Post-stroke Fatigue Research Articles

The association of personality traits with poststroke fatigue in daily life: An exploratory experience sampling method and cross-sectional study

ABSTRACT Fatigue is a frequently occurring and persistent symptom after stroke. Many biological, psychosocial, and behavioural factors are associated with poststroke fatigue, but research into associations with personality traits is relatively sparse. In this study, we explored whether personality traits were related to poststroke fatigue measured with conventional fatigue questionnaires as well as experience sampling methodology (ESM). Twenty-four individuals with stroke completed 10 daily questionnaires about momentary (here-and-now) fatigue for six consecutive days using the mHealth ESM application PsyMateTM. Further, they completed questionnaires assessing personality (NEO-FFI and LOR-T) and fatigue (FSS). Results showed that higher extraversion (ß = -.44, SE = .12, p = .001; 95% CI = -.67-.19) and optimism (ß = -.18, SE = .06, p = .007; 95% CI = -.30-.05) were associated with lower momentary fatigue. No association was found between neuroticism and momentary fatigue, but higher neuroticism (r = 0.531, p = .008, 95% CI = .160-.759; r = .574, p = .003, 95% CI = .245-.767) was associated with higher scores on the retrospective FSS scales. We conclude that personality traits differentially influence poststroke fatigue, but this also depends on the way fatigue is measured (with retrospective or with momentary measures). When functional gains are not in line with expected progress during the rehabilitation treatment of fatigue, it may be appropriate to take into account how person characteristics are related to momentary fatigue.

Minimal and robust clinically important difference of three fatigue measures in chronic stroke survivors

ABSTRACT Background Fatigue assessment scale (FAS), fatigue subscale of the Profile of Mood States (POMS-F), and vitality subscale of the Short Form Health Survey (SF-36-VT) are among the first and most widely used adapted tools for assessing post-stroke fatigue. Objective To identify the minimal clinically important difference (MCID) and robust clinically important difference (RCID) of FAS, POMS-F, and SF-36-VT in stroke survivors. Methods Participants completed the FAS, POMS-F, and SF-36-VT before and after receiving 6-week intervention including graded activity training and pacing therapy. MCID was calculated using the distribution-based and anchor-based methods. Further, accuracy, sensitivity, and specificity of calculated values using the distribution-based method were used for determining RCID. Result A total of 124 stroke survivors participated in this study. MCID for FAS, POMS-F, and SF-36-VT was found to be 4.86, 3.32, and −10.10 (using score change) and 3.5, 2.5, and −10.5 (using ROC analysis), respectively. Using the distribution-based method, the MCID value obtained for the FAS was in the range of 3.16 to 8.76, for the POMS-F was in the range of 1.49 to 5.63, and for the SF-36-VT was in the range of −15.43 to −5.58. ½SD for FAS, ½ SD and 1.96 SEM for POMS-F, and 1.96 SEM and SD for SF-36-VT showed the best discriminative ability to use as the RCID. Conclusions The MCID and RCID were calculated for FAS, POMS-F, and SF-36-VT using different methods. The results can be used by researchers and clinicians for interpreting their findings in subjects similar to those who participated in this study.

Stroke survivors’ perceptions of the factors that influence engagement in activity outside dedicated therapy sessions in a rehabilitation unit: A qualitative study

Objective To investigate stroke survivors’ perceptions of factors influencing their engagement in activity outside of dedicated therapy sessions during inpatient rehabilitation. Design Qualitative study. Setting Four metropolitan rehabilitation units in Australia. Participants People undertaking inpatient rehabilitation after stroke. Methods Semi-structured interviews conducted in person by a speech pathologist A stepped iterative process of inductive analysis was employed until data saturation was achieved with themes then applied against the three domains of the Theory of Planned Behaviour (perceived behavioural control, social norms and attitude). Results Interviews of 33 stroke survivors (60% female, median age of 73 years) revealed five themes (i) uncertainty about how to navigate and what was available for use in the rehabilitation unit restricts activity and (ii) post-stroke mobility, fatigue and pre- and post-stroke communication impairments restrict activity (perceived behavioural control); (iii) unit set up, rules (perceived and actual) and staff expectations influence activity and (iv) visiting family and friends are strong facilitators of activity (social norms), and (v) personal preferences and mood influence level of activity (attitude). Conclusion At the individual level, stroke survivors perceived that their ability to be active outside of dedicated therapy sessions was influenced by their impairments, including mood, and their attitude towards and preference for activity. At the ward level, stroke survivors perceived that their ability to be active was influenced by ward set-up, rules and staff expectations. Visitors were perceived to be important facilitators of activity outside of therapy sessions.

Factors Associated With Early and Late Post-stroke Fatigue in Patients With Mild Impairment. Results From the Stroke Cohort Study Augsburg.

BackgroundPost-stroke fatigue is a common symptom after stroke. However, studies on the factors associated with early and late fatigue are scarce. The objective of this study was to identify variables associated with early and late fatigue.MethodsIn the German Stroke Cohort Augsburg (SCHANA) study, participants were interviewed during their hospital stay and completed a postal questionnaire 3 and 12 months post-stroke. Fatigue was assessed using the Fatigue Assessement Scale (FAS). In addition, depression was measured by the Patient Health Questionnaire (PHQ-9), general health status by the EQ-5D visual analog scale, and physical activity by the International Physical Activity Questionnaire (IPAQ). Multivariable regression models were used to determine the associations between FAS scores at 3 and 12 months post-stroke and demographic, psychosocial and health-related covariables.ResultsAmong 505 participants, the frequency of fatigue was 31.1% 3 months and 29.1% 12 months post-stroke. Prior stroke (ß = 2.37, p = 0.0076), prior diagnosis of depression (ß = 5.04, p = 0.0001), higher NIHSS (ß = 0.25, p = 0.0360) and higher PHQ-9 scores (ß = 0.55, p < 0.0001) were significantly associated with higher fatigue levels 3 months post-stroke. Additionally, younger age (ß = −0.07, p = 0.0219), a worse rating of general health at baseline (ß = −0.04, p = 0.0287) and low pre-stroke physical activity (ß = −0.0004, p = 0.0089) were significantly associated with higher fatigue levels 12 months after stroke.ConclusionsFatigue is a common and persisting symptom even in patients with mild impairment. Prior depressive disorder and early depressive symptoms were the most relevant predictors of both early and late fatigue.

Effects of transcranial direct current stimulation on patients with post-stroke fatigue: a study protocol for a double-blind randomized controlled trial

IntroductionPost-stroke fatigue (PSF) is an abnormal, persistent, and unexplained physical and psychological tiredness in patients after stroke. It is a common symptom of stroke patients with poor quality of life and bleak prognosis, and the incidence rate is up to 39% to 72%. It has been widely reported that medicine treatments achieved a lot of progress, there still needs to develop more powerful new strategies to more powerful effect. The transcranial direct-current stimulation (tDCS) shows great potential for the treatment of PSF. This study proposes to apply a double-blind randomized controlled clinical trial to explore the effect and safety of tDCS combined with routine rehabilitation for PSF.Methods and analysisOne hundred patients with PSF will be randomly divided into two groups. One of the groups will receive conventional rehabilitation therapy and active tDCS, whereas another group will receive conventional rehabilitation treatment and sham tDCS. Both groups will receive the intervention for 4 weeks, during which time they will undergo either active or sham tDCS 20 min a day, 6 days a week. Primary outcome: Fatigue Severity Scale (FSS) will be measured at baseline every weekend during the intervention period. Secondary results: Fatigue Impact Scale (FIS), Functional Assessment Chronic Illness Therapy (Fatigue) (FACIT-F), and Specialized Quality of Life Scale in Stroke (SS-QOL) will be measured at baseline and at the end of the intervention time of 4 weeks. Throughout the study, adverse events and adverse reactions will be measured during every treatment. The research study “Effects of transcranial direct current stimulation on patients with post-stroke fatigue” has been approved by the Ethics Committee of the First Affiliated Hospital of Nanchang University: Clinical Medicine Ethics Review [2015]043 in Nov 2015.DiscussionThis study will provide insight into the efficacy of transcranial direct-current stimulation for post-stroke fatigue. This is a double-blind randomized controlled trial whose aim is to assess the effects of tDCS on PSF. This study can provide more information about the treatment of PSF. This study has a period of follow-up, which allows for greater accuracy. It is a single-center trial, and this may be a limitation. The other limitation of this study is the relatively small number of participants; thus, the influence of chance on experimental results cannot be completely ruled out.Trial registrationChinese Clinical Trial Registry ChiCTR2000031120. Registered on March 22, 2020. This protocol version number is V1.1.

Association Between Stroke Characteristics and Post-Stroke Fatigue: A Meta-Analysis.

Post-stroke fatigue (PSF), a highly distressing symptom, could exert an influence on the quality of life of stroke survivors. A previous meta-analysis reported that PSF was associated with mood disturbances such as depressive symptoms and anxiety. However, the association between stroke characteristics (stroke type and location) and PSF remains unclear. We performed a meta-analysis to study the association between stroke characteristics and PSF. We conducted a search of electronic databases (PubMed, Web of Science, Cochrane Library) from the inception of all databases up to July 9, 2019. The quality of eligible articles was evaluated. Odds ratios (ORs) and 95% confidence intervals (95% CIs) were applied to represent the combined effect value of each study. Eight eligible studies including a total of 1816 stoke patients were identified. Three studies discussed the association between stroke type and PSF, and five studies investigated the relationship between stroke location and PSF. The results demonstrated PSF had a strong correlation with stroke type (OR = 2.42, 95% CI = [1.27, 4.61], P = 0.007) but was not relevant to stroke location, indicating that PSF was a complex, heterogeneous syndrome and that stroke characteristics may play only a very small role in the risk of developing PSF. Our meta-analysis indicated that PSF was closely relevant to stroke type and had no significant relationship with stroke location. However, the findings should be interpreted cautiously. Thus, we suggest an updated meta-analysis on this subject when more comprehensive studies that explore the above issue are available.

Serum Uric Acid Levels at Admission Could Predict the Chronic Post-stroke Fatigue

BackgroundPost-stroke fatigue (PSF) is a frequent complication of stroke. Serum uric acid (SUA) is frequently thought to be a risk factor for stroke. This study aimed to investigate whether SUA also played a role in PSF.MethodsSubjects with ischemic stroke were screened from The First Affiliated Hospital of Wenzhou Medical University between January 2020 and October 2020. Patients' fatigue symptoms were assessed by the Fatigue severity scale (FSS). To investigate the relationship between SUA and PSF, binary logistic regression analysis was conducted, with the confounders being controlled. SUA levels were divided into four layers (Q1 ≤ 245 μmol/L; Q2 246–308 μmol/L; Q3 309–365 μmol/L; Q4 ≥366 μmol/L) based on the quartiles.ResultsSUA levels were significantly higher in the PSF group (345.96 ± 73.78 μmol/L) than the non-PSF group (295.97 ± 87.8 μmol/L, P < 0.001). There were no differences in any other variables between these two groups. After adjusting the confounders, the risk of PSF in the Q4 layer (≥366 μmol/L) was 6.05 times (95% CI 1.79–20.43, P = 0.004) higher than that in Q1 (≤245 μmol/L).ConclusionHigh SUA at admission was an independent risk factor for fatigue 1 year after stroke onset. High SUA (≥366 μmol/L) during stroke deserves more attention, and active control of high SUA levels may be beneficial to reduce the incidence of PSF in the chronic stage following stroke.

Motivators for physical activity in patients with minor stroke: a qualitative study

Purpose Physical inactivity is a major risk factor for stroke. However, to encourage physical activity after stroke, it is important to know what motivates the patients. We aimed to explore possible motivators and barriers for physical activity in patients discharged after minor stroke or transient ischemic attack (TIA). Methods A qualitative study including 35 patients (21 men) with minor stroke or TIA (median age; 69 years, range 47–90) in semi-structured focus group interviews. Audio recordings were transcribed to text verbatim and analyzed with qualitative content analysis. Results Six interviews of 60 min. revealed five categories; the patients had a positive attitude towards physical activity, and they preferred to exercise locally under supervision of health professionals. Physical activity with others was motivating and obligating, and if possible as a weekly habit. Some experienced physical- and mental sequelae, which kept them from exercising. Conclusion This study provides valuable knowledge of what motivates and prevents patients with minor stroke or TIA to be physically active after hospital discharge, and what to consider when designing future exercise studies. Consequently, it is recommended that patients with minor stroke or TIA are offered supervised physical activity to prevent worsening of cardiovascular disease and recurrent cardiovascular event. Implications for rehabilitation Participants were positive towards physical activity after minor stroke or transient ischemic attack (TIA). Physical activity with others was perceived as both motivating and obligating. Post-stroke fatigue, lack of energy, and overview should be considered when designing secondary prevention programs. Participants call for exercise opportunities arranged locally and as group exercise supervised by health professionals with knowledge of stroke.

Safety, feasibility, acceptability and preliminary effects of the Neurofenix platform for Rehabilitation via HOMe Based gaming exercise for the Upper-limb post Stroke (RHOMBUS): results of a feasibility intervention study

ObjectivesTo investigate the safety, feasibility and acceptability of the Neurofenix platform for home-based rehabilitation of the upper limb (UL).DesignA non-randomised intervention design with a parallel process evaluation.SettingParticipants’ homes, South-East England.ParticipantsThirty...

Effects of focus training on heart rate variability in post-stroke fatigue patients

ObjectiveThis study discusses the effects of focus training on heart rate variability (HRV) in post-stroke fatigue (PoSF) patients.MethodsSelf-generate physiological coherence system (SPCS) was used for the focus training of PoSF patients for 12 weeks. Then, fatigue severity scale (FSS), Hamilton depression scale (HAMD), HRV and satisfaction scale (SASC-19) before and after the training were assessed.ResultsCompared with the control group, FSS score, HAMD score, RMSSD, PNN50% were significantly lower in the research group at the end of the intervention (P < 0.05); SDNN, SDANN, LF, HF, LF/HF intervention satisfaction rate increased significantly in the research group at the end of the intervention (P < 0.05).ConclusionThe use of SPCS software during the focus training of PoSF patients reduced the fatigue and depression, meanwhile improved the HRV of the patients. Therefore, these patients were greatly satisfied with the intervention.

Патогенетичні аспекти превентивної корекції патологічної втоми в ранньому відновному періоді ішемічного інсульту у хворих з метаболічним синдромом

Мета дослідження: вивчити клінічну ефективність та безпечність препарату Армадин® у ранньому відновному періоді гострого ішемічного інсульту, його вплив на відновлення втрачених функцій та постінсультну втому в пацієнтів із метаболічним синдромом (МС). Особливістю роботи було визначення стратегічних ділянок мозку за даними магнітно-резонансної томографії (МРТ) при когнітивних та емоційних розладах у пацієнтів з ішемічним інсультом на фоні МС та порівняння з даними пацієнтів без МС. Матеріали і методи. Основну групу становили 28 пацієнтів віком від 44 до 79 років (у середньому 66,0 ± 4,2 року), які знаходились у ранньому відновному періоді ішемічного інсульту. Пацієнти основної групи крім базового лікування отримували Армадин®. Контрольну групу становили 16 хворих у ранньому відновному періоді ішемічного інсульту віком від 54 до 76 років (середній вік 63,0 ± 3,8 року), які отримували лише стандартне лікування. Стан пацієнтів оцінювали за шкалами NIHSS, Ренкіна, індексом Бартел. Когнітивний і емоційний стан — за шкалами HADS, MMSE. Кількісну оцінку постінсультної втоми проводили за шкалою оцінки втоми (FAS). МРТ-дослідження головного мозку виконувалось на апараті Siemens MAGNETOM Avanto 1.5T. Визначали розміри вогнищ, індекс гіпокампу. Результати. Патологічна постінсультна втома визначалась в обох групах: медіана вираженості втоми за опитувальником FAS становила 32,2 (Q1 = 16,5; Q3 = 51,5) в основній та 34,25 (Q1 = 14,5; Q3 = 48,5) у контрольній групі до лікування. У 95 % пацієнтів визначалась клінічно значима втома (FAS ≥ 22), а ознаки депресії (вираженої та помірної) мали близько 20 %. Не було визначено статистично вірогідної кореляційної залежності патологічної втоми й депресії. Патологічна втома за шкалою FAS була вірогідно більшою в жінок, ніж у чоловіків. Після проведеного лікування ознаки патологічної втоми зменшились за шкалою FAS в обох групах, але статистичної вірогідності досягли в групі, що додатково приймала Армадин®. За шкалою NIHSS та індексом Бартел вірогідне покращення після лікування визначалось серед хворих основної групи. Не було визначено залежності між вираженістю патологічної втоми за шкалою FAS і ступенем тяжкості інсульту за шкалою NIHSS. Покращення показників когнітивних функцій за період лікування визначалось в обох групах. Але в основній групі когнітивні функції покращились на 5 %, а в групі контролю — на 1,66 %. За методикою, що була запропонована Scheltens et al., виконано дослідження гіпокампу на 1,5 Tл МРТ у пацієнтів з МС (перша група) і пацієнтів без МС (друга група). У пацієнтів із МС визначалось вірогідне зменшення індексу гіпокампу праворуч і ліворуч порівняно з пацієнтами без МС: праворуч 0,50 [0,41; 0,54] проти 0,594 [0,58; 0,61] (р &lt; 0,05); ліворуч 0,56 [0,52; 0,60] проти 0,61 [0,58; 0,63] (р &lt; 0,05). Обговорення. Своєчасне діагностування патологічної постінсультної втоми має велике значення в лікуванні хворих з ішемічним інсультом. У нашому дослідженні патологічна втома була діагностована в 95,5 % хворих. Різниця з літературними даними, ймовірно, пов’язана з наявністю кластера МС у пацієнтів, які брали участь у дослідженні. Досить невелика кількість пацієнтів унеможливлює висновок про вплив МС на розвиток патологічної втоми. Слід враховувати, що патологічна втома може розвинутись і без депресії і вона потребує спеціального лікування без залучення антидепресантів. Покращення когнітивних функцій та зменшення проявів астенії в пацієнтів, які приймали Армадин®, ймовірно, можна пояснити, з одного боку, здатністю Армадину® підвищувати рівень дофаміну в головному мозку, а з іншого — наявністю у складі Армадину® янтарної кислоти, що сприяла, через ланцюг нейрохімічних реакцій, підвищенню в головному мозку рівня ГАМК. Отже, використання цього сучасного антиоксиданту сприяло зменшенню астенії й тим самим покращувало якість життя пацієнтів. Вимірювання гіпокампу показало вірогідно більше виражену атрофію в пацієнтів з ішемічним інсультом на фоні МС порівняно з показниками пацієнтів з ішемічним інсультом без МС (P &lt; 0,05). Ймовірно, кластер МС, що поєднує артеріальну гіпертензію, інсулінорезистентність, дисліпідемію та ін., прискорює атрофічні процеси гіпокампу більше, ніж окремо кожний з цих компонентів, які визначали у пацієнтів з ішемічним інсультом без МС. Висновки. Призначення Армадину® в ранньому відновному періоді ішемічного інсульту сприяло зменшенню проявів патологічної втоми в пацієнтів з МС, відновленню функцій за шкалою NIHSS і індексом Бартел.

Management of Psychiatric Disorders in Patients with Stroke and Traumatic Brain Injury.

Management of Psychiatric Disorders in Patients with Stroke and Traumatic Brain Injury.

Effect of Poststroke Fatigue on Physical Functions, Depression-Anxiety and Functional Independence

Effect of Poststroke Fatigue on Physical Functions, Depression-Anxiety and Functional Independence

POSTSTROKE FATIGUE AND MOTOR RECOVERY AFTER ISCHEMIC STROKE.

The aim: To determine the effect of post-stroke fatigue on the motor recovery after ischemic stroke. Materials and methods: The study was conducted on the basis of the department of vascular neurology of the Uzhhorod Central City Clinical Hospital during the six months of 2020. We examined 92 patients who suffered a hemispheric ischemic stroke in the early recovery period. Results: At the end of therapy, improvement of motor function was observed in patients in both groups. We received a significant improvement(p<0,05) in the patients of the main group on the SSS and 6-point scale of muscle strength. We found that a high score on the FAS showed a significant correlation with the worst dynamics of recovery on the NIHSS, Scandinavian scale of stroke and 6-point scale of muscle strength (p <0,05). Conclusions: According to the results of the study, it was found that the presence of post-stroke fatigue significantly impairs the improvement of motor functions in patients with hemispheric ischemic stroke, patients who had more severe fatigue had worse recovery rates after stroke.

Acupuncture for the Adjunctive Therapy of Post-stoke Fatigue: A Systematic Review and Meta-analysis

The aim of this research is to assess the effectiveness and safety of acupuncture combined with rehabilitation therapy for post-stroke fatigue. The methods used in this research are as follows: systematically retrieving China National Knowledge Infrastructure, Chinese Scientific Journal Database, Chinese Biological Medicine Database, Cochrane Library, Medline and Embase were electronically searched from inception to Dec 2020. The dataset included randomized controlled trials (RCTs) with Chinese and English only that compared acupuncture as an adjunct to rehabilitation in stroke patients with fatigue. The methodological quality of the included trials was assessed using the Cochrane risk of bias assessment tool. Statistical analyses were performed by RevMan V.5.4.A total of 6 RCTs were included in this study, including 426 cases (213 cases in the treatment group and 213 cases in the control group). The results of meta-analysis showed that compared with conventional treatment, acupuncture as an adjuvant therapy can significantly reduce the incidence of post-stroke fatigue [MD = -5.45, 95% CI = (-6.75, -4.14), Z = 8.19 (P &lt; 0.001)]. In terms of energy, acupuncture also has an obvious effect [MD = 1.69, 95% CI = (0.27, 3.12), Z = 2.33 (P &lt; 0.02)]. Our systematic review and meta-analysis suggests that acupuncture combined with conventional rehabilitation therapy is an effective therapy for patients suffering from post-stroke fatigue, which is suitable for clinical promotion and use. However, due to methodological weakness and limited number of RCTs, the results should be interpreted cautiously. Further clinical trials with large sample sizes and a rigorous design are needed.

A Systematic Review and Meta-Analysis of the Effects of Herbal Medicine Buyang Huanwu Tang in Patients with Poststroke Fatigue.

Poststroke fatigue (PSF) is reported to occur in 30%–72% of all patients with stroke. PSF not only is a symptom of stroke but has also been reported to adversely affect the prognosis of patients with stroke. However, no treatment has had a significant effect on PSF. In East Asian countries, several herbal medicines have been used to treat stroke, with Buyang Huanwu Tang (BHT) being the most common. This review aimed to evaluate the efficacy and safety of BHT for PSF. A literature search was conducted on MEDLINE, CENTRAL, Scopus, CiNii, CNKI, OASIS, NDSL, and KTKP databases for randomized controlled trials that evaluated the effects and safety of BHT on PSF. Six studies (n = 427) were included. The overall methodological quality of these studies was relatively low. In the adjunctive BHT group, the meta-analysis indicated statistically significant improvements in the Fatigue Severity Scale score (mean difference −1.49, 95% CI [−2.25, −0.73]) and total clinical efficacy rate (risk ratio 0.11, 95% CI [0.03, 0.41]) compared to those in the nonherbal group. Adverse events were only reported in one study, and no serious adverse events occurred. BHT administration might be effective in the treatment of PSF. We were unable to draw definitive conclusions owing to the limitations of the included studies. The trial is registered with CRD42019130178 in PROSPERO.

An Analysis of Characteristics of Post-Stroke Fatigue in Patients without Depression: A Retrospective Chart Review.

Post-stroke fatigue (PSF) is among the most common stroke sequelae and affects rehabilitation, resulting in poor recovery. A main influencing factor may be depression, which has been investigated with fatigue in several clinical trials. We aimed to evaluate the characteristics of fatigue in post-stroke patients without depression through a retrospective chart review. The medical records of stroke patients hospitalized in the Stroke and Brain Disease Center, Kyung Hee University Korean Medicine Hospital were reviewed. Stroke patients without depression were divided into a PSF group and control group (without fatigue). The demographic characteristics, type of stroke, medical history, laboratory examinations, clinical features, and pattern identification of each patient were recorded and compared between the study groups. The medical records of 216 patients were reviewed; 85 and 131 patients were assigned to the PSF and control group, respectively. Apolipoprotein A1 levels were significantly lower in the PSF than in the control group (105.6 ± 16.5 vs. 116.2 ± 21.8). We found a significantly higher occurrence of reversal cold of the extremities and a lower probability of fire-heat pattern in the PSF group than in the control group. This study suggests that apolipoprotein A1 levels are lower and cold manifestations are more common in PSF patients without depression than in those without fatigue.

Analysis of Factors Affecting Post-Stroke Fatigue: An Observational, Cross-Sectional, Retrospective Chart Review Study.

Post-stroke fatigue (PSF) is one of the most common emotional and mood disorders in stroke survivors. Several studies have suggested associations between PSF and various factors. However, they describe conflicting results. Therefore, this study aimed to evaluate the factors affecting PSF. We retrospectively reviewed the medical records of 178 hospitalized stroke patients. The collected data were compared between the PSF and control groups. To evaluate the association between factors and PSF, regression analysis was conducted. A total of 96 patients (53.9%) were assigned to the PSF group, and 82 patients were assigned to the control group. Age, neurological deficits, cognitive dysfunction, degree of depression, hs-CRP, and ESR differed significantly between the two groups. For both types of stroke, multiple linear regression analyses showed that degree of depression and degree of inflammation were significantly associated with PSF. Through subgroup analysis, multiple linear regression analyses showed that the degree of depression in ischemic and hemorrhagic stroke and the platelet-to-lymphocyte ratio in hemorrhagic stroke had a significant association with PSF. In conclusion, post-stroke depression and degree of inflammation could be clinically significant predictors of PSF in all types of stroke patients. However, larger, prospective studies are required to obtain more concrete results.

Neural effective connectivity explains subjective fatigue in stroke.

Persistent fatigue is a major debilitating symptom in many psychiatric and neurological conditions, including stroke. Post-stroke fatigue has been linked to low corticomotor excitability. Yet, it remains elusive as to what the neuronal mechanisms are that underlie motor cortex excitability and chronic persistence of fatigue.In this cross-sectional observational study, in two experiments we examined a total of 59 non-depressed stroke survivors with minimal motoric and cognitive impairments using ‘resting-state’ MRI and single- and paired-pulse transcranial magnetic stimulation.In the first session of Experiment 1, we assessed resting motor thresholds—a typical measure of cortical excitability—by applying transcranial magnetic stimulation to the primary motor cortex (M1) and measuring motor-evoked potentials in the hand affected by stroke. In the second session, we measured their brain activity with resting-state MRI to assess effective connectivity interactions at rest. In Experiment 2 we examined effective inter-hemispheric connectivity in an independent sample of patients using paired-pulse transcranial magnetic stimulation. We also assessed the levels of non-exercise induced, persistent fatigue using Fatigue Severity Scale (FSS-7), a self-report questionnaire that has been widely applied and validated across different conditions. We used spectral dynamic causal modelling in Experiment 1 and paired-pulse transcranial magnetic stimulation in Experiment 2 to characterize how neuronal effective connectivity relates to self-reported post-stroke fatigue. In a multiple regression analysis, we used the balance in inhibitory connectivity between homologue regions in M1 as the main predictor, and have included lesioned hemisphere, resting motor threshold and levels of depression as additional predictors.Our novel index of inter-hemispheric inhibition balance was a significant predictor of post-stroke fatigue in Experiment 1 (β = 1.524, P = 7.56 × 10−5, confidence interval: 0.921 to 2.127) and in Experiment 2 (β = 0.541, P = 0.049, confidence interval: 0.002 to 1.080). In Experiment 2, depression scores and corticospinal excitability, a measure associated with subjective fatigue, also significantly accounted for variability in fatigue.We suggest that the balance in inter-hemispheric inhibitory effects between primary motor regions can explain subjective post-stroke fatigue. Findings provide novel insights into neural mechanisms that underlie persistent fatigue.

Астенический синдром при мозговых катастрофах

Патологическая усталость или истощение (астения) — это субъективное ощущение потери физической и ментальной энергии, мешающее выполнять обычные и желаемые действия. Усталость, возникшая в результате травмы головного мозга, инсульта или других заболеваний центральной нервной системы, называется первичной; если она вызвана другими факторами (боль, стресс, расстройства сна), тогда ее расценивают как вторичную. Частой причиной патологического истощения является постинсультная и посттравматическая усталость. Распространенность первой составляет, по данным различных литературных источников, от 23 до 77 %; второй — 32–73 %. В ряде исследований показаны клинические и патогенетические аспекты влияния препарата Митра на мозговое кровообращение и когнитивные нарушения, продемонстрированы нормализация биоэлектрической активности головного мозга, положительное влияние на когнитивные функции, кохлеовестибулярный, астеноневротический и цефалгический синдромы на фоне приема препарата мельдония в суточной дозе 500 мг парентерально в течение 20 дней.