Deans' stroke musings: Visuospatial Function at Sub-Acute Phase Predicts Fatigue 10 Years After Stroke

Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Tuesday, November 3, 2020

Visuospatial Function at Sub-Acute Phase Predicts Fatigue 10 Years After Stroke

Are you really that fucking stupid that you think that predicting fatigue rather than solving fatigue is what stroke survivors want?

Visuospatial Function at Sub-Acute Phase Predicts Fatigue 10 Years After Stroke

Eva Elgh¹ and

Xiaolei Hu²^*

¹Department of Psychology, Umeå University, Umeå, Sweden
²Department of Community Medicine and Rehabilitation, Umeå University, Umeå, Sweden

Background and Objective: Fatigue is common among stroke survivors; and has significant negative consequences. However, long-term follow-up on post-stroke fatigue and it's association with cognitive and physiological parameters remains vague.

Methods: A prospective cohort study was carried out on 38 young stroke survivors (aged 18–65 at stroke onset) living in the community 10 years after first-ever stroke. Fatigue was assessed by Fatigue assessment scale (FAS). Global cognition and cognitive sub-domains were assessed repeatedly at 1 week, 7 months, and 10 years after their first-ever stroke. Univariate correlation analysis was used to investigate associations and multivariate regression was used to investigate predictors and association with fatigue.

Results: At 10-years follow-up after stroke onset, more than half of the 38 participants suffered from fatigue [with median score 25 on FAS with 25–75% percentile (21–28)]. Most of them were independent in their everyday life [mRS median score 1 (0–2)]. In univariate correlation analyses, higher fatigue score was significantly correlated to higher independence in the daily activity, higher BMI, anxiety, higher scores on global cognition and better working memory at 10-years follow-up as well as better visuospatial functions after 7 months and 10-years. In a multiple regression analysis, only visuospatial function at 7-months follow-up was a significant predictor of fatigue 10 years after stroke onset [F = 23.07, p < 0.009], with adjusted (R² = 0.815) i.e., higher scores on Block design were associated with more fatigue.

Conclusion: Our results extended the time course of post-stroke fatigue up to 10 years after stroke onset. The participants with more fatigue performed better in cognitive assessments and daily activity, which indicated dissociation between fatigue and fatigability among stroke patients. Visuospatial function at the sub-acute phase predicted independently late post-stroke fatigue. This may offer a broad time window for rehabilitation and information about fatigue. The clinical implications of the current findings are worth to be studied further.

Introduction

Fatigue is a common disabling symptom following stroke. It occurs not only in the early phase but also in the chronic phase after stroke (1, 2). Post-stroke fatigue is an independent predictor of shorter survival (3, 4), institutionalization (3, 5), poorer functional outcome (6), and greater dependency for daily activity (7). However, studies of post-stroke fatigue have often been carried out within 2–3 years after stroke onset. Very long-term follow-up on post-stroke fatigue has been rarely reported (8).

Fatigue is often examined subjectively with self-assessment questionnaires and objective measure of fatigue are challenging (9). Kluger et al. suggests a distinction between a person's own perceived fatigue (fatigue) and objective fatigue defined as a deterioration in performance when performing a mental or physical task (fatigability) (10). Fatigability could possibly be assessed with various objective motor and cognitive tests (9). However, knowledge of objective assessments of fatigue is largely lacking.

Furthermore, many clinical parameters, emotional and cognitive experiences have been suggested to play a role for fatigue in patients with stroke (2). Knowledge of factors underlying post-stroke fatigue may supply important information regarding treatment strategies. However, it's still difficult to predict the extent and duration of post-stroke fatigue.

The aim of the current study was to investigate the occurrence of fatigue 10 years after stroke onset, and assess potential relationship between fatigue and cognition as well as other clinical characteristics of participants among young stroke survivors in the unique longitudinal design.