that this gradual change in behavior is due to one stroke only or due to her bipolar disorder?

Any reactions will be greatly appreciated.

[the_quest]

Thank you for your reply. It is good to know my theory seems to be correct, for it means that we can actually do something about it.

The mental institution she is taken into is in fact part of a hospital. Therefore it should not be a problem to find a neuropsychiatrist there. I wonder what they will find.

Best regards and thanks once more!

[Dr. Kokil Mathur]

Hi
Welcome to the MedHelp forum!
Well, yes, generally the behavior changes following a stroke are immediate except in case of multiple strokes or multiple infarcts. This can only be detected by a MRI. Other than that it can be a mental disorder like bipolar disorder, given her family history and history of TIA. It is difficult to comment whether it is multiple infarct dementia or a bipolar disorder, both being strong differentials for her condition. Please consult a neuropsychiatrist regarding this. Hope this helps. Take care!