Predicting fatigue 1 year after aneurysmal subarachnoid hemorrhage

Abstract

Fatigue is an important contributor to quality of life in patients who survive aneurysmal subarachnoid hemorrhage (SAH), but the determinants of this fatigue are unclear. We assessed the occurrence of fatigue 1 year after SAH and its relation to physical or cognitive impairment, passive coping, and emotional problems, measured 3 months after SAH. This was a prospective cohort study of 108 patients who visited our SAH outpatient clinic 3 months after SAH and who were living independently in the community 1 year after SAH. Fatigue was evaluated using the Fatigue Severity Scale (FSS). Analysis of variance was used to analyze the data. Fatigue (FSS ≥ 4) was present in 77 patients (71%). Mean FSS scores were 4.1 (SD 1.6) in the group of patients having 'neither physical nor cognitive impairment,' 5.2 (1.4) having 'either physical or cognitive impairment,' and 5.9 (0.9) having 'both physical and cognitive impairments.' Mean FSS scores were higher in patients scoring high on passive coping (85 vs. 58%; RR 1.46, 95% CI 1.13-1.87), anxiety (84 vs. 55%; RR 1.53, 95% CI 1.17-2.02), or depression (85 vs. 62%; RR 1.36, 95% CI 1.08-1.72) than in patients without these complaints. Relationships between these complaints and FSS scores were higher in patients having neither physical nor cognitive impairments than in patients having physical or cognitive impairments. Fatigue is common after SAH and is related to physical and cognitive impairments. In patients with neither physical nor cognitive impairments, passive coping style and emotional problems are important predictors of fatigue.

Temporal Associations between Fatigue, Depression, and Apathy after Stroke: Results of the Cognition and Affect after Stroke, a Prospective Evaluation of Risks Study

“…In addition, baseline depression scores were associated with high fatigue scores at follow-up. This is in line with a previous longitudinal study that suggested that baseline depression was associated with long-term fatigue [10]. …”

“…Longitudinal studies found evidence that early PSD was associated with long-term PSF [10, 11], and long-term PSD was also associated with long-term PSF [7]. Early depressive symptoms correlated positively with both early fatigue and long-term fatigue, but no long-term depression data were available [12].…”

Post-Stroke Fatigue: Epidemiology, Clinical Characteristics and Treatment

“…This reduction has been reported to remain stable at 6 month-follow-up producing an overall better functional health status, characterized by fewer symptoms of depression, and improvements in both sleep and physical endurance [44]. …”

“…Cognitive impairment has been found to worsen fatigue after subarachnoid haemorrhage [44,45] and brain injuries; nonetheless, this association has received little attention. Additionally, in a sub-study on quality of life of the International Stroke trial, Mead and colleagues found that a worse mental health score and worse emotional role function measured with SF-36 and increasing age were significantly associated with fatigue [23].…”

Are Mental Disorders Brain Diseases, and What Does This Mean? A Clinical-Neuropsychological Perspective

“…[22]. Fatigue is often underdiagnosed in acute neurological treatment as it may become apparent only in complex, highly stimulating everyday life situations with numerous sources of distraction and multitasking [23]. Such a ‘holistic' perspective adequately captures how clinical neuropsychologists actually understand and treat brain diseases, instead of overemphasizing a lesion-deficit view [13].…”