Emotions after stroke: A narrative update

Abstract

Aim In this narrative review we aimed to describe how stroke affects emotions and update the readers on the emotional disturbances that occur after stroke. Methods We searched Medline from 1.1.2013 to 1.7.2019, personal files and references of selected publications. All retrieved systematic reviews and randomized controlled trials were included. Other references were selected by relevance. Summary of review The emotional response includes a reactive behavior with arousal, somatic, motivational and motor components, and a distinctive cognitive and subjective affective experience. Emotional category responses and experiences after stroke can show dissociations between the behavioral response and the cognitive and affective experiences. Emotional disturbances that often occur after stroke include fear, anger, emotional indifference, lack of understanding of other emotions, and lack of control of emotional expression. Emotional disturbances limit social reintegration of the persons with stroke and are a source of caregiver burnout. The evidence to support the management of the majority of emotional disorders in stroke survivors is currently weak and of low or very low methodologic quality. An exception are the disorders of emotional expression control where antidepressants can have a strong beneficial effect, by reducing the number and duration of the uncontrollable episodes of crying or laughing. Conclusion Our current knowledge of the emotional disorders that occurs in acute stroke patients and in stroke survivors is heterogeneous and limited. Joint efforts of different research approaches, methodologies and disciplines will improve our current understanding on emotional disorder after stroke and indicate rational pathways to manage them.

Neuropsychiatric issues after stroke: Clinical significance and therapeutic implications

“…Even early neuropsychiatric disorders after stroke (NDS) may increase the risk of mortality and recurrence in patients with stroke[ 4 , 5 ]. The current management and treatment of the majority of NDS is not satisfactory, except for some antidepressants that show therapeutic benefit[ 3 , 6 ]. Patients with NDS do not even benefit from existing advanced medical intervention.…”

Delirium Post-Stroke: Short- and Long-Term Effect on Depression, Anxiety, Apathy and Aggression (Research Study—Part of PROPOLIS Study)

“…It has been shown that a substantial number of stroke survivors develop long term mental health problems such as anxiety, anger, depression, fear and others that have a negative influence on recovery, limit social reintegration of the persons with stroke, reduce quality of life, and are a source of caregiver burnout [ 6 ]. Moreover, previous research has associated delirium with an increased risk of long term mental health problems in different in-hospital populations; however, the data are equivocal [ 7 ].…”

Spectrum of neuropsychiatric symptoms in chronic post-stroke aphasia

“…Agitation and aggression: Agitation, inability to control anger and aggression are observed symptoms in PWA[ 22 , 36 , 131 ]. Anger represents an emotional reaction, whereas aggressiveness is understood as the subsequent behavioral reaction[ 132 ].…”

“…In general, NPS are a frequent and challenging consequence of stroke, derived from the crossroad of lesion-related brain factors and psychological distress related to the event and its functional impact in daily life[ 16 , 17 ]. Several comprehensive reviews dealing with NPS in post-stroke patients have been reported[ 18 - 22 ] and a recent original study evaluating 518 non-aphasic stroke patients found that half of the sample presented at least one NPS based on Neuropsychiatric Inventory (NPI)[ 23 , 24 ]. However, one relevant limitation of the above studies is that they exclude aphasic participants due to the inherent linguistic-assessment difficulties[ 25 - 29 ].…”