Post-stroke fatigue: characteristics, related experiences and pathophysiological mechanisms in a longitudinal perspective

The incidence of stroke in Norway is estimated to be between 12 000 and 15 000 per year. Studies show that post-stroke fatigue, with or without depression, occurs in 30 to 68% of the stroke patients. Post-stroke fatigue is a common and persistent complain t viewed by patients to be difficult to manage, impacting negatively on their daily lives. In spite of this, fatigue is relatively understudied in the stroke population. In this study, fatigue will be studied from three perspectives. Study 1 will examine the characteristics of fatigue and its relationships to depression, functioning, sleep disturbance, and quality of life over an 18 month period, by applying a longitudinal, prospective, quantitative design. A sample of 200 first-ever stroke patients will be recruited for data collection at 4 time-points. The major objective of Study 2 is to gain in-depth understandings regarding the nature, characteristics, patterns, and trajectories of post-stroke fatigue. It also seeks to gain patients' descriptions of fatigue in the context of post-stroke depression and their daily lives. It will be studied through a qualitative, descriptive design using in-depth interviews four times over a period of 18 months on a strategic sub-sample from the base sample for Study 1 . The major aim for Study 3 is to explore pathophysiological mechanisms of post-stroke fatigue in relation to brain abnormalities and pro-inflammatory cytokines. Study 3 will use a quantitative, exploratory design with a stratified sub-sample to compare h igh and low fatigue groups in relation to brain abnormaties (examined by CT/MRI) and pro-inflammatory cytokines in the early phase of stroke. These findings will be contrasted to the level of fatigue over 18 months. Through these studies we seek to gain k nowledge regarding post-stroke fatigue, but also to examine whether post-stroke fatigue differs from fatigue in other population groups in its characteristics, modulations and trajectories, and mechanisms.