Poststroke fatigue is a common and disabling condition. However, few studies on or therapeutic trials addressing poststroke fatigue have appeared in the literature. We aimed to review the prevalence, natural course, potential predisposing factors (physiological, psychocognitive, and organic), and pharmacological and nonpharmacological treatments of poststroke fatigue. Using PubMed CINAHL and PsycINFO, we reviewed all the available literature on poststroke fatigue and related issues. The prevalence of poststroke fatigue ranges from 23% to 75%, depending on the definition of fatigue and the characteristics of the patients included. Post-stroke fatigue seems to be of complex etiology. Predisposing factors were physiological ones including functional disability, prestroke fatigue, medical comorbidities, medication, sleep disturbances, and nutritional problems; psychocognitive ones including depression and cognitive dysfunction; and organic ones including damage to particular brain areas with consequent neurochemical alterations, perfusion deficit, and neuroinflammation. Poststroke fatigue is a persistent and debilitating symptom in some patients, and can have adverse affects on patient's neurological recovery, quality of life, and mortality. Few therapeutic trials have been reported, and the therapy was rarely successful, possibly because of the complex nature of poststroke fatigue. Poststroke fatigue is a common and frequently disabling problem of complex etiology. Further studies are urgently needed to improve our understanding of the pathophysiology of post-stroke fatigue and to develop better treatments for this condition.
LeegaardOF. Diffuse cerebral symptoms in convalescents from cerebral infarction and myocardial infarction. Acta Neurol Scand1983; 67:348–55.
2.
InglesJLEskesGAPhillipsSJ. Fatigue after stroke. Arch Phys Med Rehabil1999; 80:173–8.
3.
Van der WerfSPvan den BroekHLAntenHWBleijenbergG. Experience of severe fatigue long after stroke and its relation to depressive symptoms and disease characteristics. Eur Neurol2001; 45:28–33.
4.
StaubFAnnoniJMGramignaSBogousslavskyJ. Time dynamics of post-stroke fatigue. Cerebrovasc Dis2004; 17:49.
5.
GladerELStegmayrBAsplundK. Poststroke fatigue: A two-year follow-up study of stroke patients in Sweden. Stroke2002; 33:1327–33.
6.
Choi-KwonSHanSWKwonSUKimJS. Poststroke fatigue: Characteristics and related factors. Cerebrovasc Dis2005; 19:84–90.
7.
NaessHNylandHIThomassenLAarsethJMyhrKM. Fatigue at long-term follow-up in young adults with cerebral infarction. Cerebrovasc Dis2005; 20:245–50.
8.
ChristensenDJohnsenSPWattTHarderIKirkevoldMAndersenG. Dimensions of post-stroke fatigue: A two-year follow-up study. Cerebrovasc Dis2008; 26:134–41.
9.
MichaelK. Fatigue and stroke. Rehabil Nurs2002; 27:89–94, 103.
10.
MorleyWJacksonKMeadGE. Post-stroke fatigue: An important yet neglected symptom. Age Ageing2005; 34:313.
11.
MalccJFRichardsonJWSinakiMO'BricnMW. Types of affective response to stroke. Arch Phys Med Rehabil1990; 71:279–84.
12.
Van ZandvoortMJKappelleLJAlgraADe HaanEH. Decreased capacity for mental effort after single supratentorial lacunar infarct may affect performance in everyday life. J Neurol Neurosurg Psychiatry1998; 65:697–702.
13.
NaessHWaje-AndreassenUThomassenLNylandHMyhrKM. Health-related quality of life among young adults with ischemic stroke on long-term follow-up. Stroke2006; 37:1232–6.
14.
Multiple Sclerosis Council for Clinical Practice Guidelines.Fatigue and multiple sclerosis: Evidence-based management strategies for fatigue in multiple sclerosis. Washington, DC: Paralyzed Veterans of America, 1998.
15.
StaubFBogousslavskyJ. Fatigue after stroke: A major but neglected issue. Cerebrovasc Dis2001; 12:75–81.
16.
De GrootMHPhillipsSJEskesGA. Fatigue associated with stroke and other neurologic conditions; Implications for stroke rehabilitation. Arch Phys Med Rehabil2003; 84:1714–20.
17.
TsengBYBillingerSAGajewskiBJKludingPM. Exertion fatigue and chronic fatigue are two distinct constructs in people post-stroke. Stroke2010; 41:1–5.
18.
LynchJMeadGGreigC. Fatigue after stroke: The development and evaluation of a case definition. J Psychosom Res2007; 63:539–44.
19.
SmithORvan den BroekKCRenkensMDenolletJ. Comparison of fatigue levels in patients with stroke and patients with end-stage heart failure: Application of the fatigue assessment scale. J Am Geriatr Soc2008; 56:1915–9.
20.
Choi-KwonSChoiJKwonSUKangDWKimJS. Fluoxetine is not effective in the treatment of post-stroke fatigue: A double-blind, placebo controlled study. Cerebrovasc Dis2007; 23:103–8.
21.
WinwardCSackleyCMethaZRothwellPM. A population-based study of the prevalence of fatigue after transient ischemic attack and minor stroke. Stroke2009; 40:757–61.
22.
Van de PortIGKwakkelGSchepersVPHeinemansCTLindemanE. Is fatigue an independent factor associated with activities of daily living, instrumental activities of daily living and health-related quality of life in chronic stroke?Cerebrovasc Dis2007; 23:40–5.
23.
ParkJYChunMHKangSHLeeJAKimBRSinMJ. Functional outcome in post stroke patients with or without fatigue. Am J Phys Med Rehabil2009; 88:554–8.
24.
TangWKChenYKMokV. Acute basal ganglia infarcts in poststroke fatigue: An MRI study. J Neurol2010; 257:178–82.
25.
SchepersVPVisser-MeilyAMKetelaarMLindemanE. Poststroke fatigue: Course and its relation to personal and stroke-related factors. Arch Phys Med Rehabil2006; 87:184–8.
26.
MichaelKMAllenJKMackoRF. Fatigue after stroke: Relationship to mobility, fitness, ambulatory activity, social support, and falls efficacy. Rehabil Nurs2006; 31:210–7.
27.
Van de PortIGKwakkelGBruinMLindemanE. Determinants of depression in chronic stroke: A prospective cohort study. Disabil Rehabil2007; 29:353–8.
28.
LerdalABakkenLNRasmussenEF. Physical impairment, depressive symptoms and pre-stroke fatigue are related to fatigue in the acute phase after stroke. Disabil Rehabil2011; 33:334–42.
29.
MeadGLynchJGreigCYoungALewisSSharpeM. Evaluation of fatigue scales in stroke patients. Stroke2007; 38:2090–5.
30.
PortenoyRKItriLM. Cancer-related fatigue: Guidelines for evaluation and management. Oncologist1999; 4:1–10.
31.
AppelrosP. Prevalence and predictors of pain and fatigue after stroke. A population-based study. Int J Rehabil Res2006; 29:329–33.
32.
LaiSMDuncanPWDewPKeighleyJ. Sex differences in stroke recovery. Prev Chronic Dis2005; 2:1–11.
33.
JaraczKMielcarekLKozubskiW. Clinical and psychological correlates of poststroke fatigue. Preliminary results. Neurol Neurochir Pol2007; 41:36–43.
34.
LogeJHEkebergOKaasaS. Fatigue in the general Norwegian population: Normative data and associations. Psychosom Res1998; 45:53–65.
35.
FalconerMWalshSHarbisonJA. Estimated prevalence of fatigue following stroke and transient ischemic attack is dependent on terminology used and patient gender. J Stroke Cerebrovasc Dis2010; 19:431–34.
36.
HarbisonJAWalshSKennyRA. Hypertension and daytime hypotension found on ambulatory blood pressure is associated with fatigue following stroke and TIA. QJM2009; 102:109–15.
37.
TsengBYKludingP. The relationship between fatigue, aerobic fitness, and motor control in people with chronic fatigue: A pilot study. J Geriatr Phys Ther2009; 32:97–102.
38.
SaundersDHGreigCAYoungAMeadGE. Physical fitness training for stroke patients. Stroke2004; 35:22–35.
39.
WessekySNicksonJCoxB. Symptoms of low blood pressure: A population study. Br Med J1990; 301:362–5.
40.
PfefferMABurdmannEAChenCY. A trial of darbepoetin alfa in type 2 diabetes and chronic kidney disease. N Engl J Med2009; 361:2019–32.
41.
BeltowskiJWójcickaGJamroz-WiœniewskaA. Adverse effects of statins – mechanisms and consequences. Curr Drug Saf2009; 4:209–28.
42.
HermannDMBassettiCL. Sleep-related breathing and sleep–wake disturbances in ischemic stroke. Neurology2009; 73:1313–22.
43.
LeppävuoriAPohjasvaaraTVatajaR. Insomnia in ischemic stroke patients. Cerebrovasc Dis2002; 14:90–7.
44.
SandbergOFranklinKABuchtGGustafsonY. Sleep apnea, delirium, depressed mood, cognition, and ADL ability after stroke. J Am Geriatr Soc2001; 49:391–7.
45.
SchwartzSWCarlucciCChamblessLERosamondWD. Synergism between smoking and vital exhaustion in the risk of ischemic stroke: Evidence from the ARIC Study. Ann Epidemiol2004; 14:416–24.
46.
SchuttemakerGEDinantGJVan der PolVerhelstAFMAppelsA. Vital Exhaustion as a Risk Indicator for First Stroke. Psychosomatics2004: 114–8.
47.
KornerupHMarottJLSchnohrPBoysenGBarefootJPrescottE. Vital exhaustion increases the risk of ischemic stroke in women but not in men: Results from the Copenhagen city heart study. J Psychosom Res2004; 45:114–8.
Choi-KwonSChoiJMKwonSUKangDWKimJS. Factors affecting the quality of life at 3 years post-stroke. J Clin Neurol2006; 2:34–41.
50.
WidarMEkA-CAhlströmG. Coping with long-term pain after a stroke. J Pain Symptom Manage2004; 27:215–2.
51.
NaessHLundeLBroggerJWaje-AndreassenU. Post-stroke pain on long-term follow-up: The Bergen stroke study. J Neurol2010; 257:1446–52.
52.
AxelssonKNorbergAAsplundK. Eating after a stroke – towards an integrated view. Int J Nurs Stud1984; 21:93–9.
53.
CarrEKHawthornPJ. Lip function and eating after a stroke: A nursing perspective. J Adv Nurs1988; 13:447–51.
54.
AxelssonKAsplundKNorbergAErikssonS. Eating problems and nutritional status during hospital stay of patients with severe stroke. J Am Diet Assoc1989; 89:1092–6.
55.
JacobssonCAxelssonKOsterlindPONorbergA. How people with stroke and healthy older people experience the eating process. J Clin Nurs2000; 9:255–64.
56.
WestergrenAKarlssonSAnderssonPOhlssonOHallbergIR. Eating difficulties, need for assisted eating, nutritional status and pressure ulcers in patients admitted for stroke rehabilitation. J Clin Nurs2001; 10:257–69.
57.
WestergrenAOhlssonOHallbergIR. Eating difficulties in relation to gender, length of stay, and discharge to institutional care, among patients in stroke rehabilitation. Disabil Rehabil2002; 24:523–3.
58.
FinestoneHMGreene-FinestoneLSWilsonESTeasellRW. Prolonged length of stay and reduced functional improvement rate in malnourished stroke rehabilitation patients. Arch Rhys Med Rehab1996; 77:340–5.
59.
YooSHKimJSKwonSUYunSCKohJYKangDW. Undernutrition as a predictor of poor clinical outcomes in acute ischemic stroke patients. Arch neurol2008; 65:39–43.
60.
JönssonACLindgrenINorrvingBLindgrenA. Weight loss after stroke: A population-based study from the Lund stroke register. Stroke2008; 39:918–23.
61.
SidenvallBFjellstromCEkAC. The meal situation in geriatric care –intentions and experiences. J Adv Nurs1994; 20:613–21.
62.
JacobssonCAxelssonKWenngrenBINorbergA. Eating despite severe difficulties: Assessment of poststroke eating. J Clin Nurs1996; 5:23–31.
63.
JacobssonCAxelssonKNorbergAAsplundKWenngrenBI. Outcomes of individualized interventions in patients with severe eating difficulties. Clin Nurs Res1997; 6:25–44.
64.
PerryLMcLarenS. Eating difficulties after stroke. J Adv Nurs2003; 43:360–9.
65.
ThomasDRZdrowskiCDWilsonMM. Malnutrition in subacute care. Am J Clin Nutr2002; 75:308–13.
66.
WestergrenA. Nutrition and its relation to mealtime preparation, eating, fatigue and mood among stroke survivors after discharge from hospital – a pilot study. Open Nurs J2008; 2:15–20.
67.
de CosterLLeentjensAFLodderJVerheyFR. The sensitivity of somatic symptoms in post-stroke depression: A discriminant analytic approach. Int J Geriatr Psychiatry2005; 20:358–62.
68.
ManesFParadisoSRobinsonRG. Neuropsychiatric effects of insular stroke. J Nerv Ment Dis1999; 187:707–12.
69.
BogousslavskyJ. William Feinberg lecture 2002: Emotions, mood, and behavior after stroke. Stroke2003; 34:1046–50.
70.
StaubFAnnoniJMBogousslavskyJ. Fatigue after stroke: A pilot study. Cerebrovasc. Dis2000; 10(Suppl. 2): 62.
71.
StaubFAnnoniJMBogousslavskyJ. Post-stroke fatigue: A major problem in “non-disabling” stroke. Cerebrovasc. Dis2002; 13(Suppl. 3): 96.
72.
SissonRA. Cognitive status as a predictor of right hemisphere stroke outcomes. J Neurosci Nurs1995; 27:152–6.
73.
SissonRA. Life after a stroke: Coping with change. Rehabil Nurs1998; 23:198–203.
CarlssonGEMöllerABlomstrandC. Consequences of mild stroke in persons < 75 years– a 1-year follow-up. Cerebrovasc Dis2003; 16:383–8.
76.
LavretskyHZhengLWeinerMW. The MRI brain correlates of depressed mood, anhedonia, apathy, and anergia in older adults with and without cognitive impairment or dementia. Int J Geriatr Psychiatry2008; 23:1040–5.
77.
BrunoRLCreangeSLFrickNM. Parallels between post-polio fatigue and chronic fatigue syndrome: A common pathophysiology?Am J Med1998; 105:66–73.
78.
OwenAMRobertsACHodgesJR. Contrasting mechanisms of impaired attentional set-shifting in patients with frontal lobe damage or Parkinson's disease. Brain1993; 116:1159–75.
79.
KruppLBColyePKDoscherC. Fatigue therapy in multiple sclerosis: Results of a double-blind, randomized, parallel traila of amantadine, pemoline, and placebo. Neurolgy1995; 45:1956–61.
80.
ComiGLeocaniLRossiColomboB. Physiopathology and treatment of fatigue in multiple sclerosis. J Neurol2001; 248:174–9.
81.
KennedyGSpenceVUnderwoodCBelchJJ F. Increased neutrophil apoptosis in chronic fatigue syndrome. J Clin Pathol2004; 57:891–3.
82.
PatarcaR. Cytokines and chronic fatigue syndrome. Ann NY Acad Sci2001; 933:185–200.
83.
RaisonCLLinJMSReevesWC. Association of peripheral inflammatory markers with chronic fatigue in a population-based sample. Brain Behav Immun2009; 23:327–3.
84.
SteinauMUngerERVernonSDJonesJFRajeevanMS. Differential-display PCR of peripheral blood for biomarker discovery in chronic fatigue syndrome. J Mol Med2004; 82:750–5.
85.
LyallMPeakmanMWesselyS. A systematic review and critical evaluation of the immunology of chronic fatigue syndrome. J Psychosom Res2003; 55:79–90.
86.
SasohMOgasawaraKKurodaK. Effects of EC-IC bypass surgery on cognitive impairment in patients with hemodynamic cerebral ischemia. Surg Neurol2003; 59:455–63.
87.
TiemeierHBretelerMMvan PopeleNMHofmanAWittemanJCM. Late life depression is associated with arterial stiffness: A population-based study. J Am Geriatr Soc2003; 51:1105–10.
88.
RodingJLindstromBMalmJOhmanA. Frustrated and invisible-younger stroke patients' experiences of the rehabilitation process. Disabil Rehabil2003; 25:867–74.
89.
FawzyNW. A psychoeducational nursing intervention to enhance coping and affective state in newly diagnosed malignant melanoma patients. Cancer Nursing1995; 18:427–38.
90.
WardNWintersS. Results of a fatigue management programme in multiple sclerosis. Br J Nurs2003; 12:1075–80.
91.
LorigKRRitterPStewartAL. Chronic disease self-management program: 2-year health status and health care utilization outcomes. Med Care2001; 39:1217–23.
92.
McGeoughEPollockASmithLN. Interventions for post-stroke fatigue. Cochrane Database Syst Rev. July 8 2009: CD007030. Review.
93.
OgdenJAMeeEWUtleyT. Too little, too late: Does tirilazad mesylate reduce fatigue after subarachnoid haemorrhage?Neurosurgery1998; 4:782–7.
94.
AndersonGVestergaardKLauritzenL. Effective treatment of post-stroke depression with the selective serotonin reuptake inhibitor citalopram. Stroke1994; 25:1099–104.
95.
RammohanKWRosenbergJHLynnDJBlumenfeldAMPollakCPNagarajaHN. Efficacy and safety of modafinil (Provigil) for the treatment of fatigue in multiple sclerosis: A two centre phase 2 study. J Neurol Neurosurg Psychiatry2002; 72:179–83.
96.
BrioschiAGramignaSWerthE. Effect of modafinil on subjective fatigue in multiple sclerosis and stroke patients. Eur Neurol2009; 62:243–9.
