Mental versus physical fatigue after subarachnoid hemorrhage: differential associations with outcome.

Abstract

Background and purposeFatigue is a major consequence of subarachnoid hemorrhage (SAH), but the specific characteristics are unclear. Our objective was to investigate the nature of post‐SAH fatigue (mental or physical) and to determine the relationship with functional outcome in the chronic stage. Also, the possible influence of mood disorders and acute SAH‐related factors [SAH type and external cerebrospinal fluid (CSF) drainage] on the presence of fatigue was investigated.MethodsPatients with an aneurysmal SAH (aSAH) or angiographically negative SAH (anSAH) were assessed 3–10 years post‐SAH (N = 221). Questionnaires were used to investigate mental and physical fatigue and mood. Functional outcome was examined with the Glasgow Outcome Scale Extended. Between‐group comparisons and binary logistic regression analysis were performed.ResultsFrequencies of mental and physical fatigue were 48.4% and 38.5%, respectively, with prevalence of mental fatigue being significantly higher. A two‐way anova with SAH type and external CSF drainage as independent variables and mental fatigue as dependent variable showed a significant main effect of CSF drainage only (P < 0.001). Only mental fatigue explained a significant part of the variance in long‐term functional outcome (model χ 2 = 52.99, P < 0.001; Nagelkerke R² = 0.32).ConclusionsMental fatigue after SAH is a serious burden to the patient and is associated with impaired long‐term functional outcome. Distinguishing different aspects of fatigue is relevant as mental post‐SAH fatigue might be a target for treatment aimed to improve long‐term outcome.