Do they get better after having a stroke or do they get worse?

My sister-in-law (SIL) experienced a ruptured cerebral aneurysm followed by three small strokes at age 42. The strokes damaged her right side motor control, vision, and left some minor aphasia when speaking; we were very lucky her personality and memory from before the strokes remained intact. Initially she was in a type of "fog" from the brain injury and co-operated with physical therapy (she retained no memory of this period). As she healed from the initial injury and became fully aware of her situation, she became very depressed and didn't want to get off the couch. Unfortunately, her husband supported her getting released from rehab against medical advice and took her home to veg on the couch. Over the next several months she spent mainly on the couch, SIL lost a lot of mobility she had gained during rehab, then muscle tone, and finally decided she didn't want to live anymore. I finally convinced her there were days ahead worth living for even from a wheelchair if needed: college graduation days, her children's wedding days, the births of her grandchildren, the days watching those kids playing in the yard. She got better, able to walk slowly with a ankle brace and a half crutch, getting enough muscle tone back in her shoulder so it could support her arm and not painfully pinch the nerves, then rolling around her house on an office chair. When her son started bringing his clothes home from college for her to wash, she really turned the corner and starting taking care of her house and cooking again. Every year was an improvement but the next big step was when the grandchildren began arriving. She had a good quality of life for a number of years, then one afternoon her fall detector alarm went off and when the neighbor got there she was having a seizure and died in the hospital without ever regaining consciousness.

My understanding is depression is a natural chemical reaction to a brain injury. Depression is also a natural reaction to finding your body no longer responding to your commands. I believe people with brain injuries need medication and people to "push" them through the difficult stroke aftermath. There can be some improvement even years after a stroke.

On the other hand, my father had a series of TIAs or mini-strokes beginning in his mid-50s and developed vascular dementia; his first brain scan at age 63 showed 8 medium sized "dead" areas in his brain and 6 smaller ones. Although his memory remained mostly intact, his personality changed and he loss a lot of balance, executive function, and reasoning/decision making abilities. Stuff he did easily for decades became beyond his capabilities. Dad never improved, only declined. Vascular dementia can be very strange as some brain functions remain completely intact or nearly so while others are just as completely lost.

Hope, it can go either way. Much depends on how bad the stroke was and on what centers are hit. As a nurse we pretty much came to think that the most spontaneous and the best recovery happened in the early weeks after stroke; primarily this was because the injury caused some swelling to the brain, and when the swelling subsided the brain did some recovering. Usually the first three weeks could tell what would come back easily. Often the other stuff had to be worked for very hard. Of course when you add depression, then you have even more problems. Some people honestly DO give up and would as soon not go on. After one year, quite honestly, it is unlikely your Aunt will get a lot better; they tend to stop intensive therapies before that time frame. Then, with time, you get muscle wasting, and there honestly isn't the strength to get a lot of work in to get better. You do not mention if your Aunt was quite well before the stroke? This would make this change profound and so shocking. You don't mention her limitations. Or her age. Has she had to make huge changes to where she lives and so on? This would add to the problems. Wishing you good luck. Each case is as individual as a thumbprint really. Good luck to your Aunt; sorry for how hard this is to see happen to her.

Very often, strokes have side effects of depression and sometimes vascular dementia. At the acute rehab mom was in, they started an anti-depressant as soon as she was admitted as part of their protocol.

Has she been seen by a geriatric psychiatrist?