Struggling to Communicate: Cognitive Issues After Head Injury

Q: Struggling to Communicate: Cognitive Issues After Head Injury

Hello, Miss： You mentioned that you are becoming increasingly forgetful, such as opening the refrigerator and suddenly forgetting what you were going to get, or switching tabs on your phone and forgetting what you were just about to do. <br>Since this has already affected your da

Often struggles to express thoughts clearly, unable to fully articulate an event or a sentence?

Hello, Doctor.
About eight years ago, I lost consciousness suddenly while getting off a bus and fell to the ground, hitting my forehead against a parked motorcycle.
I regained consciousness immediately but did not seek medical attention right away.
The next day, due to a headache, I went to a local private hospital.
The doctor simply asked for my name and checked if I could write it down.
When asked to perform simple mental arithmetic with two-digit addition, I realized I couldn't do it at all.
After about 1-2 minutes, when the doctor asked me to write it down, I was finally able to calculate it.
Therefore, the doctor concluded that I had just bumped my head, which caused dizziness, and advised me to rest more.
I work as an engineer, a profession that requires significant mental effort.
Since the head injury, my speech has become increasingly incoherent (this has worsened over the years).
I struggle to share updates with others, communicate at work, or respond to questions from passersby clearly.
During presentations, I sometimes suddenly forget what I was going to say, especially if interrupted, leaving my mind blank.
I used to be good at remembering people; I could recall names of colleagues I hadn't seen in years, but now I can no longer remember them.
When asked to provide an example while sharing something, my mind goes blank.
Even when participating in activities that require sharing insights, I find my mind is completely empty.
Gradually, I have become less inclined to socialize due to the fear of not being able to engage in conversation.
I have also become increasingly forgetful, such as opening the refrigerator and suddenly forgetting what I intended to take out, or switching tabs on my phone and forgetting what I was doing.
About seven years ago, I visited a psychiatrist who diagnosed me with anxiety disorder.
However, after experiencing side effects from the medication, I stopped returning after a few months.
I am uncertain whether I should first see a neurologist or a psychiatrist for my current condition.
Could you please provide your advice? Thank you.

Niming, 30~39 year old female. Ask Date: 2024/07/15

Dr. Jiang Junyi reply Neurology

Hello, Miss: You mentioned that you are becoming increasingly forgetful, such as opening the refrigerator and suddenly forgetting what you were going to get, or switching tabs on your phone and forgetting what you were just about to do.
Since this has already affected your daily life, it is advisable to seek medical evaluation.
Generally, a neurological and laboratory examination will be arranged, including a CT scan or MRI of the brain to check for any brain lesions, as well as blood tests to assess general biochemical values, vitamin B12 and folate levels, and thyroid function.
Please be aware of the "12 major risk factors for dementia," which include: lack of education, hearing loss, head trauma, hypertension, diabetes, excessive alcohol consumption, obesity, lack of exercise, smoking, depression, social isolation, and air pollution.
It is recommended to first consult a neurologist for an assessment of cognitive decline, and then discuss with a psychologist.
Thank you for your inquiry, and feel free to discuss any related questions! Wishing you good health and peace.
Dr.
Jiang Junyi, Department of Neurology, Taoyuan Hospital / Hualien Hospital, cares about you.

Reply Date: 2024/07/15

More Info

It sounds like you have been experiencing significant cognitive challenges since your head injury eight years ago. The symptoms you describe, including difficulties with communication, memory lapses, and increased anxiety, can be quite distressing and may impact your daily life and professional responsibilities as an engineer.
First, it is important to understand that head injuries, even those that seem minor at the time, can lead to a variety of cognitive and emotional issues. The brain is a complex organ, and trauma can affect different areas, leading to problems with memory, attention, language, and emotional regulation. Your experience of struggling to articulate your thoughts, forgetting names, and feeling blank during conversations may be indicative of cognitive impairment, which can occur after a traumatic brain injury (TBI).

Given your history, it would be advisable to seek a comprehensive evaluation from a neurologist. A neurologist can conduct a thorough assessment of your cognitive function, which may include neuropsychological testing to evaluate your memory, attention, language skills, and executive function. This testing can help determine the extent of your cognitive difficulties and guide appropriate treatment options. Additionally, imaging studies such as an MRI may be warranted to rule out any structural changes in the brain that could be contributing to your symptoms.

While your previous diagnosis of anxiety may still be relevant, it is crucial to differentiate between cognitive issues stemming from your head injury and those related to anxiety or other psychological factors. Anxiety can indeed exacerbate cognitive difficulties, leading to a cycle of worry and impaired performance. If your cognitive issues are primarily due to the TBI, addressing these through cognitive rehabilitation and therapy may be more beneficial than solely focusing on anxiety management.

In terms of treatment, cognitive rehabilitation therapy can be particularly effective for individuals with cognitive impairments following a TBI. This type of therapy focuses on improving specific cognitive skills, such as memory and attention, and can provide strategies to help you cope with daily challenges. Additionally, working with a speech-language pathologist may help improve your communication skills, allowing you to express yourself more clearly and confidently.

It is also worth considering a multidisciplinary approach that includes both neurological and psychological support. A mental health professional, such as a psychologist or psychiatrist, can help you address any anxiety or emotional distress you may be experiencing. They can work with you to develop coping strategies and may recommend therapy options such as cognitive-behavioral therapy (CBT), which has been shown to be effective for anxiety and cognitive issues.

In summary, I recommend that you first consult with a neurologist for a comprehensive evaluation of your cognitive function. This will help clarify the nature of your difficulties and guide appropriate interventions. Additionally, consider engaging with mental health support to address any anxiety and emotional challenges you may be facing. With the right support and treatment, many individuals experience significant improvements in their cognitive function and overall quality of life after a head injury.

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