Abstract 89: Fatigue and Anxiety in Patients Following Stroke and TIA.

Abstract

Introduction. Up to 60% of patients report fatigue in the 6 months following acute stroke but the cause of this is poorly understood. Previous studies have reported a correlation with depression however the majority of fatigued subjects are not depressed and the majority of depressed subjects are not fatigued. We hypothesised that the association between fatigue and depression may not be direct and that it may be due to the enhanced level of arousal associated with anxiety disorder. Methods: Data was reviewed from four previous studies performed to identify associations of fatigue in stroke patients. All studies were performed in cognitively intact, independent (Modified Rankin Score <3) stroke patients by trained clinicians. Assessments of fatigue (Fatigue Severity Score), Anxiety and Depression (Hospital Anxiety and Depression Scale) were performed on all or subgroups of patients in all 4 studies. The FSS is a 9 item scale predominantly evaluating physical manifestations of fatigue. A score>4 is indicative of severe fatigue. The Hospital Anxiety and Depression Scale is a simple fourteen item questionnaire (seven questions on symptoms of anxiety (HADS-A) and seven depression (HADS-D) based). Each question may be scored between 0 and 3. A score in either subset <8 is considered normal, between 8 and 10 borderline abnormal and >10 definitely abnormal. Results: Data on 94 patients were included in the assessment. 57 (61%) were male and median age was 68 years (range 44-90 years). Mean FSS was 3.6 and 38 subjects (40.4%) had an FSS >4. Mean HADS-A score was 6.4, 14 (14.9%) subjects had a HADS-A >10 and 21 (22.3%) had a score 8-10. Mean HADS-D score was 4.4, 6 (6.4%) subjects had a score >10 and 10 (10.6%) had a HADS-D between 8 and 10. FSS correlated strongly with both HADS-A (r=0.57 (95% ci 0.42-0.69) p<0.0001 and HADS-D (r=0.51 (95% ci 0.34-0.64) p<0.0001). Positive predictive value (PPV) for an FSS>4 for possible anxiety (HADS-A >7) was 0.61. (PPV) for an FSS>5 for possible anxiety was 0.73. Negative predictive value for a FSS</=4 for HADS-A <8 was 0.79. PPV for an FSS>4 for possible depression (HADS-D <7) was 0.32 and NPV was 0.93. PPV for an FSS of >6 for both HADS-A and HADS-D was 0.87. Conclusion: Post stroke fatigue is strongly correlated with both anxiety and depression in patients with stroke but the prevalence of symptoms of anxiety is higher. It is worthwhile assessing stroke patients complaining of fatigue for evidence of anxiety disorder.