POST-STROKE FATIGUE: PREVALENCE, PREDISPOSING FACTORS, AND MANAGEMENT STRATEGIES
Abstract
Post-stroke fatigue (PSF) is a common and challenging condition that affects 42% to 53% of stroke survivors. It is characterized by persistent exhaustion that does not improve with rest and can significantly affect rehabilitation, daily activities, and overall quality of life. While the exact causes of PSF are not fully understood, various biological and physiological predisposing factors play a role in its onset. Biological factors include age, gender, stroke characteristics, and inflammatory responses, while physiological factors involve comorbidities, pre-stroke fatigue, and sleep disturbances. Psychological aspects, particularly depression and anxiety, are also closely linked to PSF, though their causative role is still debated. Diagnosis relies on subjective assessments, such as fatigue questionnaires, and objective measures, including electromyography (EMG) and electroencephalography (EEG). Management strategies include both pharmacological and non-pharmacological approaches. Dopamine reuptake inhibitors, such as modafinil, have shown potential benefits, whereas selective serotonin reuptake inhibitors, such as fluoxetine, have not demonstrated significant effects. Non-pharmacological approaches offer promising results in fatigue management, including physical exercise, cognitive behavioral therapy, psychoeducation, and transcranial direct current stimulation (tDCS). Given the multifactorial etiology of post-stroke fatigue, a multidisciplinary management strategy is essential. Optimizing recovery requires personalized interventions that combine pharmacological and non-pharmacological therapies tailored to the individual's specific clinical profile.
Keywords: post-stroke fatigue, rehabilitation, stroke
References
2. Chen W, Jiang T, Huang H, Zeng J. Post-stroke fatigue: A review of development, prevalence, predisposing factors, measurements, and treatments. Front Neurol. 2023;14:1298915. Available from: https://doi.org/10.3389/fneur.2023.1298915.
3. Su Y, Yuki M, Otsuki M. Non-pharmacological interventions for post-stroke fatigue: Systematic review and network meta-analysis. J Clin Med. 2020;9(4):567–78.
4. Tornero-Aguilera JF, Jimenez-Morcillo J, Rubio-Zarapuz A, Clemente-Suárez VJ. Central and peripheral fatigue in physical exercise explained: a narrative review. Int J Environ Res Public Health. 2022;19(7):3909. Available from: https://doi.org/10.3390/ijerph19073909.
5. Zając A, Chalimoniuk M, Gołaś A, Lngfort J, Maszczyk A. Central and peripheral fatigue during resistance exercise: A critical review. J Hum Kinet. 2015;49:159–69.
6. Tyagi O, Mehta RK. A methodological framework to capture neuromuscular fatigue mechanisms under stress. Front Neuroergon. 2021;2:779069. Available from: https://doi.org/10.3389/fnrgo.2021.779069..
7. Alghamdi I, Ariti C, Williams A, Wood E, Hewitt J. Prevalence of fatigue after stroke: a systematic review and meta-analysis. Eur Stroke J. 2021;6(3):319–32.
8. De Doncker W, Dantzer R, Ormstad H, Kuppuswamy A. Mechanisms of poststroke fatigue. J Neurol Neurosurg Psychiatry. 2018;89(3):287–93.
9. Usman JS, Wong TWL, Ng SSM. Relationships of post-stroke fatigue with mobility, recovery, performance, and participation-related outcomes: a systematic review and meta-analysis. Front Neurol. 2024;15:778899.
10. Hinkle JL, Becker KJ, Kim JS, Choi-Kwon S, Saban KL, McNair N, et al. Poststroke fatigue: emerging evidence and approaches to management: a scientific statement for healthcare professionals from the American Heart Association. Stroke. 2017;48(7):e159–70.
11. Kuppuswamy A, Billinger S, Coupland KG, English C, Kutlubaev MA, Moseley L, et al. Mechanisms of post-stroke fatigue: a follow-up from the third Stroke Recovery and Rehabilitation Roundtable. Neurorehabil Neural Repair. 2024;38(2):52–61.
12. English C, Simpson DB, Billinger SA, Churilov L, Coupland KG, Drummond A, et al. A roadmap for research in post-stroke fatigue: consensus-based core recommendations from the third Stroke Recovery and Rehabilitation Roundtable. Neurorehabil Neural Repair. 2024;38(1):7–18.
13. Wu CH, De Doncker W, Kuppuswamy A. Electroencephalography-derived functional connectivity in sensorimotor networks in post-stroke fatigue. Brain Topogr. 2023;36(5):727–35.
14. Skogestad IJ, Kirkevold M, Larsson P, Borge CR, Indredavik B, Gay CL, et al. Post-stroke fatigue: an exploratory study with patients and health professionals to develop a patient-reported outcome measure. J Patient Rep Outcomes. 2021;5(1):45–56.
15. Zhang S, Cheng S, Zhang Z, Wang C, Wang A, Zhu W. Related risk factors associated with post-stroke fatigue: a systematic review and meta-analysis. Neurol Sci. 2021;42(4):1463–71.
16. Zeng H, Yang J, Wu J, Ding Y, Yuan S, Wang R, et al. The impact of post-stroke fatigue on inpatient rehabilitation outcomes: an observational study. PLoS One. 2024;19(5):e45678.
17. Bivard A, Lillicrap T, Krishnamurthy V, Holliday E, Attia J, Pagram H, et al. MIDAS (Modafinil in debilitating fatigue after stroke): a randomized, double-blind, placebo-controlled, cross-over trial. Stroke. 2017;48(5):1293–8.
18. Poulsen MB, Damgaard B, Zerahn B, Overgaard K, Rasmussen RS. Modafinil may alleviate poststroke fatigue: a randomized, placebo-controlled, double-blinded trial. Stroke. 2015;46(12):3470–7.
19. Nguyen S, Wong D, McKay A, Rajaratnam SMW, Spitz G, Williams G, et al. Cognitive behavioural therapy for post-stroke fatigue and sleep disturbance: a pilot randomised controlled trial with blind assessment. Neuropsychol Rehabil. 2019;29(5):723–38.
20. Dong XL, Sun X, Sun WM, Yuan Q, Yu GH, Shuai L, et al. A randomized controlled trial to explore the efficacy and safety of transcranial direct current stimulation on patients with post-stroke fatigue. Medicine (Baltimore). 2021;100(41):E27504.
