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By Dr. Bonnie-Kate Dewar, Clinical Neuropsychologist
Cognition refers to mental processes such as attention, memory, language, problem solving, decision making, planning and organisation. These processes support our everyday activities from running a household, maintaining friendships, working, driving and studying. Following encephalitis, an individual will experience changes in these mental abilities to varying degrees and, in turn, may have difficulties in their everyday activities. The pattern of cognitive impairments following encephalitis will be different from person to person, depending on the brain systems affected and the type of encephalitis. A neuropsychological assessment is recommended to determine the pattern of cognitive changes following encephalitis, to then develop a rehabilitation plan to allow an individual to manage their cognitive problems and improve their everyday functioning.
Information processing refers to the ability to think quickly, pay attention and concentrate. Attention refers to the ability to focus on one task, to take in information, or to divide attention between tasks. Concentration generally refers to the ability to sustain attention across a period. Individuals affected by encephalitis may have difficulty processing information quickly, which may result in a slowness to answer questions or the need for increased time to complete tasks. It may be difficult to concentrate, with increased distractibility and poor mental stamina across the day. Following encephalitis, it may also be difficult to take in and process information leading to an overload of information and a sense of being overwhelmed by conversation or noise.
To manage information processing problems, it can help to allow more time to complete tasks. Distraction should be kept to a minimum, including a reduction in background noise where possible. To support the initial intake of spoken information, it may help to take notes in conversation, during meetings or phone calls to capture key points and then clarify the information. Attempting one task at a time, during peak energy times can also help reduce distractibility and get things done. A diary to record energy levels may be useful to identify peak energy times during the day and those activities that restore stamina.
Memory can be affected by encephalitis in different ways. It may be difficult to remember recent events, such as what happened last week, where a belonging was left within the house or conversations. It may be hard to learn a new skill, such as lessons at school or how to use a new mobile phone. Some people may have difficulty remembering events and people from their life before the encephalitis. Remembering what has to be done at a future time, such as appointments or paying a bill next week, may also be affected.
Memory problems can have a devastating impact upon an individual’s everyday functioning, including their sense of who they are. Fortunately, although memory problems following encephalitis cannot be cured, there are a number of good techniques to compensate for these problems. External memory aids include devices such as diaries, calendars, post it notes, smart phone and apps, message boards and medication boxes. With consistent use, including a way to remember to use the memory support, these compensatory devices can help an individual to work around their memory problem and function in everyday life. A Clinical Neuropsychologist or Occupational Therapist can help to explore available memory supports following encephalitis and provide training to use effectively these supports.
Another common memory problem is difficulty remembering people’s names. To overcome this problem, it may be helpful to develop a picture of the person and their name based on a distinct feature of their face or personality. Written notes of that person, their name and the distinct picture can then strengthen this association.
Following encephalitis, many people describe difficulty remembering what they have read. To remember books or magazine, it may be helpful to have a small voice recorder or notebook to make a few key points at the end of each chapter. A bookmark could also serve this purpose. These notes can then be reviewed when the book is next picked up.
Many people experience language difficulties following encephalitis, typically word finding problems. As noted above, it may also be difficult to take in and understand conversations so that an individual experiences an overload of information. A Speech and Language Therapist can assess language changes and develop ways to support communication. To lessen the frustration of word finding difficulties, it may help to talk around the word to communicate thoughts as opposed to searching the lost, forgotten word. This process is termed circumlocution. Taking more time, relying on notes and managing the frustration associated with finding words may also help to make conversation more fluent.
The term ‘executive function’ refers to the high level cognitive skills required to identify and successfully complete goals. This includes abilities such as planning, problem solving, organisation, flexibility in changing a strategy that is not being effective, and holding back inappropriate responses. Difficulty in one or all of these areas occurs to varying degrees following encephalitis with a significant impact on everyday life and relationships. Again, a neuropsychological assessment can help to identify executive function impairments following encephalitis and then develop rehabilitation strategies to manage everyday problems.
Increased structure, routine, and the use of compensatory supports such as a diary, message board, smart phone or alarm may support everyday executive difficulties. With the help of family and the rehabilitation team, a structured approach to planning everyday tasks can be adopted. Daily activities can be written in a weekly planner (paper based or smart phone), with a list of steps required to complete tasks, to be crossed off one by one. Reviewing progress and learning from experiences form part of the problem solving process. Alarms (e.g. mobile phone alarms) can be used to help monitor performance and keep a person on track. Written prompt cards may be useful to control inappropriate responding (e.g. stop and think!) or to keep on track of tasks.
Following encephalitis, an individual may have reduced awareness of their difficulties as a direct result of the brain systems affected. It may be hard for them to recognise changes in their thinking or behaviour and how such changes may affect their return to everyday life, including driving and working. An individual may also understandably find it difficult to accept the impact of the Encephalitis and deny that they have any problems. Both reduced insight and denial of problems pose challenges for family members and the support of the Neuro-rehabilitation team is recommended. Direct challenging of a person’s beliefs is not recommended. Patience and listening to frustrations can be of help whilst establishing goal directed rehabilitation programs to gently test and reveal a person’s weaknesses in addition to their strengths.
FS066V2 Cognitive and behavioural changes after encephalitis
Date Created: March 1999/ Last Update: April 2016/ Review date: April 2019
The Encephalitis Society is the operating name of the Encephalitis Support Group which is a registered Charity and Company Limited by Guarantee.
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