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.
"By and large women had higher fatigue scores than men, which is to be expected according to results in earlier studies  . The associations found between IHD, stroke and fatigue were also consistent with earlier findings  . However, it is interesting that type 1 diabetes was found to be an independent predictor of fatigue when controlling for the age, sex, smoking, stroke and IHD. "
[Show abstract][Hide abstract] ABSTRACT: Abstract Aims Type 2 diabetes has been linked to fatigue, but results on type 1 diabetes are ambiguous. Our aim was to determine if type 1 diabetes is associated with fatigue and whether the fatigue is due to complications or to the disease itself. Methods The Multidimensional Fatigue Inventory (MFI-20), was submitted to all 435 adult patients with type 1 diabetes in the National Diabetes Register at the Sunderby Hospital clinic and to a control group of 2500 persons. The participation rate was 62% in both groups. Results Type 1 diabetes was associated with greater fatigue, with a 1.4-point difference (0.9-1.9, 95% CI) in general fatigue on a scale of 4-20. Type 1 diabetes was an independent predictor of fatigue, as were cardiovascular and cerebrovascular disease. Women with long diabetes duration but without complications experienced more fatigue than women in the general population (difference in general fatigue = 2.5, p = 0.021), whereas men showed no significant difference. Conclusions Type 1 diabetes is associated with greater fatigue, partly ascribed to vascular disease. Type 1 diabetes of long duration might be associated with fatigue regardless of classical complications, but further research is needed to confirm results.
Journal of Clinical and Translational Endocrinology 09/2015; 2(3):105-109. DOI:10.1016/j.jcte.2015.06.001
"There is an inadequate understanding of the relationship between PSF and PSD. Although fatigue and depression are undoubtedly associated, research has shown that each of these sequelae can occur in the absence of the other (Choi-Kwon et al. 2005; Ingles et al. 1999; Ormstad et al. 2012; van der Werf et al. 2001). However, the nature of this relationship remains unclear. "
[Show abstract][Hide abstract] ABSTRACT: Many stroke survivors suffer from poststroke fatigue (PSF) and poststroke depression (PSD), indicating the importance of increasing the base of knowledge about the mechanisms underlying these sequelae. The primary aim of this study was to determine whether activation of the kynurenine (KYN) pathway predicts subsequent fatigue or depression in acute ischemic stroke (AIS) patients. Acute serum levels of 5-hydroxytryptamine (5-HT), tryptophan (TRP) catabolites (TRYCATs), and competing amino acids, as well as subsequent fatigue and depression, were measured in 45 stroke patients. TRP index [=100 × TRP / (tyrosine + valine + phenylalanine + leucine + isoleucine)] was significantly lower in patients with a Fatigue Severity Scale (FSS) score of ≥4 at 12 months than in those with an FSS score of <4 (p = 0.039). Furthermore, the serum level of kynurenic acid in the acute stroke phase was significantly higher in patients with an FSS of score ≥4 at 18 months than in those with an FSS score of <4 (p = 0.026). These findings indicate that stroke patients with PSF have a lower bioavailability of TRP for 5-HT synthesis in the brain in the acute stroke phase. However, they also appear to have greater neuroprotective potential in that phase. In contrast to PSF, no predictors of PSD were found. These findings together with those of previous studies suggest that the immune response and indoleamine 2,3-dioxygenase activation that follows AIS can predict PSF but not PSD.
"Nevertheless, fatigue can also occur in the absence of depression, a dissociation already highlighted in patients with Parkinson's disease (Friedman and Friedman, 1993) or multiple sclerosis(Van der Werf et al., 1998, Vercoulen et al., 1996) and which is equally valid in stroke patients (Ingles et al., 1999, Van der Werf et al., 2001). For example, only 38% of patients with severe fatigue after a stroke were found to be depressed (Van der Werf et al., 2001) and 57% of non-depressed patients reported frequent fatigue (Crosby et al., 2011). "
[Show abstract][Hide abstract] ABSTRACT: To explore the potential relationship between fatigue following strokes and poststroke mood, cognitive dysfunction, disability, and infarct site and to determine the predictive factors in the development of poststroke fatigue (PSF) following minor infarcts.
Ninety-nine functionally active patients aged less than 70 years with a first, nondisabling stroke (NIH Stroke Scale score ≤6 in acute phase and ≤3 after 6 months, modified Rankin Scale score ≤1 at 6 months) were assessed during the acute phase and then at 6 (T1) and 12 months (T2) after their stroke. Scores in the Fatigue Assessment Inventory were described and correlated to age, gender, neurologic and functional impairment, lesion site, mood scores, neuropsychological data, laboratory data, and quality of life at T1 and T2 using a multivariate logistic regression analysis in order to determine which variables recorded at T1 best predicted fatigue at T2.
As many as 30.5% of the patients at T1 and 34.7% at T2 (11.6% new cases between T1 and T2) reported fatigue. At both 6 and 12 months, there was a significant association between fatigue and a reduction in professional activity. Attentional-executive impairment, depression, and anxiety levels remained associated with PSF throughout this time period, underlining the critical role of these variables in the genesis of PSF. There was no significant association between the lesion site and PSF.
This study suggests that attentional and executive impairment, as well as depression and anxiety, may play a critical role in the development of PSF.
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