21828: Use of Subjective Fatigue to Predict Cognition in Patients with Acute Stroke or Brain Injury

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Journal of Neurologic Physical Therapy: Academy of Neurologic Physical Therapy Poster Presentations


Purpose/Hypothesis: Sleep disturbances and fatigue are very prevalent in patients post stroke and traumatic brain injury (TBI), contributing to deficits in attention and cognition. Increased fatigue in patients post-stroke is associated with poorer functional outcomes. The purpose of this study was to determine whether daytime fatigue measures predict cognitive performance in patients attending inpatient rehabilitation for stroke or TBI. Number of Subjects: Thirty-three subjects (64.8±17.4 years, n=19 male) admitted to an inpatient rehabilitation facility post-stroke or TBI were included in the study. Materials and Methods: On a single test day, subjects reported their fatigue levels on three subjective scales: Karolinska Sleepiness Scale (KSS), Wits Pictorial Sleepiness Scale (WITS), and Fatigue Visual Analogue Scale (VAS). Subjects also completed three cognitive performance measures: Trail Making Test Version A (TMTA) and Version B (TMTB), and Rey Auditory Verbal Learning Test (RAVLT). Descriptive statistics and simple linear regression analysis were conducted using SPSS version 24. Results: Regression analyses indicated that the KSS, WITS, and VAS each independently predicted performance on both the TMTA and more cognitively challenging TMTB (all p<0.05), with lower fatigue ratings predictive of better performance. None of the fatigue measures predicted RAVLT scores (p>0.05). Conclusions: Findings from this study suggest that lower ratings of fatigue are predictive of better performance on the TMT in a sample of patients post-acute stroke or TBI. Conversely, fatigue ratings were not predictive of performance on the RAVLT, a measure of verbal and auditory learning and memory. The TMT assesses cognition by evaluating attention, the ability to execute and modify a plan of action, and the capacity to maintain two simultaneous trains of thought. The ability of the fatigue measures’ ability to predict TMT scores but not RAVLT scores may be due to impairments related to brain-injury in this patient population, compromising verbal or auditory learning pathways more than pathways required for sequencing and speed. Clinical Relevance: Patient fatigue is an important consideration given its ability to predict cognitive performance. In turn, cognitive performance is positively correlated with improved functional outcomes. Physical therapists should consider that, while fatigue may play a role in some specific aspects of cognition, it may not be associated with others. Congruently, while patient-reported fatigue did not correlate with auditory and verbal learning, it did influence performance on tasks requiring cognitive abilities such as speed and sequencing in a sample of patients post stroke or TBI. Further research is warranted to determine whether fatigue-reducing i

Clinical Institute

Neurosciences (Brain & Spine)