Experience of Severe Fatigue Long after Stroke and Its Relation to Depressive Symptoms and Disease Characteristics

Abstract

Although the experience of abnormal fatigue is recognised as a major disabling symptom in many chronic neurological diseases, little is known about the persistence of severe fatigue after an abrupt neurological incident like a stroke. Therefore, the objectives of this study were to test whether the experience of severe fatigue persists long after a stroke has occurred, and to assess the relation between experienced fatigue and levels of physical impairment and depression. Ninety stroke outpatients and 50 controls returned mailed questionnaires. Compared to age-matched controls, a significantly larger proportion (16 vs. 51%) of the stroke respondents experienced severe fatigue, while 20% of the patients and 16% of the controls had elevated depression symptom scores. The time which had elapsed since the stroke occurred could not explain levels of fatigue. In the control group, the number of depressive symptoms explained most of the variance in levels of fatigue, while impairment of locomotion explained most of the variance in the stroke group.

Inflammation and the Silent Sequelae of Stroke

“…First, PSF is more prevalent than PSD, meaning that there is a subset of patients with stroke who develop fatigue without being depressed. For instance, in a study of patients who were at least a year poststroke, only 38% of the patients with fatigue were depressed [9]. Second, effective treatment of PSD by pharmacologic means does not eliminate PSF [14,15].…”

“…Most studies of PSD are cross-sectional; the longitudinal studies that have been done tend to be small and have limited follow-up [4]. Fatigue, defined as a feeling of weariness, tiredness, or lack of energy, affects up to three-quarters of patients who suffer stroke [5][6][7][8][9][10][11][12]. Similar to PSD, most studies of PSF are cross-sectional in design and do not adequately address the natural history of PSF [13].…”

Cognitive and Graded Activity Training Can Alleviate Persistent Fatigue After Stroke

“…Patients were eligible if they (1) had sustained a stroke Ͼ4 months before recruitment, (2) reported severe fatigue (Checklist Individual Strength-subscale Fatigue score Ն40), 7,17 (3) were between ages 18 -70 years, and (4) were able to walk independently. Patients were excluded if they had severe cognitive deficits (Behavioral Inattention Test Յ129, Rivermead Behavioral Memory Test-screening score Ͻ8, Behavioral Assessment of the Dysexecutive Syndrome less than borderline, Token Task Ͼ12) 18 or severe comorbidity, such as cardiac disease, pulmonary disease, or depression (Hospital Anxiety and Depression Scaledepression subscale score Ͼ10, 19 or based on a clinical DSM-IV interview 20 if the Hospital Anxiety and Depression Scale (HADS) depression subscore was 8, 9, or 10).…”

“…The CIS-f has good reliability, is sensitive to change, 3,17 and has been validated for the stroke population. 7,9 Questions are answered on a 7-point Likert scale (1-7; summed range, 8 -56; higher scores represent greater fatigue). Patients with a score Ն40 were regarded as severely fatigued.…”

Poststroke Fatigue Is Still a Neglected Issue: Findings from an Internet-Based Study on the Need for Information and Treatment in The Netherlands

“…Prevalence rates of poststroke fatigue (PSF) are substantial, varying between 38 and 73% [4]. These rates seem to be stable over time, with no marked decline after the postacute stage to even years following the injury [5][6][7][8][9]. As no unequivocal associations with clinical or demographical variables, such as stroke type, age, sex, or education, have been found, all patients who have experienced a stroke may be at risk to develop this symptom [4].…”