Stroke patients with cognitive and emotional problems have higher risk of being more fatigued

Reviewed by Emily Henderson, B.Sc.Feb 14 2023

Some people feel worse than others after a stroke. Stroke patients with cognitive and emotional problems tend to experience fatigue more often and sleep more during the day, according to recent research.

Approximately 9 000 people are admitted to Norwegian hospitals with stroke each year. About half of these patients feel exhausted afterwards, and many patients sleep more during the day than before the stroke. These after-effects are challenging and significantly affect patients' everyday life.

However, we still have a limited understanding of which factors lead to increased fatigue and daytime sleep after stroke. Our research group at the Norwegian University of Science and Technology (NTNU) therefore wanted to investigate whether cognitive and emotional complaints are related to increased fatigue and sleep during the day.

Our results were recently published in an article in the journal Frontiers in Neurology.

People with cognitive and emotional disorders struggle

Our analyses show that patients who report poorer memory and concentration three months following stroke have a higher risk of being more fatigued and sleeping more during the day at twelve months.

The same applies to patients who report major anxiety and depressive symptoms three months after the stroke.

Cognitive and emotional complaints are thus both important factors for increased daytime sleep and fatigue after a stroke. This finding was also evident when we took into account other factors such as age, sex, the severity of the stroke and quality of sleep at night, as well as their relationship to each other over time.

The study was carried out by collaborating researchers in the Vascular Diseases Research Group (VaD) at NTNU and researchers from the Department for Health Service Research (HØKH) at Akershus University Hospital.

Ramune Grambaite heads the group at NTNU. She is an associate professor in clinical neuropsychology and clinical manager of the Neuropsychological Outpatient Clinic at NTNU's Department of Psychology. Elisabeth Kliem is the PhD candidate in the research group and the first author of this article.

We used data from NORSPOT, a study that was carried out at Akershus University Hospital between 2012 and 2013. In that study, stroke patients answered questionnaires three and twelve months after their stroke. The patient sample in our study had relatively mild strokes and had no known cognitive or emotional challenges before the stroke.

Important to follow up patients following stroke

Both cognitive and emotional problems are common after a stroke. Our results show the importance of following up on these complaints in the subacute phase after the stroke.

We can reduce the risk of increased fatigue and need for sleep in the long term if we manage to identify and treat stroke patients who struggle cognitively and emotionally.

More research needed

This study is an important step towards a better understanding of fatigue and increased need for sleep following a stroke. Cognitive and emotional problems after a stroke are often not detected in the routine follow-up, but have the potential to greatly affect the patient's everyday life.

We therefore hope to see more research undertaken in this field, as it can lead to improved diagnostics and treatment of patients in the long term.