Is post-stroke fatigue associated with changes in mental state?

This study evaluated whether psychological (mental) factors, such as mood and anxiety, are related to post-stroke fatigue to investigate if psychological therapy may be an appropriate treatment option.  

A stroke occurs when there is a disturbance of blood supply to a part of the brain. This can be caused by a blood clot in the brain (ischemic stroke) or a burst blood vessel (hemorrhagic stroke). Both types of stroke result in a lack of oxygen and food reaching the brain tissue and can cause brain damage.

Most stroke survivors suffer from changes in their physical and emotional well-being. One common problem is post-stroke fatigue, which affects more than a third of stroke survivors. Fatigue can be both physical and psychological (mental). Individuals might find it physically difficult to gather the strength to move muscles easily or be overwhelmed with sleepiness and unable to concentrate properly.

Currently, there is no effective treatment for post-stroke fatigue but psychological interventions have been shown to improve fatigue in other conditions such as cancer and multiple sclerosis.

The investigators carried out a review of past studies to evaluate whether post-stroke fatigue was mainly associated with mental, rather than physical, disturbances. This was done to determine whether psychological therapy such as targeting thoughts, mood, and behavior, should be considered to help treat post-stroke fatigue.

The study found that in 35 studies, involving over 9,000 stroke survivors, post-stroke fatigue was associated with at least one psychological factor. 19 studies found that individuals with post-stroke fatigue were 4 times more likely to shown signs of depression. Four studies found that individuals with post-stroke fatigue were 2.34 times more likely to suffer from anxiety. Two studies found post-stroke fatigue was associated with poor coping styles and 1 study associated it with loss of control. Six studies reported other emotional or behavioral associations such as changes in mental health, inappropriate laughing, and changes in alertness behavior. 

This study concluded that post-stroke fatigue is associated with depressive symptoms, anxiety, poor coping, loss of control, emotional and behavioral symptoms. Therefore, targeting these psychological factors may help treat post-stroke fatigue. 

One limitation of this study is that only one author identified elegible studies for this review and therefore introduces the risk that some research articles may have been missed or left out.

If you or someone you know suffer from post-stroke fatigue, talk to a doctor or therapist about receiving psychological treatment.