Abstract
Background and Objective: Fatigue is common among stroke survivors; and has significant negative consequences. However, long-term follow-up on post-stroke fatigue and it's association with cognitive and physiological parameters remains vague.Methods: A prospective cohort study was carried out on 38 young stroke survivors (aged 18–65 at stroke onset) living in the community 10 years after first-ever stroke. Fatigue was assessed by Fatigue assessment scale (FAS). Global cognition and cognitive sub-domains were assessed repeatedly at 1 week, 7 months, and 10 years after their first-ever stroke. Univariate correlation analysis was used to investigate associations and multivariate regression was used to investigate predictors and association with fatigue.Results: At 10-years follow-up after stroke onset, more than half of the 38 participants suffered from fatigue [with median score 25 on FAS with 25–75% percentile (21–28)]. Most of them were independent in their everyday life [mRS median score 1 (0–2)]. In univariate correlation analyses, higher fatigue score was significantly correlated to higher independence in the daily activity, higher BMI, anxiety, higher scores on global cognition and better working memory at 10-years follow-up as well as better visuospatial functions after 7 months and 10-years. In a multiple regression analysis, only visuospatial function at 7-months follow-up was a significant predictor of fatigue 10 years after stroke onset [F = 23.07, p < 0.009], with adjusted (R2 = 0.815) i.e., higher scores on Block design were associated with more fatigue.Conclusion: Our results extended the time course of post-stroke fatigue up to 10 years after stroke onset. The participants with more fatigue performed better in cognitive assessments and daily activity, which indicated dissociation between fatigue and fatigability among stroke patients. Visuospatial function at the sub-acute phase predicted independently late post-stroke fatigue. This may offer a broad time window for rehabilitation and information about fatigue. The clinical implications of the current findings are worth to be studied further.
Highlights
Fatigue is a common disabling symptom following stroke
The participants with better performance on Block design had more fatigue assessed by Fatigue assessment scale (FAS). This longitudinal study demonstrated more than half of 38 participants suffered fatigue even though most of them were independent in their everyday life 10 years after stroke onset
Higher fatigue score was correlated to higher independency in the daily activity, anxiety, higher BMI, better global cognition and better working memory at 10-years follow-up as well as better visuospatial function after 7 months and 10-years
Summary
Fatigue is a common disabling symptom following stroke. It occurs in the early phase and in the chronic phase after stroke [1, 2]. Studies of post-stroke fatigue have often been carried out within 2–3 years after stroke onset. Very long-term follow-up on post-stroke fatigue has been rarely reported [8]. Fatigability could possibly be assessed with various objective motor and cognitive tests [9]. Knowledge of objective assessments of fatigue is largely lacking. Fatigue is common among stroke survivors; and has significant negative consequences. Long-term follow-up on post-stroke fatigue and it’s association with cognitive and physiological parameters remains vague
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