Fatigue in Stroke

Post-stroke fatigue (PSF) affects more than 50% of stroke survivors. Therefore, it is one of the most common complications of stroke. PSF is negatively associated with patients’ adherence to medication and rehabilitation and the ultimate functional outcome. It therefore adversely impacts patients’ quality of life and daily life activities and increases the caregivers’ burden. Although researchers have attempted to explain PSF mechanisms, its pathophysiologic mechanism remains unclear. This is partly because there are multiple contributing factors for PSF, which include neurological disability, cognitive decline, comorbid diseases, multiple medications, and neuropsychiatric symptoms such as depression/anxiety, sleep disturbances, pain, and unfavorable social/familial environments. Considering the diverse pathophysiology, it is understandable that there is no single, best treatment option. Recent trials have shown that pharmacological treatment using modafinil improved fatigue symptoms in some patients. Nonpharmacological therapies including cognitive behavioral therapy may exert additional benefits. However, it is likely that the treatment should be individualized based on the underlying causes of PSF in each patient.