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Scopelliti G, Rossi C, Kuchcinski G, Boulouis G, Moulin S, Cordonnier C, Hénon H, Casolla B. Fatigue after spontaneous intracerebral haemorrhage: prevalence and associated factors. Neurol Sci 2024; 45:2127-2135. [PMID: 37993682 DOI: 10.1007/s10072-023-07196-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 11/08/2023] [Indexed: 11/24/2023]
Abstract
BACKGROUND Fatigue is a major complaint in stroke survivors, but data focusing on intracerebral haemorrhage (ICH) survivors are scarce. In a cohort of spontaneous ICH survivors, we assessed the long-term prevalence of fatigue and its associated factors. METHODS We included consecutive 1-year ICH survivors from the prospective, observational, single-centre Prognosis of Intracerebral Haemorrhage (PITCH) study. We evaluated fatigue (defined as a score ≥ 4 in Chalder Fatigue Scale); the severity of neurological, depressive, and anxiety symptoms; and functional disability 1, 3, and 6 years after ICH. We performed univariable and multivariable models to evaluate clinical factors and brain magnetic resonance imaging (MRI) small vessel disease (SVD) markers associated with fatigue. RESULTS Of 255 1-year ICH survivors, 153 (60%) underwent fatigue screening and were included in this study. Seventy-eight patients (51%) reported fatigue at 1-year, 56/110 (51%) at 3-year, and 27/67 (40%) at 6-year follow-up. Patients with fatigue exhibited more severe concomitant depressive/anxiety symptoms, but the severity of depressive symptoms was the only clinical factor significantly associated with 1-year fatigue in multivariable analysis (adjusted odds ratio 1.4 for one-point increase; 95% confidence interval 1.2-1.6). Patients with severe cortical atrophy at baseline had increased risk of fatigue at 1-year follow-up compared to patients with mild/no cortical atrophy (adjusted odds ratio 2.5; 95% confidence interval 1.1-5.8). CONCLUSIONS Fatigue after ICH is frequent and long-lasting, and it is associated with cortical atrophy (but not with other MRI markers of cerebral SVD). The link between fatigue and depressive symptoms may represent a potential therapeutic target.
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Affiliation(s)
- Giuseppe Scopelliti
- Department of Neurology, Inserm, U1172-LilNCog-Lille Neuroscience & Cognition, CHU-Lille, Univ. Lille, F-59000, Lille, France
- Neurology and Stroke Unit, Luigi Sacco Hospital, Milan, Italy
| | - Costanza Rossi
- Department of Neurology, Inserm, U1172-LilNCog-Lille Neuroscience & Cognition, CHU-Lille, Univ. Lille, F-59000, Lille, France
| | - Grégory Kuchcinski
- Department of Neuroradiology, Inserm, U1172-Lille Neuroscience & Cognition, CHU-Lille, Univ. Lille, F-59000, Lille, France
| | - Grégoire Boulouis
- Diagnostic and Interventional Neuroradiology Department, INSERM U1253 iBrain, University Hospital of Tours, Centre Val de Loire, Tours, France
| | | | - Charlotte Cordonnier
- Department of Neurology, Inserm, U1172-LilNCog-Lille Neuroscience & Cognition, CHU-Lille, Univ. Lille, F-59000, Lille, France.
| | - Hilde Hénon
- Department of Neurology, Inserm, U1172-LilNCog-Lille Neuroscience & Cognition, CHU-Lille, Univ. Lille, F-59000, Lille, France
| | - Barbara Casolla
- Department of Neurology, Inserm, U1172-LilNCog-Lille Neuroscience & Cognition, CHU-Lille, Univ. Lille, F-59000, Lille, France
- UR2CA-URRIS, Stroke Unit, CHU Pasteur 2, Nice Cote d'Azur University, Nice, France
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Pedersen A, Almkvist E, Holmegaard L, Lagging C, Redfors P, Blomstrand C, Jood K, Samuelsson H, Jern C. Fatigue 7 years post-stroke: Predictors and correlated features. Acta Neurol Scand 2022; 146:295-303. [PMID: 35791041 PMCID: PMC9545687 DOI: 10.1111/ane.13665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 06/08/2022] [Accepted: 06/14/2022] [Indexed: 11/29/2022]
Abstract
Background Post‐stroke fatigue (PSF) is common with great impact on quality of life. We explored predictive and cross‐sectionally correlated features in the long term after ischemic stroke. Methods This study comprises 430 participants of the prospective Sahlgrenska Academy Study on Ischemic Stroke (SAHLSIS), aged 18–69 years at index stroke. Information on acute stroke severity and cardiovascular risk factors was collected at index stroke. After 7 years, PSF was assessed by the Daily Fatigue Impact Scale (D‐FIS). Cognitive, neurological, and functional outcomes, and symptoms of depression and anxiety, pain, insomnia, and physical activity were also assessed. Associations between baseline variables and PSF were analyzed by ordinal regression. Correlations between PSF and cross‐sectionally assessed variables, and between PSF and baseline variables, were analyzed with Spearman's or point‐biserial correlation for the whole sample and in sex‐stratified analyses. Results At 7 years post‐stroke, 80% of the participants reported some impact of fatigue. Female sex and stroke severity were independently associated with PSF, whereas no associations were detected with baseline cardiovascular risk factors. In cross‐sectional analyses at 7 years, we found correlations between PSF and poor functional, neurological, and cognitive outcomes, as well as depressive symptoms, anxiety, insomnia, pain, and low physical activity (p < .001 throughout). The correlation with insomnia was stronger in women than in men (two‐way ANOVA interaction test, p = .03). Conclusions Our findings confirm that PSF is common in the long term after ischemic stroke and show a complex interplay with sex and several other outcomes. Future studies should address causal relationships and interventions towards fatigue and coexisting features.
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Affiliation(s)
- Annie Pedersen
- Institute of Biomedicine, Department of Laboratory Medicine, the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Clinical Genetics and Genomics, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Emelie Almkvist
- Institute of Biomedicine, Department of Laboratory Medicine, the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Lukas Holmegaard
- Institute of Neuroscience and Physiology, Department of Clinical Neuroscience, the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Neurology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Cecilia Lagging
- Institute of Biomedicine, Department of Laboratory Medicine, the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Clinical Genetics and Genomics, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Petra Redfors
- Institute of Neuroscience and Physiology, Department of Clinical Neuroscience, the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Neurology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Christian Blomstrand
- Institute of Neuroscience and Physiology, Department of Clinical Neuroscience, the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Katarina Jood
- Institute of Neuroscience and Physiology, Department of Clinical Neuroscience, the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Neurology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Hans Samuelsson
- Institute of Neuroscience and Physiology, Department of Clinical Neuroscience, the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Neurology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden.,Institute of Psychology, Faculty of Social Sciences, University of Gothenburg, Gothenburg, Sweden
| | - Christina Jern
- Institute of Biomedicine, Department of Laboratory Medicine, the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Clinical Genetics and Genomics, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
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Mead G, Gillespie D, Barber M, House A, Lewis S, Ensor H, Wu S, Chalder T. Post stroke intervention trial in fatigue (POSITIF): Randomised multicentre feasibility trial. Clin Rehabil 2022; 36:1578-1589. [PMID: 35866206 PMCID: PMC9574032 DOI: 10.1177/02692155221113908] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To test the feasibility of a telephone delivered intervention, informed by cognitive behavioural principles, for post-stroke fatigue, and estimated its effect on fatigue and other outcomes. DESIGN Randomised controlled parallel group trial. SETTING Three Scottish stroke services. SUBJECTS Stroke survivors with fatigue three months to two years post-stroke onset. INTERVENTIONS Seven telephone calls (fortnightly then a 'booster session' at 16 weeks) of a manualised intervention, plus information about fatigue, versus information only. MAIN MEASURES Feasibility of trial methods, and collected outcome measures (fatigue, mood, anxiety, social participation, quality of life, return to work) just before randomisation, at the end of treatment (four months after randomisation) and at six months after randomisation. RESULTS Between October 2018 and January 2020, we invited 886 stroke survivors to participate in postal screening: 188/886 (21%) returned questionnaires and consented, of whom 76/188 (40%) were eligible and returned baseline forms; 64/76 (84%) returned six month follow-up questionnaires. Of the 39 allocated the intervention, 23 (59%) attended at least four sessions. At six months, there were no significant differences between the groups (adjusted mean differences in Fatigue Assessment Scale -0.619 (95% CI -4.9631, 3.694; p = 0.768), the Generalised Anxiety Disorder 7 -0.178 (95% CI -3.823, 3.467, p = 0.92), and the Patient Health Questionnaire -0.247 (95% CI -2.935, 2.442, p = 0.851). There were no between-group differences in quality of life, social participation or return to work. CONCLUSION Patients can be recruited to a trial of this design. These data will inform the design of further trials in post-stroke fatigue.
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Affiliation(s)
- Gillian Mead
- Usher institute, University of Edinburgh, Edinburgh, UK
| | - David Gillespie
- Department of Clinical Neurosciences, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Mark Barber
- NHS Lanarkshire, 4468University Hospital Monklands, Coatbridge, UK
| | - Allan House
- Leeds Institute of Health Sciences, Leeds, UK
| | - Steff Lewis
- Edinburgh Clinical Trials Unit, University of Edinburgh, Edinburgh, UK
| | - Hannah Ensor
- Edinburgh Clinical Trials Unit, University of Edinburgh, Edinburgh, UK
| | - Simiao Wu
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Trudie Chalder
- Department of Psychological Medicine, Kings College London, London, UK
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Röttgering JG, Douw L, de Witt Hamer PC, Kouwenhoven MCM, Würdinger T, van de Ven PM, Sharpe L, Knoop H, Klein M. Reducing severe fatigue in patients with diffuse glioma: a study protocol for an RCT on the effect of blended cognitive behavioural therapy. Trials 2022; 23:568. [PMID: 35841104 PMCID: PMC9287927 DOI: 10.1186/s13063-022-06485-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 06/19/2022] [Indexed: 11/10/2022] Open
Abstract
Background Fatigue is the most frequent and burdensome symptom of patients with diffuse glioma. It is closely linked to decreased health-related quality of life and symptoms such as depression and sleep disturbances. Currently, there is no evidence-based treatment that targets severe fatigue in patients with brain tumours. Cognitive behavioural therapy is aimed at fatigue-maintaining beliefs and behaviour. This therapy has been proven effective in reducing severe fatigue in cancer survivors and patients with multiple sclerosis. A blended therapy program combines sessions with a therapist with therapist-guided web-based therapy modules. The aim of this randomized controlled trial is to determine the efficacy of blended cognitive behavioural therapy in treating severe fatigue in patients with diffuse glioma. Methods We will include a maximum of 100 patients with diffuse glioma with clinically and radiologically stable disease and severe fatigue (i.e. Checklist Individual Strength, subscale fatigue severity ≥ 35). Patients will be randomized to blended cognitive behavioural therapy or a waiting list condition. The 12-week intervention GRIP on fatigue consists of five patient-therapist sessions and five to eight individualized web-based therapy modules supported by email contact. The primary outcome measure is fatigue severity. Secondary outcome measures include sleep quality, health-related quality of life, depression, anxiety, functional impairment and subjective and objective cognitive functioning. Primary and secondary outcome measures will be assessed at baseline and after 14 and 24 weeks. Magnetoencephalography and MRI will be used to evaluate potential biomarkers for intervention success. This trial has a Bayesian design: we will conduct multiple interim analyses to test for efficacy or futility of the trial. This is the first trial within the GRIP trial platform: a platform developing four to five different interventions for the most common symptoms in patients with diffuse glioma. Discussion The results of the GRIP on fatigue trial will provide information about the efficacy of this intervention on fatigue in patients with diffuse glioma. Multiple other outcomes and possible predictors of treatment success will also be explored. Trial registration Netherlands Trial Register NL8711. Registered on 14 June 2020. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-022-06485-5.
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Affiliation(s)
- Jantine Geertruida Röttgering
- Amsterdam UMC location Vrije Universiteit Amsterdam, Medical Psychology, De Boelelaan 1117, Amsterdam, The Netherlands. .,Cancer Center Amsterdam, Brain Tumor Center, Amsterdam, The Netherlands. .,Amsterdam UMC location Vrije Universiteit Amsterdam, Anatomy and Neurosciences, De Boelelaan 1117, Amsterdam, The Netherlands.
| | - Linda Douw
- Cancer Center Amsterdam, Brain Tumor Center, Amsterdam, The Netherlands.,Amsterdam UMC location Vrije Universiteit Amsterdam, Anatomy and Neurosciences, De Boelelaan 1117, Amsterdam, The Netherlands.,Department of Radiology, Massachusetts General Hospital, Athinoula A. Martinos Center for Biomedical Imaging, 149 13th Street, Boston, MA, 02129, USA
| | - Philip C de Witt Hamer
- Cancer Center Amsterdam, Brain Tumor Center, Amsterdam, The Netherlands.,Amsterdam UMC location Vrije Universiteit Amsterdam, Neurosurgery, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Mathilde C M Kouwenhoven
- Cancer Center Amsterdam, Brain Tumor Center, Amsterdam, The Netherlands.,Amsterdam UMC location Vrije Universiteit Amsterdam, Neurology, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Tom Würdinger
- Cancer Center Amsterdam, Brain Tumor Center, Amsterdam, The Netherlands.,Amsterdam UMC location Vrije Universiteit Amsterdam, Neurosurgery, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Peter M van de Ven
- Amsterdam UMC location Vrije Universiteit Amsterdam, Epidemiology and Data Science, Amsterdam, The Netherlands
| | - Louise Sharpe
- The School of Psychology, University of Sydney, Sydney, NSW, Australia
| | - Hans Knoop
- Amsterdam UMC location Vrije Universiteit Amsterdam, Medical Psychology, De Boelelaan 1117, Amsterdam, The Netherlands.,Amsterdam UMC location University of Amsterdam, Medical Psychology, Meibergdreef 9, Amsterdam, The Netherlands.,Amsterdam Public Health Research Institute, Expert Center for Chronic Fatigue, Amsterdam, The Netherlands
| | - Martin Klein
- Amsterdam UMC location Vrije Universiteit Amsterdam, Medical Psychology, De Boelelaan 1117, Amsterdam, The Netherlands.,Cancer Center Amsterdam, Brain Tumor Center, Amsterdam, The Netherlands
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