Fatigue a major barrier to recovery after stroke
Fatigue is closely related to poorer physical recovery after stroke, according to a new study by the Heart and Stroke Foundation Canadian Partnership for Stroke Recovery.
A third of people who have a stroke experience debilitating fatigue, which may be caused by depression, sleep disturbances, lesions in the brain, or other unidentified factors.
“Post-stroke fatigue is paralyzing,” says Dr. Bradley MacIntosh, lead author and a neuroimaging scientist at Sunnybrook Research Institute. “It is characterized by extreme tiredness, weakness, and exhaustion. It is the feeling that even if I could move, it would take too much effort.” Sunnybrook’s Dr. Walter Swardfager, scientist in the Brain Sciences Program and senior author of the study adds: “It is easy to imagine how these symptoms might impact recovery, given the many benefits of being physically active after a stroke.”
To complicate things, some symptoms of fatigue overlap with post-stroke depression, making it difficult to disentangle their impacts on different aspects of stroke recovery.
If fatigue is misidentified as depression, some anti-depressants may, in fact, make fatigue worse. “There is no proven treatment for fatigue after a stroke,” says Dr. Swardfager. “We need to identify how fatigue poses a barrier to recovery, and understand the causes of fatigue so that we can treat it specifically.”
“Fatigue and depressive symptoms have influences that we previously failed to appreciate,” Dr. MacIntosh says. The study found that fatigue was directly linked to poorer physical recovery. Fatigue was also related to poorer cognitive recovery, but only if patients also experienced depressive symptoms.
The authors say that improved screening is required to identify and treat fatigue and depression in order to ensure the best possible physical and cognitive recovery from stroke. Dr. Swardfager says that identifying and studying fatigue “opens the door to finding the intervention that will be most useful for each person.”
“For many patients, fatigue is a major limiting factor," says Sunnybrook stroke neurologist Dr. Rick Swartz. "I hear this especially often from my younger patients after stroke. They frequently tell me that they may be doing very well when, all of a sudden, they "hit a wall" and just need to rest or sleep. This is often a source of frustration, especially as they are trying to recover or reintegrate back to work or life responsibilities.”
