Cognition is the act of knowing or thinking. Cognitive abilities include the ability to choose, understand, remember and use information. Cognition also includes attention and concentration; the ability to process and understand information; memory; communication; planning, organizing, and assembling; the ability to utilize reasoning, problem-solving, decision-making, and judgment; and the ability to controlling impulses and desires and being patient.

Cognitive consequences of TBI depend greatly on what regions of the brain the injury affects. The severity of the injury also significantly effects what cognitive difficulties patient experiences and the extent of those cognitive difficulties. In general, cognitive deficits are greatest in the weeks and months following the brain injury, with improvements generally noted over time. Neuropsychological testing can be helpful in identifying cognitive strengths and weaknesses and clarifying how cognitive difficulties may impact work/school functioning, and/or monitoring changes over time.

Specific cognitive deficits that are often associated with TBIs include:

Trouble paying attention and concentrating  

An individual with TBI may have difficulty focusing, paying attention, or attending to more than one thing at a time. Difficulty concentrating may lead to restlessness and being easily distracted or they may have difficulty finishing a project or working on more than one task at a time.  Problems carrying on long conversations or sitting still for long periods of time may be noticed.

Attention and concentration may be improved over time with techniques such as decreasing distractions and focusing on one task at a time; practicing attention skills on simple, yet practical activities (such as reading a paragraph or adding numbers) in a quiet room and gradually attempting harder tasks (such as read a short story or balance a checkbook) or by working in a more noisy environment.  Often taking breaks when the individual becomes tired is noticed.

Feeling confused or mentally “foggy”; Slowed thinking speed; Problems understanding others

After a brain injury, a person’s ability to process and understand information often slows down. These complications may result in an individual requiring more time to grasp what others are saying or requiring more time to understand and follow directions.  They may have trouble following television shows, movies, etc. or require more time to read and understand written information including books, newspapers or magazines

There may be delays in reaction time; and being slower to carry out physical tasks including routine daily living activities such as getting dressed or cooking. An individual’s delayed reaction time is especially important for driving, which may become unsafe if the person cannot react fast enough to stop signs, traffic lights or other warning signs. Individuals with TBI should not drive until their visual skills and reaction time have been tested by a specialist.

Problems remembering and/or selecting the proper words and speech

Communication problems may cause individuals with TBI to have difficulty understanding and expressing information. Individuals may have problems thinking of the right word; trouble starting or following conversations or understanding what others say; rambling or getting off topic easily; difficulty with more complex language skills, such as expressing thoughts in an organized manner.

You may notice trouble communicating thoughts and feelings using facial expressions, tone of voice and body language (non-verbal communication).  They may have problems reading others’ emotions and not responding appropriately to another person’s feelings or to the social situation and may misunderstand jokes or sarcasm.

Learning and memory difficulties

Individuals with TBI may have trouble learning and remembering new information and events. Individuals may have problems remembering events that happened several weeks or months before the injury (although this often comes back over time). Individuals with TBI are usually able to remember events that happened long ago, but may have problems remembering entire events or conversations. In these instances, the mind tries to “fill in the gaps” of missing information and recalls things that did not actually happen. Sometimes bits and pieces from several situations are remembered as one event. These false memories are not lies.

Techniques for improving memory problems include:

  • Organizing a structured routine of daily tasks and activities
  • Using memory aids such as memory notebooks, calendars, daily schedules, daily task lists, computer reminder programs and cue cards
  • Devoting time and attention to review and practice new information often
  • Being well rested and trying to reduce anxiety as much as possible
  • And speaking with your doctor about how medications may affect your memory.

Difficulty completing complex tasks

Persons with TBI may have difficulty planning their day and scheduling appointments. They may have trouble with tasks that require multiple steps done in a particular order, such as laundry, managing a checkbook, driving or cooking.

Individuals with TBI may have difficulty recognizing when there is a problem, which is the first step in problem-solving. They may have trouble analyzing information or changing the way they are thinking (being flexible). When solving problems, individuals may have difficulty deciding the best solution or focusing on one solution and not considering other, better options. Individuals may also make quick decisions without thinking about the consequences, or not use the best judgment.

Inability to understand one’s own impairments

Individuals with TBI may lack self-control and self-awareness, and as a result may behave inappropriately or impulsively in social situations. Individuals may deny they have cognitive problems, even if these are obvious to others. Individuals may say hurtful or insensitive things, act out of place, or behave in inconsiderate ways. Individuals may lack awareness of social boundaries and others’ feelings, such as being too personal with people they don’t know well or not realizing when they have made someone uncomfortable.

Other cognitive difficulties

Individuals with TBI may experience include problems judging distances and getting lost in familiar places.