Fitness, depression, and poststroke fatigue: Worn out or weary?

From The Florey Institute for Neuroscience and Mental Health (A.B.), Melbourne Brain Centre, Heidelberg, Australia
Neurology (Impact Factor: 8.29). 09/2013; 81(18). DOI: 10.1212/WNL.0b013e3182a9f59b
Source: PubMed


Each year, around 15 million people worldwide have a stroke. Of these, at least 5 million die, a third remain disabled, and the remainder make a good recovery.(1) Yet more than half of all these 10 million survivors will have fatigue, one of the most debilitating, but least studied, poststroke symptoms. Poststroke fatigue (PSF) is a multifaceted phenomenon.(2) It has been correlated with lowered mood, as well as being influenced by other factors, like age, sex, and cognition. Many researchers have demonstrated that the presence of fatigue negatively influences quality of life, return to work, and perhaps mortality.(3,4) However, most studies have been conducted cross-sectionally, in the subacute or chronic phase after stroke.(4-6.)

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    ABSTRACT: To determine whether fatigue in the acute phase following stroke predicts long-term patient-reported physical and mental health outcomes 18 months later. Patients (n = 96, mean age 67.8 years, SD 12.9) were assessed within 2 weeks of hospital admission for first-ever stroke (acute phase) and 18 months later. Measures included the Fatigue Severity Scale and the Beck Depression Inventory II. The Short Form-36 was used to assess self-reported physical and mental health. Multivariate regression analysis was used to evaluate the relationship between acute phase fatigue and later health outcomes, controlling for relevant covariates. Acute phase fatigue was associated with physical health at 18-month follow-up, but not with mental health. After adjusting for other potential predictors of health outcomes, including age, sex, cohabitation status, acute phase physical or mental health, and depressive symptoms, acute phase fatigue remained a significant predictor of later physical health but not of later mental health. The reverse relationships were also examined, but neither physical nor mental health in the acute phase predicted fatigue at 18 months; the best predictor of fatigue at 18-month follow-up was acute phase fatigue. These findings suggest that acute phase fatigue is an independent risk factor for poor physical health 18 months after stroke. Diagnosis and treatment of acute phase fatigue may improve physical health-related quality of life among stroke survivors. Effective treatments for poststroke fatigue, both in the acute phase and later in the recovery period, are needed.
    Neurology 09/2013; 81:1581-1587. DOI:10.1212/WNL.0b013e3182a9f471 · 8.29 Impact Factor