A fucking useless writeup! EXACT PROTOCOLS ARE NEEDED THAT PREVENT FATIGUE!
And you are so blitheringly stupid you can't see that?
Send me personal hate mail on this: oc1dean@gmail.com. I'll print your complete statement with your name and title(If you can't stand by your name don't bother replying anonymously) and my response in my blog. Or are you afraid to engage with my stroke-addled mind? No excuses are allowed! You're medically trained; it should be simple to precisely state EXACTLY WHERE I'M WRONG. I want to hear your excuses for failure(not preventing fatigue IS FAILURE!) so I can demolish them! You aren't solving to 100% recovery protocols with NO EXCUSES! I've never received any communications from any stroke association. You'd think they would want to talk to their fiercest critic, but no, they are hiding under a rock someplace, probably don't even know I exist! Swearing at me is allowed, I'll return the favor. Don't even attempt to use the excuse that brain research is hard.
Post-stroke fatigue
- CMAJ
- October 26, 2026
- 198
- (37)
- E1443;
- DOI: https://doi.org/10.1503/cmaj.260287
Post-stroke fatigue is common, debilitating, and underrecognized
Post-stroke fatigue is characterized by early exhaustion, lack of energy, and aversion to effort during physical or mental activity that is not relieved by rest.1 It affects 30% to 70% of stroke survivors, regardless of stroke severity, and is associated with poor functional outcomes.2,3 Risk factors include depression, sleep disturbances, and pain.4 Although post-stroke fatigue frequently co-exists with depression, it manifests as overwhelming physical and mental exhaustion rather than persistent sadness, guilt, or loss of interest.1
Systematic screening during routine follow-up after stroke identifies post-stroke fatigue1
Fatigue typically emerges within 2 weeks of stroke and often improves by 3 months. It persists in approximately 40% of patients at 2 years,4 and some patients have permanent fatigue. The Fatigue Severity Scale, a 9-item questionnaire, is the most widely used screening tool; scores of 4 or higher (out of 7) indicate clinically important fatigue.3,5
Reversible contributors to post-stroke fatigue should be identified and addressed
Throughout recovery, during routine follow up in primary care and outpatient settings, clinicians should investigate patients who have had a stroke for reversible causes of fatigue. Causes may include depression, sleep disorders (e.g., sleep apnea), pain, infections, dehydration, hypo-thyroidism, anemia, nutritional deficiencies, and sedating medications.1,2
Multidisciplinary nonpharmacological care is the cornerstone of treatment
Patients and caregivers should be counselled on post-stroke fatigue, sleep hygiene, energy conservation, balancing activity with rest, anticipating energy demands, sitting during chores, and delegating low priority activites.1,2 Progressive exercise and graded activity can support physical recovery and a gradual return to work.2 Cognitive behavioural therapy and mindfulness-based stress reduction may be considered as adjuncts.1,2 Patients should be encouraged to communicate their needs for rest with family, caregivers, health care professionals, and employers.1
Pharmacological options for treatment are limited
Antidepressants are not recommended unless comorbid depression or anxiety is being treated.1,2 Modafinil has shown benefit in small trials but requires further evidence before routine use.1,2
Footnotes
Competing interests: Outside the submitted work, Mark Boulos reports funding from the Canadian Institutes of Health Research, Heart and Stroke Foundation of Canada, CanStroke Recovery Trials Network, Restless Legs Syndrome Foundation, Alternative Funding Plan from the Academic Health Sciences Centres of Ontario, Temerty Centre for AI Research and Education in Medicine, McLaughlin Centre for Molecular Medicine, and Toronto Dementia Research Alliance; consulting fees and honoraria from Sentrex, Axsome, Takeda, Jazz Pharmaceuticals, Paladin Labs, Eisai, Precision AQ, and Lundbeck; unrestricted educational grants from Takeda, Eisai, Jazz Pharmaceuticals, and Paladin Labs; receipt of sleep equipment from Zoll Itamar and CGX Systems; and a stipend from Sleep Medicine for a role as field editor. Mark Boulos also reports salary support from the Department of Medicine at the University of Toronto and at the Sunnybrook Health Sciences Centre. No other competing interests were declared.
This article has been peer reviewed.
This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY-NC-ND 4.0) licence, which permits use, distribution and reproduction in any medium, provided that the original publication is properly cited, the use is noncommercial (i.e., research or educational use), and no modifications or adaptations are made. See: https://creativecommons.org/licenses/by-nc-nd/4.0/
References
- 1↵LanctôtKLLindsayMPSmithEE. Canadian stroke best practice recommendations: mood, cognition and fatigue following stroke, update 2019. Int J Stroke 2020;15:668–88.
- 2↵YaoJKSalbachNMLindsayMP. Canadian Stroke best practice recommendations rehabilitation, recovery, and community participation following stroke, part three: optimizing activity and community participation following stroke, 7th edition update, 2025. Am J Phys Med Rehabil 2026;105:238–52.
- 3↵CummingTBPackerMKramerSF. The prevalence of fatigue after stroke: a systematic review and meta-analysis. Int J Stroke 2016;11:968–77.
- 4
- 5↵ChenWJiangTHuangH. Post-stroke fatigue: a review of development, prevalence, predisposing factors, measurements, and treatments. Front Neurol 2023 Dec. 21:14:1298915.
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