Elgh Eva, Hu Xiaolei
Department of Psychology, Umeå University, Umeå, Sweden.
Department of Community Medicine and Rehabilitation, Umeå University, Umeå, Sweden.
Front Neurol. 2020 Oct 23;11:562706. doi: 10.3389/fneur.2020.562706. eCollection 2020.
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. 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. 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 [ = 23.07, < 0.009], with adjusted ( = 0.815) i.e., higher scores on Block design were associated with more fatigue. 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.
疲劳在中风幸存者中很常见，并且会产生严重的负面后果。然而，对中风后疲劳及其与认知和生理参数的关联进行的长期随访仍不明确。对38名首次中风后10年居住在社区的年轻中风幸存者（中风发作时年龄在18 - 65岁）进行了一项前瞻性队列研究。通过疲劳评估量表（FAS）评估疲劳情况。在首次中风后的1周、7个月和10年对整体认知和认知子领域进行多次评估。采用单变量相关分析来研究关联，采用多变量回归来研究预测因素以及与疲劳的关联。在中风发作后的10年随访中，38名参与者中有超过一半患有疲劳[FAS中位数评分为25，第25 - 75百分位数为（21 - 28）]。他们中的大多数在日常生活中能够自理[mRS中位数评分为1（0 - 2）]。在单变量相关分析中，更高的疲劳评分与10年随访时日常活动中更高的自理能力、更高的体重指数、焦虑、整体认知更高的评分以及更好的工作记忆显著相关，同时与7个月和10年后更好的视觉空间功能也显著相关。在多变量回归分析中，仅7个月随访时的视觉空间功能是中风发作后10年疲劳的显著预测因素[β = 23.07，P < 0.009]，调整后R² = 0.815，即更高的方块设计得分与更多的疲劳相关。我们的结果将中风后疲劳的时间进程延长至中风发作后10年。疲劳程度较高的参与者在认知评估和日常活动中表现更好，这表明中风患者的疲劳和易疲劳性之间存在分离。亚急性期的视觉空间功能可独立预测中风后期的疲劳。这可能为康复提供一个广阔的时间窗口以及有关疲劳的信息。当前研究结果的临床意义值得进一步研究。
