Abstract
Nearly 2 million traumatic brain injuries occur annually, most of which are mild (mTBI). One debilitating sequela of mTBI is cognitive fatigue: fatigue following cognitive work. Cognitive fatigue has proven difficult to quantify and study, but this is changing, allowing models to be proposed and tested. Here, we review evidence for four models of cognitive fatigue, and relate them to specific treatments following mTBI. The evidence supports two models: cognitive fatigue results from the increased work/effort required for the brain to process information after trauma-induced damage; and cognitive fatigue results from sleep disturbances. While there are no evidence-based treatments for fatigue after mTBI, some pharmacological and nonpharmacological treatments show promise for treating this debilitating problem. Future work may target the role of genetics, neuroinflammation and the microbiome and their role in complex cognitive responses such as fatigue.
Highlights
This study suggested that cognitive behavioral therapy (CBT) in combination with client-centered therapy was an effective intervention for individuals with PCS associated with mTBI, some symptoms, including cognitive fatigue, irritability, poor frustration tolerance and feeling overwhelmed were not affected
Summary of treatments Overall, while there are no evidence-based treatments for post-TBI fatigue, the extant literature suggests the following: r Methylphenidate and bright blue light have shown some promise in alleviating mental fatigue; r Very limited work suggests that CBT and Mindfulnessbased stress reduction (MBSR) may help reduce mental fatigue; r There is equivocal evidence that cranial electrotherapy stimulation may reduce mental fatigue; r In general, it is important to provide evidence-based treatment and rehabilitation services early in the recovery period, even when the etiology of the fatigue not clearly understood
As we look to the future, we will move beyond studies investigating the neural substrates of cognitive fatigue and bring to bear advances in other domains of clinical science
Summary
A form of fatigue that is associated with changes in the synaptic concentration of neurotransmitters within the CNS, including the brain and spinal cord, which affects exercise performance and muscle function and cannot be explained by factors that affect muscle function. It is linked to neurotransmitter systems in the brain, primarily involving serotonin, noradrenaline and dopamine, which are linked to arousal, sleepiness and mood. The CNS is unable to sufficiently enervate the muscles to maintain optimal muscle activation, resulting in reduced muscle force as well as generalized feelings of tiredness, loss of drive and sleepiness. Central fatigue tends to be of a lower intensity and duration than peripheral fatigue
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