Schumann Andy, Di Giuliano Monica, Schulz Steffen, de la Cruz Feliberto, Kreuder Teresa, Seifert Georg, Bär Karl-Jürgen
Lab for Autonomic Neuroscience, Imaging and Cognition (LANIC), Department of Psychosomatic Medicine and Psychotherapy, Jena University Hospital, Krautgasse 8, 07743 Jena, Germany.
Charité Competence Center for Traditional and Integrative Medicine (CCCTIM), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Augustenburger Platz 1, 13353 Berlin, Germany.
Brain Commun. 2025 Aug 28;7(5):fcaf315. doi: 10.1093/braincomms/fcaf315. eCollection 2025.
Mental fatigue is a significant psychopathological symptom that has recently gained attention, particularly in chronic fatigue syndrome/myalgic encephalomyelitis and Post-COVID-19 condition. However, fatigue is a clinically relevant symptom across a wide range of mental and neurological disorders. To identify a transdiagnostic functional network associated with fatigue, we conducted an activation likelihood estimation meta-analysis of neuroimaging studies. The primary inclusion criterion was studies involving any medical condition where patients exhibited significantly higher levels of fatigue compared to healthy controls. A systematic literature review across three major scientific databases identified 46 eligible neuroimaging studies, including a total of 2603 individuals. The meta-analysis of these studies revealed a widespread cortical-subcortical network involving frontal, limbic, basal ganglia and parietal structures. Three main clusters were highlighted: a frontal-striatal-limbic cluster, a frontal-cingulate cluster and a parietal cluster, with regions implicated in cognitive, emotional and somatosensory symptoms associated with mental fatigue. Quality analysis indicated a moderate risk of bias in the majority of the included studies. Overall, our findings provide scientific evidence for a transdiagnostic mental fatigue network in the brain, with key nodes located in the lateral frontal cortex, cingulate cortex, insula, thalamus, precuneus and caudate. These results support the theory of thalamic-striatal-cortical dysfunction, which may impair compensatory mechanisms related to mental fatigue. Additionally, abnormal activation of limbic and parietal regions may contribute to cognitive, emotional and attentional impairments linked to fatigue.
精神疲劳是一种重要的精神病理症状，最近受到了关注，尤其是在慢性疲劳综合征/肌痛性脑脊髓炎和新冠后综合征中。然而，疲劳是广泛的精神和神经疾病中具有临床相关性的症状。为了确定与疲劳相关的跨诊断功能网络，我们对神经影像学研究进行了激活可能性估计荟萃分析。主要纳入标准是涉及任何医学状况的研究，其中患者表现出比健康对照者明显更高水平的疲劳。对三个主要科学数据库进行的系统文献综述确定了46项符合条件的神经影像学研究，共包括2603名个体。对这些研究的荟萃分析揭示了一个广泛的皮质-皮质下网络，涉及额叶、边缘系统、基底神经节和顶叶结构。突出了三个主要簇：额叶-纹状体-边缘簇、额叶-扣带回簇和顶叶簇，这些区域与精神疲劳相关的认知、情感和躯体感觉症状有关。质量分析表明，大多数纳入研究存在中度偏倚风险。总体而言，我们的研究结果为大脑中的跨诊断精神疲劳网络提供了科学证据，关键节点位于外侧额叶皮质、扣带回皮质、岛叶、丘脑、楔前叶和尾状核。这些结果支持丘脑-纹状体-皮质功能障碍理论，该理论可能损害与精神疲劳相关的代偿机制。此外，边缘系统和顶叶区域的异常激活可能导致与疲劳相关的认知、情感和注意力损害。
