Neuropsychiatric Disorders by Koho Miyoshi Yasushi Morimura & Kiyoshi Maeda

Author:Koho Miyoshi, Yasushi Morimura & Kiyoshi Maeda
Language: eng
Format: epub
Publisher: Springer Japan, Tokyo

Fatigue

Fatigue has been known to be a common sequelae in stroke survivors, with a prevalence ranging from 38% to 68% [16]. Treating this phenomenon has proven to be quite challenging given the lack of established standards in its measurement and difficulty in determining its exact etiology. Additionally, the diagnostician must take into consideration other possible contributing factors associated with fatigue from which numerous stroke patients suffer from months to years after the inciting event; these include mental factors, such as depression and anxiety, but also might be related to physical deconditioning and gross motor deficits. Because the etiology of fatigue has proven to be so complex, it is not until recently that research has began to control for some of these confounding factors and evaluate a more central origin of fatigue in stroke survivors.

In a study investigating fatigue in stroke survivors, patients who suffered from minor strokes were compared to those who experienced a transient ischemic attack (TIA). While previous studies suggested that fatigue after stroke was attributable to compensatory behaviors related to gross neurological deficits, the comparison used in this study demonstrated that poststroke fatigue may be of central origin rather than physical sequelae secondary to increased effort required after suffering a stroke [16]. By investigating patients who suffered from minor rather than major strokes, there were minimal to no residual neurological deficits to which secondary poststroke fatigue might be attributable. These results were the first set of published data investigating fatigue in relationship to stroke using this approach.

The study evaluated 149 patients: 73 status post minor stroke and 67 status post TIA. Demographic characteristics, recent life events, vascular risk factors, medications, and mental and physical disabilities were all variables that were controlled among the two patient groups. Fatigue was evaluated at 6 months after minor stroke or TIA using the Chalder Fatigue Scale [17]. The results of the study demonstrated that patients who suffered from a minor stroke had a 56% fatigue prevalence in comparison to the TIA patients with a prevalence of 29%. This finding is one that should serve to motivate neuropsychiatrists and other clinicians to move toward the consideration of a central mechanism underlying fatigue in patients who have suffered a stroke. Additionally, collaborative efforts between researchers, physicians, and pharmaceutical experts should investigate central-acting treatment modalities for these patients. Treatment is mainly symptomatic, with the use of stimulating agents, in addition to treating concurrent neuropsychiatric complaints.

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