Cognitive and behavioural changes after a heart attack?

December 30, 2021 9:15 PM

Apparently these aren’t uncommon. Two parter. 1) What can be done to mitigate any cognitive effects of hypoxia or anoxia a few weeks after a heart attack? 2) How do I deal with the changes?

My mom had a heart attack. She apparently blacked out for short periods before they were able to give her a stent. I don’t know how long she was out, or what the neurological situation is (although we do know she didn’t have a stroke). I’ve read that some people, something like 50%, experience a certain amount of brain damage after a heart attack. I’m worried this has happened to her. The event happened at 3:30 am, nothing other than aspirin was done/given until after 5:00 am (when I guess they had to use paddles, though she was apparently alert and oriented at that time, so I don’t know if she actually went into cardiac arrest. 5:00 am was when I spoke to the charge nurse, who said lots of nurses were in her room and the cardiologist was on the way.) After that there was an angiogram and a stent. So I don’t know how long or how much her brain suffered. I highly doubt they took the time to bring her body temperature down.

She has trouble with word-finding now. Can’t remember titles to movies she ought to know. I haven’t been close by since a few days after the event, so I don’t know if anything else has changed. I have a sinking feeling something has. I think she also is aware of losing words, she’s mentioned it (and this may upset her, too). She also seems a bit depressed (which I gather is common). Doesn’t want to talk for long, says she’s fatigued, which of course is possible. I think the longest conversation I’ve had with her since was under ten minutes. Seems distant, guarded.

My mom, before this, I mean apart from the pandemic blues, was ebullient, excitable, cheerful, industrious, warm, empathetic… a really good friend, to a lot of people. Fun. Sharp. A talker, a storyteller. I don’t know where she’s at now. She’s much more insular.

If she does have some kind of brain injury, what can be done now? I read that exercise helps. Diet. Can occupational therapy help?

I don’t think a neurological evaluation will be top of mind for her GP, who’s doing lots of COVID stuff and is otherwise busy. I definitely don’t want to even suggest to my mom that her brain might not be working as well as it did. She’s fixated on possible heart damage as it is. I know she needs to focus on recovering, she’s GOT to stay positive. But would a neuro assessment be worthwhile? Is there anything they can actually do for her if she does have brain damage, at this point (two weeks after the fact)? Would general cardio rehab more or less accomplish the same goals?

————————————————————————————————

How do I handle this? We’re super close. She knows me better than anyone. She’s been my champion, cheerleader, confidante… She’s also been a worrying sort of mom. I’ve tended to give her reasons to worry, I guess. I have stayed 100% away from sharing any stressful news, any dumping of emotions or complaints I might have done before. She knows me though, she knows I have stressors. I take care of my dad (they’re divorced), my partner and I both have health issues… I’m also not naturally the kind of person who’d be good to be around if you’re needing to rehab. (I am more of a red alert/annoying health-and-safety type of person, was actually there at the time and called 911, which was lucky. But like I bug her about potassium targets in her diet, and would normally be discussing world events/COVID news with her.) Someone in rehab needs to be in the presence of pleasant, optimistic, focused people who are easy to be around. Not intense worriers. Maybe that’s why she won’t talk to me. I feel like I need to get my life together so I’m not a concern or burden for her, so she can actually be proud of me. I want to do this. I want my relationship with my mom back. I want my *mom* back. I hope what I’m seeing is temporary, can it just be temporary? I’m trying to stay positive and constructive, at least while I talk to her. Hiding any distress (for which she has a spidey sense). Giving her space she asks for. Ok. (This is hard to accept, though.)

I also read she’s at risk of another cardiac event. If I get just one more year with her, I want it to count.

Cannot express enough how hard this has been. Any insight is welcome (especially if you’re a daughter to a mom who’s experienced something like this).

posted by cotton dress sock to Health & Fitness (11 answers total)

Best answer: I have no insight, but your love for your mom is so palpable that my chest got tight. Sending you and your mom lots of care, and hope that you find helpful advice and support.
posted by rrrrrrrrrt at 9:24 PM on December 30, 2021 [25 favorites]

Best answer: I would ask for a speech assessment. The speech therapists have likely seen speech/language issues related to cardiac events before and can advise you on a course of treatment that can help with the word retrieval. A neurological assessment won’t hurt, either.

It is incredibly hard as a daughter to see your once-ebullient mom go from talkative to guarded and want very badly to help. She is so lucky to have you in her corner. For me, one of the hardest things about caring for aging parents is that sometimes—and this is not a given, not at all—you will try to come at a problem with every solution blazing and your parent may, for their own reasons, decline those solutions. Sometimes they’re just too exhausted to deal with one more thing. Sometimes it’s the only way they can exercise control in a scary situation. Don’t despair if she seems resistant to finding ways to improve at first: she may just need more time to recover and feel more normal before she can tackle something like this.

Please take care of yourself and make sure you have supportive people around you, as much as you can. Judging from your description of your mom’s spidey-sense, she’s going to know if you’re not getting enough care and she’s going to worry (and likely find a way to bust you, if she’s anything like my mom.) Memail me if that would help!

(And I would bet you anything that any mom whose daughter loves someone as much as you clearly love her is proud of you.)
posted by corey flood at 10:29 PM on December 30, 2021 [3 favorites]

Best answer: Hi! First, I'm glad that your mom is OK. Thankfully your mom wasn't sick enough to warrant therapeutic hypothermia. I do, however, wonder what kind of new meds she's now taking because there are statins that are known to cause cognitive fogs.

You wrote your mom may have lost consciousness at some point prior to her stent placement, but did she actually code and stop breathing? If you suspect she's got something like vascular dementia going on (as much as it might freak your mom out), it's definitely something you might want to get a consult on so that it can be assessed and treated. Microclots can be taken care of with appropriate meds and prevent further damage.

Big, big hugs to you and your mom. You've got this!! 😉
posted by dancinglamb at 11:30 PM on December 30, 2021 [1 favorite]

Best answer: Is she getting counseling, or is there any kind of support group? (Man I wish that was a required/fully funded part of recovery.) Would she be resistant to the idea? An experienced counselor would be able to assess whether her issues are in the range of typical, and of course a support group would be an excellent environment for her to share things she may not be ready to share with you.

Of course your mom’s proud of you. There’s no perfect way to do this. You saved her life, you continue to be there for her, be proud of that.
posted by kapers at 12:55 AM on December 31, 2021

Best answer: Also, my mom has been through this and she was extremely depressed and exhausted and dull and dark for a while, but it was temporary and the stent is still stenting 15 years later. Obviously every situation is different, but I share this with you in case you need a true story to look to.
posted by kapers at 1:01 AM on December 31, 2021 [2 favorites]

Best answer: I knew a younger person who had a heart attack and they ended up having post traumatic stress. Could some of these symptoms be because she went through a very traumatic experience?
posted by pairofshades at 4:08 AM on December 31, 2021 [3 favorites]

Best answer: Find out what her blood pressure is and which drugs she is taking that might lower blood pressure

After a heart attack docs like to attack the blood pressure but if it is too low it will do the things you describe, plus low blood pressure may contribute to dementia link

Also, just research the drugs she is on and find out if she can eliminate any. The fewer drugs the fewer possibilities of side effects

Oxygen concentrators are easy to buy these days, get her one it couldn't hurt, might help
posted by cda at 4:14 AM on December 31, 2021 [1 favorite]

Best answer: Slightly off-topic response. People in rehab need to be around people who love and care for them in whatever form that manifests. Full stop. I understand the desire to filter a little more to want to minimize stress and your mom is very likely doing the same for you in some way. I'm also 1000% sure your mom is intensely proud of you just the way you are for being the person (and care taker) you are.

Can you talk to your mom about worry management? Or introduce the things you'd normally share with her but let her know you're sharing them because you want her to know BUT you & your partner are working through resolution so mom doesn't need to worry? I come from a family of worriers and I like to time box the worry (ex: We can worry about everything for the next 5 minutes and then we're going to go take a walk to transition to talking about future planning.)

In times of family crisis I have also sought out (and found) a therapist to talk through my worries (and grief). Having a non-family outlet has really helped me through tough times. A therapist has also helped me frame next steps and action plans which can be really grounding (and helpful) at times where there is lots of uncertainty.

My mom has a neurological disease (Parkinsons) which was difficult to diagnosis and symptoms that were difficult to discuss with doctors. Some of these discussions were difficult because she feared the what if. When we were able to identify that there were treatment options if we went down the neurological path, the discussions got a little easier. It might be good for you, your mom, and your mom's doctors to talk about a "well if there is neurological involvement and we know about it, there are things we can do" approach to next steps. I would recommend continuing to nudge, as best you can, for getting all of the symptoms on the table for assessment. Assessment leads to a treatment path for a diagnosed problem which is the ideal outcome.
posted by countrymod at 7:39 AM on December 31, 2021 [1 favorite]

Best answer: This summary of anoxic brain injury is probably too much detail, but you can look at the discussion under symptoms and mild injury.

You are correct that brain injury occurs after cardiac events, depending on the degree and time of low blood pressure. To have been unresponsive and been shocked, she had too low blood flow to adequately supply the brain, but that is not necessarily enough to cause a lasting injury. It is also common that older people with coronary vascular disease have brain vascular disease, making them less resilient to that kind of injury. It is normal to lose brain mass with age, which means that injuries tend to be more noticeable. It is also common to have low mood after a major illness, and these can look similar.

It sounds like the cognitive symptoms are not very severe, but she could ask to see a specialist in neurorehabilitation (or "comprehensive rehabilitation"). As you can see in the booklet I linked, there is a focus in figuring out any deficits to keep the person safe and to understand limitations they may have. Normal "cardiac rehabilitation" services which include exercise, nutrition, adjusting medications, and a limited cognitive component also seem to help. Best of luck!
posted by a robot made out of meat at 10:00 AM on December 31, 2021 [3 favorites]

Best answer: Meds can cause the symptoms she has. I’ve been through it, complete with losing words and being depressed. Changing some meds and stopping others fixed it 100%
posted by MexicanYenta at 9:42 PM on December 31, 2021

Best answer: I’m a daughter to a father who had something like this happen, if anything worse than what you describe. It’s been over 10 years, he’s entirely himself now.

He was weird for maybe six months - at first he was extremely disoriented, didn’t know where he was, talked as though it was 20 years ago. He didn’t make the jokes he normally would have, seemed to reach for words a lot more than normal, and often said the same thing repetitively. But gradually over time, he got better - knew where he was, what year it was, and where he lived. Knew that I had graduated from college and lived in a different state. By the time they got around to doing a neuro eval maybe 4 or 6 weeks later - which is something they should do and you absolutely should ask for - he passed it with flying colors in about a quarter of the time it was supposed to take. His personality still didn’t feel normal to me, but he clearly would be able to live independently at that point. Past that, every few weeks he felt “more normal”, it just took time.

My mom was there with him every step of the way, even when he was trying to break out of the hospital in the middle of the night, and I called whenever I could even though it was often confusing and depressing. A rotating array of friends and family came by to visit. I don’t think we did anything in particular for the neuro issues except be there and wait. My dad is extremely stubborn and was in unusually good shape for his age, so he did all his cardio therapy which I’m sure helped quite a bit. Everyone has a different path, though, so it’s hard to know exactly what will happen.

Good luck - it’s hard but it should get easier in time. Make sure you have support too. Memail me if you want to talk.
posted by A Blue Moon at 3:17 PM on January 1, 2022