Subcortical white matter infarcts predict 1-year outcome of fatigue in stroke

Abstract

BackgroundFatigue is common in stroke survivors. Lesion location may influence the risk of poststroke fatigue (PSF) but it is uncertain whether location has an impact on the prognosis of PSF. This study examined the association between PSF outcome and infarct location.MethodsThe study sample comprised 435 Chinese patients with acute ischemic stroke admitted to the acute stroke unit of a university affiliated regional hospital in Hong Kong. Three and fifteen months after the onset of the index stroke a research assistant administered the Fatigue Severity Scale (FSS). PSF was defined as a FSS score of 4.0 or above. Of the 139 patients with PSF three months poststroke, 97 (69.8%) attended the 15-month follow-up, when 50 (51.5%) patients still had PSF (‘non-remitters’) and 47 (48.5%) did not report fatigue (‘remitters’). The presence and location of infarcts were evaluated with magnetic resonance imaging.ResultsIn comparison with the remitters, the non-remitters were more likely to have subcortical white matter infarcts (40.0% vs 21.3%, p = 0.046). These infarcts remained an independent predictor of non-remission of PSF in the multivariate analysis, with an odds ratio of 4.208 (p = 0.011).ConclusionsThe results suggest that subcortical white matter infarcts may influence the outcome of PSF. Further investigations are needed to explore whether infarcts have any impact on the response of PSF to pharmacological or psychological interventions.

Poststroke Fatigue: Emerging Evidence and Approaches to Management: A Scientific Statement for Healthcare Professionals From the American Heart Association

“…14,17,26,[45][46][47][48] An association between diabetes mellitus and PSF was observed in 1 study 21 but not in 7 other studies. 14,16,26,27,45,46,48 The presence of heart disease was related to PSF in 2 studies 17,27 but not in 4 others. 14,47,49,50 Generally, cigarette smoking is not considered a risk factor for PSF, as reported in 3 studies.…”

“…59 Hypersomnia and excessive daytime sleepiness are observed in 27% of patients, 59 whereas insomnia occurs in 57% of patients in the early months after stroke. 60 PSF is associated with sleep disturbances 21,26,31,35,50,[61][62][63] and daytime sleepiness 46,[63][64][65] in many studies, but these associations have not been consistently demonstrated. 20,24,49 The role of sleep disturbances as they pertain to PSF thus remains uncertain.…”

“…17,19,20,[25][26][27][28][29] Determining the demographic contributions to PSF prevalence is complicated because the prevalence of fatigue is higher in older individuals and women in general. It is important to note that most of the reported studies did not include control subjects (ie, age-and sex-matched individuals without stroke).…”

“…14,21,[26][27][28][30][31][32][33][34] PSF may be less common in married people (compared with single people) and in those living at home (compared with those living in an institution), 16 but these findings have not been widely replicated. 20,21,24,30 Patients with PSF are more often unemployed or more likely to change their jobs than those without PSF, 14,21 but cause-and-effect relationships remain unclear.…”

“…77,86 Some studies suggest an association between PSF and subcortical infarcts 26,74,87,88 and infratentorial infarcts. 30,77 Physiologically, PSF appears be related to low excitability of corticospinal output and facilitatory synaptic inputs from cortical and subcortical sites.…”