Krista Kurt
10/20/2025
Professor D’Argenio
Cognitive Psychology 200
John Jay College of Criminal Justice
Abstract
Stroke and psychosis are both leading causes of disability and permanent disability worldwide. Stroke and psychosis impair cognitive functioning and memory due to the structural changes they cause to the brain as a result from the damage they inflict. While they commonly occur as independent conditions in most patients, an under researched connection and correlation between the two exists. The hippocampus, which is the part of the brain responsible for memory and learning, suffers structural changes such as reduced volume and functional circuit disruption when affected by psychosis which inevitably results in memory and cognitive impairment. A stroke can also damage the hippocampus specifically, but a stroke can affect any part of the brain damaging overall brain tissue which disrupts the neural pathway network that is responsible for memory. Both conditions on their own cause permanent structural changes to the brain leading to functional circuit disruption which inhibits the brain’s ability to create new memories or remember old ones, problems with maintaining attention, inability to maintain concentration, trouble with information processing/information retention, problems with speech such as aphasia or being unable to hold conversations, struggles with handwriting/motor skills and overall executive functioning impairment.
Often these conditions are not seen as related yet suffering from psychosis can increase your risk for stroke and neurodegenerative diseases such as Alzheimer’s while a stroke simultaneously increases the risk for psychosis and the onset of psychiatric conditions. There are cases of strokes affecting direct parts of the brain such as the right hemisphere, parietal, frontal or temporal lobe that can lead to psychotic symptoms and in cases of silent strokes psychosis can be the only lifesaving indication of the stroke occurring and not going unnoticed by medical professionals. Also, many antipsychotic medications used to treat psychotic symptoms increase the risk for stroke as well making the relation between these two disabling neurological conditions complex and somewhat intertwined.
Introduction
In this paper I will explore the multiple ways that stroke and psychosis both severely impair cognitive functioning and memory, differentiating the clinical distinctions between them, while also showing the connection between the two conditions. After reading this paper you will have a better understanding of what psychosis and stroke are, what parts of the brain are affected by them, how that correlates to cognitive decline and memory dysfunction, their differences and similarities and the connection that exists between neurodegenerative and psychiatric diseases. This paper is to provide insight into the way stroke can not only be accompanied by psychotic symptoms but also increase the risk of onset for psychiatric disorders and how psychosis also increases the risk for stroke. Psychosis and strokes cause severe permanent cognitive disability and memory loss with outcomes for both conditions statistically showing a low likelihood of recovery or improvement. Being able to identify the correlation and causation between psychiatric symptoms and strokes can help medical professionals identify stroke or psychosis onset or even help identify a silent stroke that may have gone unnoticed, making a major difference in diagnosis and patients recovery success- especially when time is of the essence.
The longer a patient is suffering from a stroke or psychosis the worse or prolonged the damage will be, leading to worse outcomes, permanent disability and less likelihood of recovery. Considering strokes are also a leading cause of mortality, this information can not only prevent severe cognitive dysfunction with earlier detection but can also be the difference between life or death for some patients. The quicker medical professionals can help patients with careful evaluation of their symptoms for accurate diagnosis, the better long term cognitive outcomes and recovery will be.
Strokes Impair Memory and Cognitive Functioning
A stroke is a medical emergency sometimes referred to as a cerebrovascular accident (CVA) that occurs when blood flow to the brain is interrupted. Ischemic strokes occur when a blood clot blocks an artery in the brain and a hemorrhagic stroke occurs when a blood vessel in the brain bursts. Stroke is a significant health concern across the globe resulting in permanent disability, mortality and cognitive impairment such as memory deficits, issues with attention, problems with executive functioning, language production and visuospatial skills (Ann Med Surg, Nov 2023.) Depending on the area of the brain stroke affects and the severity of the stroke determines specific cognitive deficits individuals may face. For example, strokes that affect the frontal lobe may lead to issues with executive functioning while strokes involving the temporal lobe may lead to memory impairment. Vascular risks like high blood pressure, diabetes, smoking, and atrial fibrillation (AF) also tend to be affiliated with cognitive decline and dysfunction. Other factors that contribute to strokes resulting in cognitive decline are cerebral hypoperfusion (deprivation of oxygen and blood flow to the brain causing damage to brain cells), white matter damage (which is responsible for facilitating communication and information transfer), and neuroinflammation (the central nervous system’s attempt to remove harmful stimuli and protect brain function).
If a stroke affects the hippocampus, which is the part of the brain responsible for memory and learning, it may have more symptoms related to memory loss, inability to make new memories, attention and concentration. If a stroke affects the occipital lobe, which is the area of the brain responsible for processing vision, it can cause blind spots or a loss of vision, distorted vision, inability to read or recognize letters, issues with spatial awareness and in some cases hallucinations or psychosis. If a stroke affects multiple other areas of the brain aside from the occipital lobe it can also occasionally result in psychotic symptoms.
Psychosis and Cognitive Impairment
Psychosis is when a person loses detachment from reality due to the brain having trouble filtering incoming information and predicting what’s likely to happen (Erin Digitale, Stanford Medicine, April 2024). The two main systems of the brain that are malfunctioning in people with psychosis are the filter to direct attention towards important external events and internal thoughts and the brain’s ability to predict events being composed of neural pathways that anticipate rewards. Functional outcomes for people with psychotic disorders or people who experience psychosis are often disappointing and cognitive impairment is one of the strongest determinants of overall recovery. The severity of cognitive decline and brain damage from this condition will determine the severity that their daily functioning and/or independence will be affected (Dialogues Clin Neurosci. Sep 2019.) Damage to the hippocampus from traumatic brain injury (TBI) can lead to dysregulation in dopaminergic circuits (neural pathways that use dopamine as a neurotransmitter to influence various functions like movement, reward, motivation and decision making) resulting in positive symptoms of post-injury psychosis- which are hallucinations and delusions (Brain Commun, Mar 2021.). Positive symptoms of psychiatric conditions, such as hallucinations, have been the primary focus of medical professionals treating psychosis while negative symptoms such as alogia (poverty of speech) and cognitive decline are less prioritized.
Psychosis leads to dysfunction in several brain regions but most prominently the limbic system leading to hippocampal atrophy (a shrinkage or loss of volume to the hippocampus which is responsible for memory and learning), structural changes to the temporal lobe such as reduced gray matter volume (the part of the brain responsible for processing sensory information, memory and emotion), compromised white matter in the frontal lobe which disrupts communication between brain areas, dysfunction in the prefrontal cortex (responsible for reasoning), loss of brain tissue, enlarged ventricles (the spaces in the brain that contain cerebrospinal fluid) and reduced cortical thickness in the brain which is a form of neurodegeneration that is also present in dementia and Alzheimer’s disease. Both psychosis, dementia and Alzheimer’s are linked to posterior cortical atrophy, which is the gradual and progressive degeneration of the outer layer of the brain and causes brain cells to die over time.
Stroke and Psychosis Are Bidirectional
Neuropsychiatric symptoms such as depression, anxiety, fatigue and apathy are common in patients who experience stroke occurring in more than 30% of stroke survivors (The Journal of Neuropsychiatry and Clinical Neurosciences, July 2021). Psychotic symptoms presenting after stroke currently range from 1% to 5.3%. However, when present in patients with no prior psychiatric history these symptoms tend to be underdiagnosed and undertreated meaning the numbers are likely higher. The underdiagnosis and undertreatment also leads to worse outcomes and further cognitive decline for patients with the condition. Oftentimes when a stroke affects the right hemisphere of the brain it tends to increase the risk of poststroke psychosis which also increases the likelihood of permanent cognitive disability that severely impairs daily functioning and life quality. Poststroke psychosis is more prevalent than previously recognized and not only is it associated with poorer functional outcomes but also an increased risk of mortality among stroke victims- making it more likely to be fatal.
A retrospective cohort study found that patients with poststroke psychosis compared to patients without psychiatric disorders were 51% more likely to die during the 10-year follow-up period (July 2021). Patients with poststroke psychosis have lower survival rates compared with other stroke survivors. In another study out of 134 patients with poststroke psychosis 79% had right-hemispheric lesions with the right parietal lobe affected most frequently. While stroke that affects specific parts of the brain can increase the risk of psychosis resulting in further cognitive decline and more acute cognitive disability, psychiatric disorders may also be associated with an elevated risk of stroke. In a total of 36 cohort studies, it was noted that depression, schizophrenia and bipolar disorder are linked to an increased risk for stroke (Front. Neurol, Dec 2024). The significant connection between psychiatric disorders and elevated risk of stroke leads to the importance of medical professionals carefully monitoring stroke prevention in patients with these conditions. The relationship between psychosis and stroke is considered bidirectional, meaning a history of psychosis is associated with increased risk for stroke while stroke itself can lead to psychosis. Both stroke and psychosis can be a predictor of developing one or the other and the presence of both conditions leads to more severe and permanent deficits in memory and cognitive functioning.
Conclusion
There is a clear relationship between psychiatric disorders and neurodegenerative diseases. If a patient has history of either medical condition their risk is increased. Traumatic Brain Injury can also lead to psychosis which in turn can increase the risk of stroke, Alzheimer’s and dementia. Understanding this significant link may help medical professionals with diagnosis, decrease prolonged brain damage, decrease mortality, minimize cognitive decline and memory loss, decrease the chance of permanent disability and lead to better outcomes regarding patients daily functioning and life quality.
References
- Annals of Medicine & Surgery, Elendu C, Amaechi DC, Elendu TC, Ibhiedu JO, Egbunu EO, Ndam AR, Ogala F, Ologunde T, Peterson JC, Boluwatife AI, Okongko AO, Fatoye JO, Akpovona OL, Onyekweli SO, Temitope AY, Achimugu AO, Temilade AV. Stroke and cognitive impairment: understanding the connection and managing symptoms. Ann Med Surg (Lond). 2023 Nov 1;85(12):6057-6066. doi: 10.1097/MS9.0000000000001441. PMID: 38098605; PMCID: PMC10718363.
- Brain Communications, Bray MJC, Sharma B, Cottrelle’s J, Peters ME, Bayley M, Green REA. Hippocampal atrophy is associated with psychotic symptom severity following traumatic brain injury. Brain Commun. 2021 Mar 9;3(2):fcab026. doi: 10.1093/braincomms/fcab026. Erratum in: Brain Commun. 2021 Jun 25;3(2):fcab122. doi: 10.1093/braincomms/fcab122. PMID: 33977261; PMCID: PMC8098106.
- Dialogues in Clinical Neuroscience, McCleery A, Nuechterlein KH. Cognitive impairment in psychotic illness: prevalence, profile of impairment, developmental course, and treatment considerations . Dialogues Clin Neurosci. 2019 Sep;21(3):239-248. doi: 10.31887/DCNS.2019.21.3/amccleery. PMID: 31749648; PMCID: PMC6829172.
- Erin Digitale, Stanford Medicine, Psychiatry & Mental Health, April 12, 2024
- Frontiers Neurology, @ARTICLE{10.3389/fneur.2024.1444862, AUTHOR={Hu, Zhonghou and Sun, Weishan and Cui, Enxiu and Chen, Bo and Zhang, Mi },TITLE={Association between psychiatric disorders and the risk of stroke: a meta-analysis of cohort studies, JOURNAL={Frontiers in Neurology}, VOLUME={Volume 15 – 2024}, YEAR={2024}, URL={https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2024.1444862}, DOI={10.3389/fneur.2024.1444862}, ISSN={1664-2295},
ABSTRACT={BackgroundPsychiatric disorders may be associated with an elevated risk of stroke; however, the existence of variations in this association between different populations remains controversial. Consequently, we conducted a comprehensive systematic review and meta-analysis to examine the magnitude of the relationship between psychiatric disorders and the risk of stroke.MethodsThe PubMed, Embase, and Cochrane Library databases were systematically searched to identify eligible studies from inception to April 2024. The aggregated findings were expressed as relative risks (RRs) with 95% confidence intervals (CIs), and the combined analysis was performed using a random-effects modeling approach. Further exploratory analyses were also performed using sensitivity and subgroup analyses.ResultsA total of 36 cohort studies, involving 25,519,635 individuals, were selected for analysis. We noted that depression (RR: 1.50; 95% CI: 1.34–1.68; p < 0.001), schizophrenia (RR: 1.74; 95% CI: 1.36–2.24; p < 0.001), and bipolar disorder (RR: 1.65; 95% CI: 1.27–2.14; p < 0.001) were associated with an elevated risk of stroke. Further exploratory analyses found that the association between depression and the risk of stroke differed according to the adjusted level (RR ratio: 0.77; 95% CI: 0.61–0.98; p = 0.034), and the association between schizophrenia and the risk of stroke differed according to the outcome definition (RR ratio: 0.68; 95% CI: 0.52–0.90; p = 0.006). Moreover, the association between bipolar disorder and the risk of stroke differed according to the study design (RR ratio: 0.68; 95% CI: 0.55–0.84; p < 0.001).ConclusionThe significant association between psychiatric disorders and an elevated risk of stroke highlights the importance of enhanced monitoring and stroke prevention in patients with psychiatric disorders.Systematic review registrationOur study was registered on the INPLASY platform (number: INPLASY202450049).}}
- Journal of Clinical Neurology, Kim JS, Hong SB, Park KW, Lee ATC. Psychotic Symptoms in Patients With Major Neurological Diseases. J Clin Neurol. 2024 Mar;20(2):153-165. doi: 10.3988/jcn.2023.0501. PMID: 38433485; PMCID: PMC10921039.
