Understanding Cognitive Fatigue After Stroke: Doug’s Journey to Doug 2.0

For many stroke survivors, the most challenging part of recovery isn’t always physical—it’s the mental exhaustion that follows them day after day. This deep, unshakable tiredness is known as cognitive fatigue, and it affects countless people who appear “fine” on the outside but are working incredibly hard behind the scenes just to function.

One stroke survivor who knows this all too well is Doug Mitchell.

What Is Cognitive Fatigue?

Cognitive fatigue is a kind of mental exhaustion that goes far beyond being “tired.” It affects your ability to think clearly, stay focused, solve problems, and complete everyday tasks. After a stroke, the brain works harder to reroute and compensate for damaged areas. Even simple activities like holding a conversation, reading a sentence, or planning a meal can feel like climbing a mountain.

Unlike physical fatigue, cognitive fatigue is invisible. It’s not something people can see—but you feel it deeply. And unfortunately, it’s often misunderstood by others who don’t know what it’s like to live with a brain that’s trying to heal.

Doug’s Story: The Invisible Stroke

Doug Mitchell lived with cognitive fatigue for two years before realizing what had happened to him. He went to the hospital thinking he might be having a heart attack, only to learn he’d had three strokes—and never knew it. The strokes were caused by a hole in his heart, and they impacted three areas of his brain, leaving him with 90% cognitive and 10% physical deficits.

Doug calls his experience an “invisible stroke” because, from the outside, he looked fine. But inside, his brain was struggling with memory, attention, task initiation, and mood regulation.

One of the hardest moments for Doug was undergoing a neuropsychological assessment. He thought he had aced the test. But the results showed he had lost his executive function—a term that includes abilities like decision-making, multitasking, and emotional regulation. These are exactly the areas impacted by cognitive fatigue.

The Power of Acceptance and Doug 2.0

For the first two years, Doug was in denial. He couldn’t believe he’d had a stroke. In his words:

“I’m a man. There’s no way I had a stroke. I looked fine. I felt fine.”

That changed when he participated in a stroke survivor-led writing group. During one of the sessions, he wrote a story inspired by the prompt: “How did I get here?” What came from that was a powerful metaphor that he now shares with others:

Imagine yourself before stroke as a pristine piece of paper—smooth, unblemished.
Then crumple it up.
That’s your reality after stroke: wrinkled, changed, but still useful.
Flatten it out, and it becomes Doug 2.0—never the same as before, but still capable of writing a beautiful new story.

How Doug Manages His Cognitive Fatigue

Doug shared several strategies that help him manage his energy and improve his quality of life:

• Chunking tasks: Breaking his day into small, manageable pieces. For example, prepping ingredients in the morning, restin