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Title: Investigation of the relationship between fatigue and cognition after stroke
Author: Lagogianni, Christodouli
ISNI:       0000 0004 6500 1071
Awarding Body: University of Nottingham
Current Institution: University of Nottingham
Date of Award: 2017
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Background: Stroke is among the most common causes of disability and stroke survivors may experience cognitive impairment, low mood and fatigue. These three are often associated, as mood and fatigue share some common symptoms and fatigue can also be expressed in a cognitive manner. Fatigue is multifaceted and cannot be easily defined which complicates its measurement. There is a lack of understanding regarding the relationship between fatigue and cognition after stroke and the studies suffer methodological limitations. Objective: This project examined the above concepts and the relationship between fatigue and cognition, more specifically, speed of information processing, sustained and selective attention. Methods: The relationship was examined by: i) systematically reviewing current evidence on this relationship and ii) by conducting three studies that investigated the relationship between fatigue, mood and cognitive impairment in first stroke survivors in the acute phase without depression, in first stroke survivors in the acute phase with depression and in chronic stroke survivors measuring cognitive aspects of fatigue (Fatigue Scale for Motor and Cognitive Functions) as well. We also iii) explored the reliability of and the components assessed by the Fatigue Severity Scale. Results: The systematic review identified 11 studies that examined the relationship. Results were inconclusive as some studies confirmed a significant relationship while others did not. Overall, the findings suggested that memory, attention and speed of information processing are associated with fatigue after stroke, with coefficients ranging from r= .36 to .46. Levels of fatigue and cognitive impairment were reported as moderate. Our three studies did not reveal any statistically significant association between fatigue (general, cognitive or motor) and cognitive performance (either selective and sustained attention or speed of information processing). We also confirmed the uni-dimensionality of the Fatigue Severity Scale in our sample with the use of component analysis; the scale also revealed nearly excellent internal consistency (α=0.95). Conclusion: The Fatigue Severity Scale is a reliable fatigue scale that is commonly used in stroke research. The Fatigue Scale for Motor and Cognitive Functions is a relatively new fatigue scale with high psychometric properties. The lack of significant relationship between fatigue and cognitive impairment may be attributed to the choice of cognitive components that were examined in this study. Implication of Project/Findings: Cognitive impairment after stroke is very common and so is fatigue. If these two are associated in any way, it will be beneficial to explore such a relationship, or even the lack of it, in order to better understand cognitive mechanisms of fatigue and to potentially incorporate them in future psychological interventions. Further Suggestions: Future studies may benefit from incorporating general and cognitive fatigue scales as well as including domain specific and general cognitive test. The findings of this study highlight the complexity of fatigue and speed of information processing as phenomena. Despite not revealing any significant relationship between certain cognitive aspects and fatigue, it may be worth examining the relationship between fatigue and memory components which are less commonly included in similar studies. Funding: This project was funded by the University of Nottingham (Vice Chancellor’s Scholarship for Research Excellence-European Union; Scholarship Reference Number: RFDX42DB2). No financial or other conflict is declared.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available
Keywords: WL Nervous system