Impact on Cognitive Function

Across the board, the Veterans we interviewed said that one of the hardest things to cope with after a brain injury was the impact on their cognitive abilities – or the way they learn, remember, problem-solve, and pay attention. After their injury, things that had once come easily and naturally were a much more challenging. People described ongoing problems with speech and communication, memory and recall, concentration and focus, and difficulty completing multi-step tasks.

Problems with word-finding, speech and communication

Many talked about having trouble finding words - or “losing words” mid-sentence - and struggling to think on their feet during conversations. Others noted the challenge of engaging in back-and-forth conversation, remembering names they “should really know,” or losing their train of thought mid-sentence and having no recollection of what they were trying to say.

 

William recalls having to search for words in his head and slowly losing his command of various languages.

William recalls having to search for words in his head and slowly losing his command of various languages.

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And then when I talked to people, I searched for words in my head. I’d lose words. I started losing words. And like the Arabic translation for “friend,” there’s two, there’s two words for “friend.” And which was the most appropriate in this conversation I was searching for and I can see them written in my brain, but I could not extract it out of the brain. And I could not articulate. So, I was losing my language, my languages. And I kept losing more and more.

So, I went through a year of cognitive therapy, a year of vestibular therapy, speech therapy. I stuttered. I did not only lose my language, but I stuttered. And the stuttering got worse. The aphasia or whatever where you search for words, even in English, it got – I mean I lost all my languages. All of them. And then English was the last to go. So, like Arabic first, then French, then Farsi, then Sign, then English. Gone.

 

Luke talks about feeling frustrated when he can’t remember words and names.

Luke talks about feeling frustrated when he can’t remember words and names.

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The biggest thing for me is, I feel like today I’m having what my wife calls a moment of clarity. So, I get hung up on word finding. It’s very difficult for me, I can be talking about a desk, we can be standing in front of one, I can have my hand on it, but I can’t come up with the term for it. And then I get frustrated because I can’t get to it, and then I think, I feel like other people around me are like waiting for me to get to my point, or I lose track of something because I get focused on trying to come up with a term for something, and it makes me feel stupid. And I know, you know, I think I’m fairly intelligent. I have my bachelor degree and I graduated with honors and I never had an issue with academics before but that can be really frustrating. That and like short term memory, so - introducing, talking to people. Trying to remember names even though I’ve said it, you know, six or eight times in my head or I’ve done all the memory games where I try to associate it with something and I just, I have a really difficult time with that.  So, word finding, short term memory. 

So, there’s things, those terms, those things that I just drilled into my head back when I was on active duty, before I deployed, that I can recall. But if I’m studying for, like say for instance I just had a recent interview for promotion at my job and it’s, you know, scenario-based questions and stuff like that, so, “Tell me about a time when you did this and this and this.” And I just have the most difficult time recalling things that even happened, you know, two days ago or specific things. I work as a deputy sheriff. I’m actually assigned as a detective right now. And so, my, my partners have this uncanny ability to recall the names of all the dirt bags they’ve ever dealt with and the addresses and their girlfriends and I used to be really, really good at that and it’s just, it’s gone now, I can’t pull it up. So that’s really frustrating. 

 

Roger talks about struggling to find words.

Roger talks about struggling to find words.

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And, and sometimes, as my wife knows, I forget. I don’t – if forget is the right word, words. What, what, what word? Well that’s what I always say. That’s what I always say, “Hey,” and I just don’t remember and it’s in there somewhere. But, but then I don’t know. And I, although I don’t – OK, I don’t think its Alzheimer’s Disease onset, because in Alzheimer’s you don’t know there is a word that means something. Even if you can’t think of the word, you don’t look for the word because it’s gone, it’s out of your life. And that’s what I have at times where, where not, not, that’s not what I have. I’m sorry. Should have said. I, I just, trying, “What is the word that means this?” Or sometimes, “You ever heard of this word?”

 

Memory, concentration, and focus

Problems with short- and long-term memory, concentration, and focus were also common. One Veteran told us that when he struggles to remember things it will “agitate the hell out of me. It will put me in a bad mood, sometimes the rest of the day because I want to remember, it’s just I can’t.” Ben described it as “ongoing fogginess,” and said there were times when “I’d be so set to go somewhere, I’d have my little sister with me, and we’d have something set to do, and I would absolutely blank.”

 

Ben had problems retaining information, following conversations and remembering what he was supposed to do next.

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Ben had problems retaining information, following conversations and remembering what he was supposed to do next.

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Yeah, I would say, I’m trying to think the biggest one. I think it was probably from driving, was I would be, I’d be so set to go somewhere, I’d have my little sister with me, and we’d have something set to do, and I would absolutely blank, like not where we were going but I had like we’re going to go do this, this and then our ultimate destination, but I would forget, you know, what we’re supposed to do, one and two, and then three for the final. Just things like that or I, I’d be having a conversation with family members and I would completely, I’d be in mid-sentence and I would completely forget the point I’m trying to get across. I just, you know, started to feel stupid, just forgetting conversations with family, forgetting like I said, the main talking points. I, I guess the fogginess too. I don’t know normally I could sit there and I could read something and I could retain the information and then after that I couldn’t.

Sarah forgets day-to-day things, like what she had for lunch yesterday, and where she parked – she has resorted to parking in the same spot every day at work, so that she can find the car more easily. Kevin used to love reading, but now “can’t stand” it because he can’t remember what he read. He also has a harder time following conversation - he can’t remember everything that is said and struggles to “pick up on everything.” Erik said he struggles with memory loss - especially when he is under a lot of stress – and will forget things “like when my daughter gets home from school and what her extracurricular activities are. I mean I’ll forget, you know.”

 

Sarah continues to struggle with her short-term memory and focus and has a hard time reading or sitting through movies.

Sarah continues to struggle with her short-term memory and focus and has a hard time reading or sitting through movies.

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A lot of short-term memory issues. I probably couldn’t tell you what I had for lunch yesterday. If it’s not on my calendar, on a post-it note - extreme OCD like everything has to be, because I need to know where things are at. I park in the same parking spot every day here. If I can’t find the parking spot I park on the same row, that way I know if I just keep walking eventually I’ll find my car. So, memory issues, mood swings, inability to focus, which here isn’t so bad because the job is very fast-paced and you’re always doing a lot of different things, so that kind of benefits that I can switch from one thing to another. But like anything that requires long term focus. Like I used to be an avid reader. I used to love going to the movies. I have a hard time sitting through a full movie now because my attention just gets like, I get bored, which is the polar opposite of how I used to be. 

 

Kevin has a harder time learning and remembering new things and following conversations.

Kevin has a harder time learning and remembering new things and following conversations.

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I was, I‘m still very intelligent, but I have a difficult time learning things anymore. I can’t, when I’m reading, after the incident. I used to like to read a lot. I, I can’t stand reading anymore because I can’t remember what I just read after I read it. That, that was a big change. So, when I was, when I opened my business and I started getting into business deals and writing contracts and everything else, it became a real disadvantage because I couldn’t understand contracts like I should have, OK. Or I’d engage in conversation and I couldn’t remember what all, everything was said because my thought process, I don’t pick up, when I’m in a conversation with someone, I don’t pick up on everything in a conversation or I, like I had here, I get, I get off on something else other than the conversation, OK. So, it became a real detriment. And, and, like with my wife, we knew, God bless her, we had a wonderful relationship. She knew something was wrong with my thinking and so she, just her blessed heart and the person she was, she became a strong point for me in that area. She could read people where I couldn’t. Because I can’t read people at all. 

 

Erik talks about forgetting things, like picking his daughter up from practice and people’s birthdays and anniversaries.

Erik talks about forgetting things, like picking his daughter up from practice and people’s birthdays and anniversaries.

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I, I forget sometimes, like day-to-day schedule, when my daughter gets home from school and what her extracurricular activities are. I mean I’ll forget, you know. The, the kid that’s waiting at the soccer field three hours after practice, you know, that’s, that’s my kid. But not because I’m getting drunk, I just simply forgot. You know? So. And the nice thing is that she’s a good kid, she realizes that, she understands that her dad is a little different than everyone else’s. So, it’s tough. It’s tough. I’m, I, with the TBI I tend to not remember important things. You know, people’s birthdays and anniversaries and – you know, like my niece, I was there when she was born, but I couldn’t tell you what her birthday is. You know? And luckily my brother, he is just the coolest guy in the world as far as I know. He doesn’t care if I remember. I’m his brother, that’s the end of that, you know? Nothing will ever change that. So, but other people take it a little more seriously.

 

Others described gaps in their long-term memory, and the feeling that they are missing out on their own lives. Some described having huge gaps in their memory. One Veteran – who sustained a TBI during a helicopter accident while in Vietnam – said the memory of his first 19 years of life was “completely erased.” Another told us that she feels like she missed a good chunk of her life, “I mean there’s pictures my kids will look at and I couldn’t tell you when or where they were taken.” Alex described his memory loss as “having a really bad VCR tape where you get to the good part” and it gets distorted.

 

Alex said his brain holds onto some things and not others and he has huge holes in his memory.

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Alex said his brain holds onto some things and not others and he has huge holes in his memory.

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I noticed there had been some memory lapses, but I thought I was just forgetting things easier. The, the biggest thing that really made me notice I had any kind of TBI was pictures, actually. I see myself in pictures six months ago, a year ago, and I would put my hand on the bible and swear I was never there. And so, it brings tears to your eyes that you kind of really it takes you back, takes you back a little bit. Like things with your, things with your children and, you know it’s, it’s kind of impactful. So, there’s certain things my memory will hang onto and certain things that it, it won’t. There’s huge gaps from high school, my childhood. It’s like having a really bad VCR tape where you get to the good part and it all goes, you know?

Slowed thinking and processing

Several of the Veterans we interviewed described feeling like their thinking was “slower,” that it took them longer to learn new things or “code” new information into their brain, or that things felt “out of whack.” Many of the people we interviewed said they had to work a lot harder than they used to – and that it took them a lot longer to learn new things or complete difficult tasks - and that they felt “diminished” or “somehow held back” compared to other people of the same age and intelligence.

 

As a writer, work was harder for Richard and everything was kind of slow, as though there was gum was stuck to his shoe.

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As a writer, work was harder for Richard and everything was kind of slow, as though there was gum was stuck to his shoe.

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I had no money, which was very difficult as well, and I'm not working really well at all because all of a sudden, everything was kind of slow. It was as though I was - gum was stuck to my shoe or as one of those old deep-sea divers in one of those big outfits with the leg, yes, and things just weren't - as I know now, the brain was working to rewire, and because sides of the brain, when this side does something, the other side has a sympathetic response, but because of my damage, it was getting like nothing. It was not - it just was not good, and I couldn’t understand it. 

 

Jason had a harder time remembering and processing things and felt like things were “out of whack."

Jason had a harder time remembering and processing things and felt like things were “out of whack."

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I realized that things weren’t like, thinking, processing things was a lot harder, like I couldn’t, I couldn’t remember things a lot of things. And a lot of guys, or a couple people got, you know, were kind of, kind of got, frustrated with me when I couldn’t remember something or if I couldn’t understand something. Most of the other guys, I got slapped in the head like “hey, he’s got a head injury, like leave him alone.” But, like, I felt like, I had been, I had, again I guess, I guess I kind of felt, almost instantly, a little handicapped, for some reason. Like, I, I couldn’t do the same things. I couldn’t, I didn’t have as good of balance as, you know…I had little, I had a lot of mood swings. A lot of problems with my, just different, different things like I couldn’t focus on certain emotions or anything. Like I would, it would just, I don’t know, it was all that, it was all out of whack. Just those things…

 

Scott talks about having difficulty “coding information” into his brain.

Scott talks about having difficulty “coding information” into his brain.

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And then – kind of, yeah. Just like I’ve also – it seems like I have difficulty with like, like coding information that I hear into my brain. I mean just a minute ago, you told me the date and then like I forgot it immediately. And that seems to happen all the time, you know? More, more than a normal person or so it strikes me. And I don’t feel like I had issues like that before experiencing this. And so that’s, that’s been the, the most difficult ways. But you know, it’s kind of tough to say because I just don’t know if, if I’m just aging and you know like your memory starts to go. But at the same time, like, I feel like, I feel like for being a 26-year-old like I shouldn’t necessarily be having these problems yet.

Others touched on changes to their executive function – their ability to plan, organize, and complete tasks – and highlighted ongoing challenges with completing multi-step tasks, even things as simple as cleaning up the house.

 

Peter can get overwhelmed when faced with complex tasks, and has trouble completing simple things like cleaning up the house.

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Peter can get overwhelmed when faced with complex tasks, and has trouble completing simple things like cleaning up the house.

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So, okay here’s another thing that I didn’t really mention related to the executive function kind of stuff. There are times in, you know, even something as simple as like cleaning up the house where I’ll find myself like, you know, picking a bunch of stuff up and not really knowing where to put it and putting it back down again and being really inefficient about doing stuff like that. And I will say that like my, you know, my office became a much worse mess than it ever was. I seem to have a lot of trouble you know – I mean so, you know, following through on all kinds of things. Like a specific task like that, but then any sort of complicated task sometimes I, I get like I feel myself getting kind of overwhelmed sometimes, I think. And I have to sort of – and actually this is something that I had a conversation with my wife about and this is actually a specific piece of advice that she offered to try to fix some of it - she said that it seems like it’s more easy for me to be distracted and that I have difficulty multitasking. So you know, she always tries to get me to just focus on, you know, a specific task and get it done instead of trying to do everything at once.

 

 

Frank discusses coming to terms with his memory issues.

Frank discusses coming to terms with his memory issues.

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I’ve got too much trauma. And now I don’t know if it’s affecting my, my memory, or if it’s age, but I forget things more. And it’s frustrating. I don’t like it and I’m trying to have a program of acceptance. I can’t do anything about it just by my paralysis. I’m still active, but I’m limited in what I can and can’t do. But like I say, I forget, I forget more and as one gets older, that, that tends to, you know, go with the aging. So, I mean I, I can’t blame it on my lifestyle or my, my past trauma, or age, or what; it just is. And I accept that, and go on with life, but it’s very frustrating. When I get up from watching TV, and go get another cup of coffee, or beer, or glass, you know, whatever I’m drinking, and I’m in the kitchen, “What did – what am I doing? Why did I, why did I come in here? Oh, shit.” You know, so I go back to then TV. “Oh yeah, that’s right,” you know?

But I found out – you know, here I am, you know, quite a bit of education. And you know, that line, this psychological thing. And caveman – he goes out to hunt. He gets saber tooth tiger – you know, leaves the campfire and, and old lady and kids, or something like that. And his focus is in – this is a survival, it’s in our genes, survival. He doesn’t think about the campfire and all that. Well this is a carry-over from our, it’s a survival thing. Now head injuries probably, you know, exacerbate that. But it’s natural for a person to get up and go someplace and then, you know, he forgets, well he forgot what he was doing because - it’s like, I’m terrible at multi-tasking. Use to be able to, can’t now. I mean it’s all I can do to do one thing at a time. But I used to do, whatever that one thing pretty well. And of course, I can do two things at once, but it’s harder splitting my attention. And, but like I say, I’m sixty-eight and I’m not going to attribute it to any one cause, and all that. That’s just the way it is.

(See also: Coping with Impacts on Memory & Cognitive Function; Medications for Mood, Concentration & Thinking; Seeking Professional Help for Emotional & Mental Health)