Memory Issues After Head Trauma: A Caregiver's Guide

My father keeps wanting to take a shower?

Hello, doctor.
My father fell from a height on October 25, resulting in a head injury.
After diagnosis, he was found to have intracranial hemorrhage, skull fractures, and a subdural hematoma.
He was sent to the hospital for a CT scan, which revealed multiple small areas of bleeding in the brain.
The doctor recommended observation for three hours, stating that if there was no further bleeding, surgery would not be necessary, and the body could absorb the blood on its own.
After three hours, a follow-up CT scan showed no continued bleeding, so he was transferred to the intensive care unit (ICU) for 10 days.
The doctor informed us that there was damage to the frontal lobe and that the bleeding was causing pressure, resulting in some brain cell necrosis, which could lead to personality changes.
He was later moved to a general ward, where he exhibited left-sided weakness and was unable to manage his bowel and bladder functions.
However, after rehabilitation, his left-sided weakness has improved.
He has been discharged for two weeks and is currently being cared for at home by family.
In the week following his discharge, his bowel and bladder issues have improved significantly, except for occasional nocturia.

However, starting this week, my father has been wanting to take a shower every day at 11 AM.
When I ask him what time it is, he says it is 5 PM.
After he showers, he repeats that he wants to take a shower again at 5 PM.
In the last two days, it seems to be getting worse; he forgets that he has just showered.
I would like to ask the doctor what kind of symptoms these are.
Are they caused by the brain injury? Is this considered a temporary condition? Thank you.

P.S.
My father also fell from a height 15 years ago, resulting in intracranial hemorrhage, and he underwent surgery at that time.
The injury was near the frontal area, and he was discharged after a week with no apparent sequelae.
However, this time, after regaining consciousness, he has difficulty remembering many things, has a confused sense of time, frequently mentions deceased individuals, and fabricates events that never occurred.

Ling, 30~39 year old female. Ask Date: 2017/12/12

Dr. Zhang Junwei reply Neurosurgery

Severe brain injury can lead to dementia.

Reply Date: 2017/12/12

More Info

Understanding memory issues after head trauma can be quite complex, especially in the context of your father's recent injuries. Given the details you provided, it appears that your father has experienced significant head trauma, including intracranial bleeding, skull fractures, and damage to the frontal lobe. These types of injuries can lead to a variety of cognitive and behavioral changes, including memory issues, confusion, and alterations in personality.

Memory Issues After Head Trauma
1. Types of Memory Affected: After a traumatic brain injury (TBI), different types of memory can be affected. Short-term memory, which involves the ability to hold onto information for a brief period, is often impacted. This could explain why your father forgets that he has already taken a shower shortly after doing so. Long-term memory may also be affected, leading to confusion about past events or the inability to recall certain memories.

2. Frontal Lobe Damage: The frontal lobe is crucial for many cognitive functions, including decision-making, problem-solving, and memory. Damage to this area can lead to difficulties in organizing thoughts and maintaining a coherent timeline of events. This could manifest as your father expressing confusion about the time of day or repeating requests, as he may not be able to accurately process or retain the information.

3. Post-Traumatic Amnesia: After a significant head injury, individuals may experience a state known as post-traumatic amnesia (PTA), where they have difficulty forming new memories or recalling events that occurred after the injury. This condition can vary in duration and severity, depending on the extent of the brain injury.

4. Behavioral Changes: Changes in personality and behavior are not uncommon after frontal lobe injuries. Your father's tendency to mention deceased individuals or fabricate events could be a result of his brain's altered processing capabilities. This can be distressing for both the patient and caregivers, as it may seem like a departure from his previous self.

Recovery and Management
1. Monitoring and Support: It's essential to continue monitoring your father's condition closely. Keeping a daily log of his behaviors and memory issues can help healthcare providers assess his progress and make necessary adjustments to his care plan.

2. Cognitive Rehabilitation: Engaging in cognitive rehabilitation therapy can be beneficial. This type of therapy focuses on improving cognitive functions, including memory, attention, and problem-solving skills. A neuropsychologist or occupational therapist specializing in brain injuries can provide tailored strategies to help your father regain some cognitive functions.

3. Routine and Structure: Establishing a consistent daily routine can help reduce confusion. Using visual aids, such as clocks, calendars, and checklists, can assist your father in understanding the time and what activities are planned for the day.

4. Family Involvement: Family support is crucial during recovery. Encouraging your father to engage in conversations, reminisce about past events, and participate in social activities can help stimulate his cognitive functions. However, it’s important to approach these interactions with patience and understanding.

5. Medical Follow-Up: Regular follow-up appointments with neurologists or rehabilitation specialists are vital. They can monitor your father's recovery, adjust medications if necessary, and provide additional resources for managing his symptoms.

Conclusion
In summary, the memory issues and behavioral changes your father is experiencing are likely related to the traumatic brain injury he sustained. While some symptoms may improve over time, others could persist, necessitating ongoing support and rehabilitation. It’s important to remain hopeful and proactive in seeking the best care for your father, as many individuals can experience significant recovery with the right interventions and support systems in place.

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