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English C, Simpson DB, Billinger SA, Churilov L, Coupland KG, Drummond A, Kuppuswamy A, Kutlubaev MA, Lerdal A, Mahmood A, Moseley GL, Pittman QJ, Riley EA, Sutherland BA, Wong CHY, Corbett D, Mead G. A roadmap for research in post-stroke fatigue: Consensus-based core recommendations from the third Stroke Recovery and Rehabilitation Roundtable. Int J Stroke 2024; 19:133-144. [PMID: 37424273 PMCID: PMC10811972 DOI: 10.1177/17474930231189135] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 06/27/2023] [Indexed: 07/11/2023]
Abstract
RATIONALE Fatigue affects almost half of all people living with stroke. Stroke survivors rank understanding fatigue and how to reduce it as one of the highest research priorities. METHODS We convened an interdisciplinary, international group of clinical and pre-clinical researchers and lived experience experts. We identified four priority areas: (1) best measurement tools for research, (2) clinical identification of fatigue and potentially modifiable causes, (3) promising interventions and recommendations for future trials, and (4) possible biological mechanisms of fatigue. Cross-cutting themes were aphasia and the voice of people with lived experience. Working parties were formed and structured consensus building processes were followed. RESULTS We present 20 recommendations covering outcome measures for research, development, and testing of new interventions and priority areas for future research on the biology of post-stroke fatigue. We developed and recommend the use of the Stroke Fatigue Clinical Assessment Tool. CONCLUSIONS By synthesizing current knowledge in post-stroke fatigue across clinical and pre-clinical fields, our work provides a roadmap for future research into post-stroke fatigue.
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Affiliation(s)
- Coralie English
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, Australia
- Heart and Stroke Program, Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - Dawn B Simpson
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, Australia
- Heart and Stroke Program, Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - Sandra A Billinger
- Department of Neurology, University of Kansas Medical Centre, University of Kansas Alzheimer’s Disease Research Centre, Kansas City, KS, USA
| | - Leonid Churilov
- Department of Medicine (RMH), University of Melbourne, Heidelberg, VIC, Australia
| | - Kirsten G Coupland
- Heart and Stroke Program, Hunter Medical Research Institute, Newcastle, NSW, Australia
- School of Biomedical Sciences and Pharmacy, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, Australia
| | - Avril Drummond
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | | | | | - Anners Lerdal
- Department of Interdisciplinary Health Sciences, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
- Research Department, Lovisenberg Diaconal Hospital, Oslo, Norway
| | - Amreen Mahmood
- Faculty of Health, Health and Education, Manchester Metropolitan University, Manchester, UK
| | - G Lorimer Moseley
- IIMPACT in Health, University of South Australia, Adelaide, SA, Australia
| | - Quentin J Pittman
- Department of Physiology and Pharmacology, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Ellyn A Riley
- Department of Communication Sciences and Disorders, Syracuse University, Syracuse, NY, USA
| | - Brad A Sutherland
- Tasmanian School of Medicine, College of Health and Medicine, University of Tasmania, Hobart, TAS, Australia
| | - Connie HY Wong
- Centre for Inflammatory Diseases, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
| | - Dale Corbett
- Department of Cellular and Molecular Medicine, University of Ottawa Roger Guindon Hall, Ottawa, ON, Canada
| | - Gillian Mead
- Ageing and Health, Usher Institute, University of Edinburgh, Edinburgh, UK
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Kuppuswamy A, Billinger S, Coupland KG, English C, Kutlubaev MA, Moseley L, Pittman QJ, Simpson DB, Sutherland BA, Wong C, Corbett D. Mechanisms of Post-Stroke Fatigue: A Follow-Up From the Third Stroke Recovery and Rehabilitation Roundtable. Neurorehabil Neural Repair 2024; 38:52-61. [PMID: 38156702 PMCID: PMC10798014 DOI: 10.1177/15459683231219266] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
BACKGROUND Post-stroke fatigue (PSF) is a significant and highly prevalent symptom, whose mechanisms are poorly understood. The third Stroke Recovery and Rehabilitation Roundtable paper on PSF focussed primarily on defining and measuring PSF while mechanisms were briefly discussed. This companion paper to the main paper is aimed at elaborating possible mechanisms of PSF. METHODS This paper reviews the available evidence that potentially explains the pathophysiology of PSF and draws parallels from fatigue literature in other conditions. We start by proposing a case for phenotyping PSF based on structural, functional, and behavioral characteristics of PSF. This is followed by discussion of a potentially significant role of early inflammation in the development of fatigue, specifically the impact of low-grade inflammation and its long-term systemic effects resulting in PSF. Of the many neurotransmitter systems in the brain, the dopaminergic systems have the most evidence for a role in PSF, along with a role in sensorimotor processing. Sensorimotor neural network dynamics are compromised as highlighted by evidence from both neurostimulation and neuromodulation studies. The double-edged sword effect of exercise on PSF provides further insight into how PSF might emerge and the importance of carefully titrating interventional paradigms. CONCLUSION The paper concludes by synthesizing the presented evidence into a unifying model of fatigue which distinguishes between factors that pre-dispose, precipitate, and perpetuate PSF. This framework will help guide new research into the biological mechanisms of PSF which is a necessary prerequisite for developing treatments to mitigate the debilitating effects of post-stroke fatigue.
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Affiliation(s)
- Annapoorna Kuppuswamy
- Queen Square Institute of Neurology, University College London, London, UK
- Department of Biomedical Sciences, University of Leeds, Leeds, UK
| | - Sandra Billinger
- Department of Neurology, University of Kansas Medical Center, University of Kansas Alzheimer’s Disease Research Center, Fairway, KS, MO, USA
| | - Kirsten G. Coupland
- School of Biomedical Sciences and Pharmacy, College of Health, Medicine and Wellbeing, University of Newcastle, Australia Heart and Stroke Program, Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - Coralie English
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Australia Heart and Stroke Program, Hunter Medical Research Institute, Newcastle, NSW, Australia
| | | | - Lorimer Moseley
- IIMPACT in Health, University of South Australia, Adelaide, SA, Australia
| | - Quentin J. Pittman
- Department of Physiology and Pharmacology, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Dawn B. Simpson
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Australia Heart and Stroke Program, Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - Brad A. Sutherland
- Tasmanian School of Medicine, College of Health and Medicine, University of Tasmania, Hobart, TS, Australia
| | - Connie Wong
- Centre for Inflammatory Diseases, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
| | - Dale Corbett
- Department of Cellular and Molecular Medicine, University of Ottawa Brain and Mind Institute, University of Ottawa, Ottawa, ON, Canada
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English C, Simpson DB, Billinger SA, Churilov L, Coupland KG, Drummond A, Kuppuswamy A, Kutlubaev MA, Lerdal A, Mahmood A, Moseley GL, Pittman QJ, Riley EA, Sutherland BA, Wong CHY, Corbett D, Mead G. A roadmap for research in post-stroke fatigue: Consensus-based core recommendations from the third Stroke Recovery and Rehabilitation Roundtable. Neurorehabil Neural Repair 2024; 38:7-18. [PMID: 37837346 PMCID: PMC10798034 DOI: 10.1177/15459683231209170] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2023]
Abstract
RATIONALE Fatigue affects almost half of all people living with stroke. Stroke survivors rank understanding fatigue and how to reduce it as one of the highest research priorities. METHODS We convened an interdisciplinary, international group of clinical and pre-clinical researchers and lived experience experts. We identified four priority areas: (1) best measurement tools for research, (2) clinical identification of fatigue and potentially modifiable causes, (3) promising interventions and recommendations for future trials, and (4) possible biological mechanisms of fatigue. Cross-cutting themes were aphasia and the voice of people with lived experience. Working parties were formed and structured consensus building processes were followed. RESULTS We present 20 recommendations covering outcome measures for research, development, and testing of new interventions and priority areas for future research on the biology of post-stroke fatigue. We developed and recommend the use of the Stroke Fatigue Clinical Assessment Tool. CONCLUSIONS By synthesizing current knowledge in post-stroke fatigue across clinical and pre-clinical fields, our work provides a roadmap for future research into post-stroke fatigue.
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Affiliation(s)
- Coralie English
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, Australia
- Heart and Stroke Program, Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - Dawn B Simpson
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, Australia
- Heart and Stroke Program, Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - Sandra A Billinger
- Department of Neurology, University of Kansas Medical Centre, University of Kansas Alzheimer’s Disease Research Centre, Kansas City, KS, USA
| | - Leonid Churilov
- Department of Medicine (RMH), University of Melbourne, Heidelberg, VIC, Australia
| | - Kirsten G Coupland
- Heart and Stroke Program, Hunter Medical Research Institute, Newcastle, NSW, Australia
- School of Biomedical Sciences and Pharmacy, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, Australia
| | - Avril Drummond
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | | | | | - Anners Lerdal
- Department of Interdisciplinary Health Sciences, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
- Research Department, Lovisenberg Diaconal Hospital, Oslo, Norway
| | - Amreen Mahmood
- Faculty of Health, Health and Education, Manchester Metropolitan University, Manchester, UK
| | - G Lorimer Moseley
- IIMPACT in Health, University of South Australia, Adelaide, SA, Australia
| | - Quentin J Pittman
- Department of Physiology and Pharmacology, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Ellyn A Riley
- Department of Communication Sciences and Disorders, Syracuse University, Syracuse, NY, USA
| | - Brad A Sutherland
- Tasmanian School of Medicine, College of Health and Medicine, University of Tasmania, Hobart, TAS, Australia
| | - Connie HY Wong
- Centre for Inflammatory Diseases, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
| | - Dale Corbett
- Department of Cellular and Molecular Medicine, University of Ottawa Roger Guindon Hall, Ottawa, ON, Canada
| | - Gillian Mead
- Ageing and Health, Usher Institute, University of Edinburgh, Edinburgh, UK
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Kim HY, Back DB, Choi BR, Choi DH, Kwon KJ. Rodent Models of Post-Stroke Dementia. Int J Mol Sci 2022; 23:ijms231810750. [PMID: 36142661 PMCID: PMC9501431 DOI: 10.3390/ijms231810750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 09/12/2022] [Accepted: 09/13/2022] [Indexed: 11/16/2022] Open
Abstract
Post-stroke cognitive impairment is one of the most common complications in stroke survivors. Concomitant vascular risk factors, including aging, diabetes mellitus, hypertension, dyslipidemia, or underlying pathologic conditions, such as chronic cerebral hypoperfusion, white matter hyperintensities, or Alzheimer’s disease pathology, can predispose patients to develop post-stroke dementia (PSD). Given the various clinical conditions associated with PSD, a single animal model for PSD is not possible. Animal models of PSD that consider these diverse clinical situations have not been well-studied. In this literature review, diverse rodent models that simulate the various clinical conditions of PSD have been evaluated. Heterogeneous rodent models of PSD are classified into the following categories: surgical technique, special structure, and comorbid condition. The characteristics of individual models and their clinical significance are discussed in detail. Diverse rodent models mimicking the specific pathomechanisms of PSD could provide effective animal platforms for future studies investigating the characteristics and pathophysiology of PSD.
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Affiliation(s)
- Hahn Young Kim
- Department of Neurology, Konkuk University Medical Center, Konkuk University School of Medicine, 120-1 Neungdong-ro, Gwangjin-gu, Seoul 05030, Korea
- Correspondence: ; Tel.: +82-2-2030-7563; Fax: +82-2-2030-5169
| | - Dong Bin Back
- Department of Neurology, Konkuk University Medical Center, Konkuk University School of Medicine, 120-1 Neungdong-ro, Gwangjin-gu, Seoul 05030, Korea
| | - Bo-Ryoung Choi
- Department of Neurology, Konkuk University Medical Center, Konkuk University School of Medicine, 120-1 Neungdong-ro, Gwangjin-gu, Seoul 05030, Korea
| | - Dong-Hee Choi
- Department of Medicine, Konkuk University School of Medicine, Seoul 05030, Korea
| | - Kyoung Ja Kwon
- Department of Medicine, Konkuk University School of Medicine, Seoul 05030, Korea
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Syeda W, Ermine CM, Khilf MS, Wright D, Brait VH, Nithianantharajah J, Kolbe S, Johnston LA, Thompson LH, Brodtmann A. Long-term structural brain changes in adult rats after mild ischaemic stroke. Brain Commun 2022; 4:fcac185. [PMID: 35898722 PMCID: PMC9309495 DOI: 10.1093/braincomms/fcac185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 03/09/2022] [Accepted: 07/20/2022] [Indexed: 11/13/2022] Open
Abstract
Preclinical studies of remote degeneration have largely focused on brain changes over the first few days or weeks after stroke. Accumulating evidence suggests that neurodegeneration occurs in other brain regions remote to the site of infarction for months and even years following ischaemic stroke. Brain atrophy appears to be driven by both axonal degeneration and widespread brain inflammation. The evolution and duration of these changes are increasingly being described in human studies, using advanced brain imaging techniques. Here, we sought to investigate long-term structural brain changes in a model of mild focal ischaemic stroke following injection of endothlin-1 in adult Long–Evans rats (n = 14) compared with sham animals (n = 10), over a clinically relevant time-frame of 48 weeks. Serial structural and diffusion-weighted MRI data were used to assess dynamic volume and white matter trajectories. We observed dynamic regional brain volume changes over the 48 weeks, reflecting both normal changes with age in sham animals and neurodegeneration in regions connected to the infarct following ischaemia. Ipsilesional cortical volume loss peaked at 24 weeks but was less prominent at 36 and 48 weeks. We found significantly reduced fractional anisotropy in both ipsi- and contralesional motor cortex and cingulum bundle regions of infarcted rats (P < 0.05) from 4 to 36 weeks, suggesting ongoing white matter degeneration in tracts connected to but distant from the stroke. We conclude that there is evidence of significant cortical atrophy and white matter degeneration up to 48 weeks following infarct, consistent with enduring, pervasive stroke-related degeneration.
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Affiliation(s)
- Warda Syeda
- The Florey Institute of Neuroscience and Mental Health , Parkville, Victoria , Australia
- Melbourne Neuropsychiatry Centre, The University of Melbourne , Parkville, Victoria , Australia
| | - Charlotte M Ermine
- The Florey Institute of Neuroscience and Mental Health , Parkville, Victoria , Australia
| | - Mohamed Salah Khilf
- The Florey Institute of Neuroscience and Mental Health , Parkville, Victoria , Australia
| | - David Wright
- Department of Neuroscience, Monash University , Clayton , Australia
| | - Vanessa H Brait
- The Florey Institute of Neuroscience and Mental Health , Parkville, Victoria , Australia
| | - Jess Nithianantharajah
- The Florey Institute of Neuroscience and Mental Health , Parkville, Victoria , Australia
| | - Scott Kolbe
- Department of Neuroscience, Monash University , Clayton , Australia
| | - Leigh A Johnston
- The Melbourne Brain Centre Imaging Unit, The University of Melbourne , Parkville, Victoria , Australia
- Department of Biomedical Engineering, The University of Melbourne , Parkville, Victoria , Australia
| | - Lachlan H Thompson
- The Florey Institute of Neuroscience and Mental Health , Parkville, Victoria , Australia
| | - Amy Brodtmann
- The Florey Institute of Neuroscience and Mental Health , Parkville, Victoria , Australia
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