Risk factors for early-onset and late-onset fatigue after a stroke

Abstract

BACKGROUND. Post-stroke fatigue is a predictor of adverse outcomes such as high mortality, worse functional outcome and daily living dependence. It is a heterogeneous syndrome that changes over time, as demonstrated by studies.

AIM. The aim of the study was to assess dynamic changes of risk factors related to post-stroke fatigue during a year after first-ever stroke.

MATERIALS AND METHODS. This study formed a section of a prospective observational study involving of a cohort of 348 patients experiencing their first-ever stroke (53.2% male, 46.8% of female, with a mean age of 66±12 years). During the acute stroke period, 75 patients completed the Fatigue Severity Scale (FSS). Additionally, 19 patients completed the FSS at both 3 and 6 months after their stroke, while 33 patients did so at 12 months post-stroke. The neurological (NIHSS, Rankin) and psychiatric (HDRS, HARS) evaluation scores, pain scores measured with visual analogue scales, cognitive test results (MMSE, TMT-B) taken at the same time point, and locus control testing were compared with these findings. Spearman coefficient was utilized. The relationship between fatigue and depression (DSM-IV), stroke location, and patients’ demographic characteristics were tested with a χ²-test to avoid partiality.

RESULTS. Fatigue following a stroke during the acute stage showed an association with pain, depression, anxiety scores and complaints about cognitive dysfunction prior to the stroke. In contrast, late-onset fatigue (12 months post-stroke) demonstrated a link with medical locus of control and more severe neurological deficit.

CONCLUSION. Post-stroke fatigue manifests as a heterogeneous syndrome, characterized by changes in risk factors over time. Due to its complexity, accurate assessment necessitates the use of modern technologies, such as EMA and digital phenotyping.

Keywords

asthenic syndrome / depression / post-stroke fatigue / risk factors

References

[1] Feigin VL, Forouzanfar MH, Krishnamurthi RV et al. Global and regional burden of stroke during 1990–2010: Findings from the Global Burden of Disease Study 2010. Lancet. 2014;383:245–255.

[2] Feigin V.L., Forouzanfar M.H., Krishnamurthi R.V. et al. Global and regional burden of stroke during 1990–2010: Findings from the Global Burden of Disease Study 2010 // Lancet. 2014. Vol. 383. P. 245–255.

[3] Lackland DT, Roccella EJ, Deutsch AF et al. Factors influencing the decline in stroke mortality: A statement from the American heart association. Stroke. 2014;45:315–353.

[4] Lackland D.T., Roccella E.J., Deutsch A.F. et al. Factors influencing the decline in stroke mortality: A statement from the American heart association // Stroke. 2014. Vol. 45. P. 315–353.

[5] Glader EL, Stegmayr BD, Asplund KR. Poststroke fatigue: A 2-year follow-up study of stroke patients in Sweden. Stroke. 2002;33:1327–1333.

[6] Glader E.L., Stegmayr B.D., Asplund K.R. Poststroke fatigue: A 2-year follow-up study of stroke patients in Sweden // Stroke. 2002. Vol. 33. P. 1327–1333.

[7] White JH, Gray KR, Magin PA et al. Exploring the experience of post-stroke fatigue in community dwelling stroke survivors: A prospective qualitative study. Disabil Rehabil. 2012;34:1376–1384.

[8] White J.H., Gray K.R., Magin P.A. et al. Exploring the experience of post-stroke fatigue in community dwelling stroke survivors: A prospective qualitative study // Disabil. Rehabil. 2012. Vol. 34. P. 1376–1384.

[9] Wu S, Mead G, Macleod M. Model of understanding fatigue after stroke. Stroke. 2015;46:893–898. DOI: 10.1161/STROKEAHA.114.006647.

[10] Wu S., Mead G., Macleod M. Model of understanding fatigue after stroke // Stroke. 2015. Vol. 46. P. 893–898. DOI: 10.1161/STROKEAHA.114.006647.

[11] Carlsson G, Möller A, Blomstrand C. Consequences of mild stroke in persons <75 years — a 1-year follow-up. Cerebrovasc Dis. 2003;16:383–388. DOI: 10.1159/000072561.

[12] Carlsson G., Möller A., Blomstrand C. Consequences of mild stroke in persons <75 years — a 1-year follow-up // Cerebrovasc. Dis. 2003. Vol. 16. P. 383–388. DOI: 10.1159/000072561.

[13] Lagogianni C, Thomas S, Lincoln N. Examining the relationship betweenfatigue and cognition after stroke: A systematic review. Neuropsychol Rehabil. 2018;28:57–116. DOI: 10.1080/09602011.2015.1127820.

[14] Lagogianni C., Thomas S., Lincoln N. Examining the relationship betweenfatigue and cognition after stroke: A systematic review // Neuropsychol. Rehabil. 2018. Vol. 28. P. 57–116. DOI: 10.1080/09602011.2015.1127820.

[15] Holmberg J, Jondell B, Abzhandadze T. Very early cognitive screening and self-reported feeling of fatigue three months after stroke. Front Hum Neurosci. 2021;11(15):74–85. DOI: 10.3389/fnhum.2021.742105. PMID: 34858152. PMCID: PMC8632493.

[16] Holmberg J., Jondell B., Abzhandadze T. Very early cognitive screening and self-reported feeling of fatigue three months after stroke // Front. Hum. Neurosci. 2021. Vol. 11. N. 15. P. 74–85. DOI: 10.3389/fnhum.2021.742105. PMID: 34858152. PMCID: PMC8632493.

[17] Delva MY, Lytvynenko NV. Post-stroke fatigue and its dimensions over the second half year after stroke. Wiad Lek. 2018;71:314–317. PMID: 29786577.

[18] Delva M.Y., Lytvynenko N.V. Post-stroke fatigue and its dimensions over the second half year after stroke // Wiad. Lek. 2018. Vol. 71. P. 314–317. PMID: 29786577.

[19] Paciaroni M, Acciarresi M. Poststroke fatigue. Stroke. 2019;50(7):1927–1933. DOI: 10.1161/STROKEAHA.119.023552. PMID: 31195940.

[20] Paciaroni M., Acciarresi M. Poststroke fatigue // Stroke. 2019. Vol. 50. N. 7. P. 1927–1933. DOI: 10.1161/STROKEAHA.119.023552. PMID: 31195940.

[21] Choi-Kwon SA, Han SW, Kwon SU et al. Poststroke fatigue: Characteristics and related factors. Cerebrovasc Dis. 2005;19:84–90. DOI: 10.1159/000082784.

[22] Choi-Kwon S.A., Han S.W., Kwon S.U. et al. Poststroke fatigue: Characteristics and related factors // Cerebrovasc. Dis. 2005. Vol. 19. P. 84–90. DOI: 10.1159/000082784.

[23] Schepers VP, Visser-Meily AM, Ketelaar M. Poststroke fatigue: Course and its relation to personal and stroke-related factors. Arch Phys Med Rehabil. 2006;87:184–188. DOI: 10.1016/j.apmr.2005.10.005.

[24] Schepers V.P., Visser-Meily A.M., Ketelaar M. Poststroke fatigue: Course and its relation to personal and stroke-related factors // Arch. Phys. Med. Rehabil. 2006. Vol. 87. P. 184–188. DOI: 10.1016/j.apmr.2005.10.005.

[25] Hamilton M. A rating scale for depression. J Neurol Neurosurg Psychiatry. 1960;23(1):56–62. DOI: 10.1136/jnnp.23.1.56. PMID: 14399272. PMCID: PMC495331.

[26] Hamilton M. A rating scale for depression // J. Neurol. Neurosurg. Psychiatry. 1960. Vol. 23. N. 1. P. 56–62. DOI: 10.1136/jnnp.23.1.56. PMID: 14399272. PMCID: PMC495331.

[27] Hamilton M. The assessment of anxiety states by rating. Br J Med Psychol. 1959;32(1):50–55. DOI: 10.1111/j.2044-8341.1959.tb00467.x. PMID: 13638508.

[28] Hamilton M. The assessment of anxiety states by rating // Br. J. Med. Psychol. 1959. Vol. 32. N. 1. P. 50–55. DOI: 10.1111/j.2044-8341.1959.tb00467.x. PMID: 13638508.

[29] Brott T, Adams HP, Olinger CP et al. Measurements of acute cerebral infarction — a clinical examination scale. Stroke. 1989;20:864–870. DOI: 10.1161/01.str.20.7.864.

[30] Brott T., Adams H.P., Olinger C.P. et al. Measurements of acute cerebral infarction — a clinical examination scale // Stroke. 1989. Vol. 20. P. 864–870. DOI: 10.1161/01.str.20.7.864.

[31] Rankin J. Cerebral vascular accidents in patients over the age of 60. II. Prognosis. Scott Med J. 1957;2(5):200–215. DOI: 10.1177/003693305700200504.

[32] Rankin J. Cerebral vascular accidents in patients over the age of 60. II. Prognosis // Scott. Med. J. 1957. Vol. 2. N. 5. Р. 200–215. DOI: 10.1177/003693305700200504.

[33] Partington J, Leiter R. Partington’s pathway test. Psychol Serv Cent Bull. 1949;(1):9–20.

[34] Partington J., Leiter R. Partington’s pathway test // Psychol. Serv. Cent. Bull. 1949. N. 1. P. 9–20.

[35] Anciferov MB, Drobizhev MYu, Surkova EV et al. Lokus kontrol’ u bol’nyh saharnym diabetom. Ob”ektivnaya ocenka sub”ektivnogo otnosheniya k lecheniyu. Problemy Endokrinologii. 2002;48(4):23–27. (In Russ.) DOI: 10.14341/probl11563.

[36] Анциферов М.Б., Дробижев М.Ю., Суркова Е.В. и др. Локус контроль у больных сахарным диабетом. Объективная оценка субъективного отношения к лечению // Проблемы эндокринологии. 2002. Т. 48 №4. С. 23–27. DOI: 10.14341/probl11563.

[37] Alghamdi I, Ariti C, Williams A et al. Prevalence of fatigue after stroke: A systematic review and meta-analysis. Eur Stroke J. 2021;6(4):319–332. DOI: 10.1177/23969873211047681.

[38] Alghamdi I., Ariti C., Williams A. et al. Prevalence of fatigue after stroke: A systematic review and meta-ana-lysis // Eur. Stroke J. 2021. Vol. 6. N. 4. Р. 319–332. DOI: 10.1177/23969873211047681.

[39] Tseng BY, Billinger SA, Gajewski BJ, Kluding PM. Exertion fatigue and chronic fatigue are two distinct constructs in people post-stroke. Stroke. 2010;41:2908–2912. DOI: 10.1161/STROKEAHA.110.596064.

[40] Tseng B.Y., Billinger S.A., Gajewski B.J., Kluding P.M. Exertion fatigue and chronic fatigue are two distinct constructs in people post-stroke // Stroke. 2010. Vol. 41. Р. 2908–2912. DOI: 10.1161/STROKEAHA.110.596064.

[41] Acciarresi M, Bogousslavsky J, Paciaroni M. Post-stroke fatigue: Epidemiology, clinical characteristics and treatment. Eur Neurol. 2014;72(5):255–261. DOI: 10.1159/000363763. PMID: 25277765.

[42] Acciarresi M., Bogousslavsky J., Paciaroni M. Post-stroke fatigue: Epidemiology, clinical characteristics and treatment // Eur. Neurol. 2014. Vol. 72. N. 5. P. 255–261. DOI: 10.1159/000363763. PMID: 25277765.

[43] Carpenter RW, Wyco AM, Trull TJ. Ambulatory assessment: New adventures in characterizing dynamic processes. Assessment. 2016;23:414–424. DOI: 10.1177/1073191116632341.

[44] Carpenter R.W., Wyco A.M., Trull T.J. Ambulatory assessment: New adventures in characterizing dynamic processes // Assessment. 2016. Vol. 23, P. 414–424. DOI: 10.1177/1073191116632341.

[45] Chia AZR, Zhang MWB. Digital phenotyping in psychiatry: A scoping review. Technol Health Care. 2022;30(6):1331–1342. DOI: 10.3233/THC-213648.

[46] Chia A.Z.R., Zhang M.W.B. Digital phenotyping in psychiatry: A scoping review // Technol. Health Care. 2022. Vol. 30. N. 6. P. 1331–1342. DOI: 10.3233/THC-213648.

[47] Wang C, Trongnetrpunya A, Samuel IB et al. Compensatory neural activity in response to cognitive fatigue. J Neurosci. 2016;36(14):3919–3924. DOI: 10.1523/JNEUROSCI.3652-15.2016.

[48] Wang C., Trongnetrpunya A., Samuel I.B. et al. Compensatory neural activity in response to cognitive fatigue // J. Neurosci. 2016. Vol. 36. N. 14. P. 3919–3924. DOI: 10.1523/JNEUROSCI.3652-15.2016.

RIGHTS & PERMISSIONS

Eco-Vector