Chronic post-stroke fatigue: It may no longer be about the stroke itself

Objective: Post-stroke fatigue (PSF) is a debilitating complication of stroke recovery. Contributing risk factors, whether they are modifiable, and if they change over time remain understudied. We determine factors associated with PSF and how they evolve from the subacute through chronic phases of recovery.

Patients and methods: A consecutive series of patients presenting to our comprehensive stroke center with acute stroke were seen in follow-up within 6 months of infarct and administered the Functional Assessment of Chronic Illness Therapy (FACIT) fatigue scale to evaluate for PSF. It was re-administered >6 months post-infarct. Demographics, stroke characteristics (NIH Stroke Scale [NIHSS], infarct size and location), medical comorbidities, and outcomes (modified Rankin Scale [mRS]) were also recorded. Regression analyses were used to determine factors associated with FACIT scores and PSF at each time point.

Results: 203 patients were administered the FACIT a mean 1.6 months post-stroke; 128 underwent re-administration (mean 13.9 months post-event). In adjusted models, stroke severity (follow-up NIHSS [p < 0.001], mRS [p = 0.005]) and posterior circulation localization (p = 0.012) were associated with lower FACIT scores (increased fatigue) in the subacute setting, while medical comorbidities (hypertension [p = 0.024], obstructive sleep apnea [p = 0.020]) and medication use (anticonvulsants [p = 0.021]) were associated with lower scores chronically. Baseline depression (p < 0.001, p = 0.029) was associated with lower scores at both time points.

Conclusion: Early PSF appears to be largely attributable to stroke severity, while chronic fatigue occurs in the setting of medical comorbidities and medication use. This has significant clinical implications when considering management strategies at different stages of recovery.