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The symptoms of pathological fatigue, apathy, and depression in patients after stroke

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Objective: to comparatively analyze the rate and correlation of the symptoms of pathological fatigue, apathy, and depression in patients in the termination phase of an acute stroke period.

Patients and methods. The symptoms of asthenia (pathological fatigue), apathy, and depression were comparatively investigated in 105 patients at 3–4 weeks after stroke. The fatigue rating scale, apathy rating scale, and hospital anxiety and depression (HAD) scale were used to evaluate the symptoms of pathological fatigue, apathy, and depression. The level of anxiety was also estimated using the appropriate HAD subscale and the Epworth daytime sleepiness scale; the magnitude of cognitive impairments was judged from the Montreal cognitive assessment. The type, basin, and recurrence of stroke were registered. The severity of neurological deficit was evaluated using the U.S. National Institutes of Health Stroke Scale (NIHSS); limited functional capacities were estimated by the modified Rankin scale (mRS). The presence of prestroke fatigue was also determined.

Results and discussion. The symptoms of asthenia were observed in 56% of the patients and associated with the severity of poststroke disability. The symptoms of apathy were detected in 10.5% of the patients; those of depression were present in 18% and determined by the magnitude of neurological deficit and the degree of poststroke disability and cognitive impairments. All the three phenomena were correlated with the magnitude of anxiety, daytime sleepiness, and between them. This suggests that they may complicate a reciprocal course in some cases. The symptoms of depression, asthenia, and apathy may also develop on their own, which is borne out by their different rates and correlations. Each of these phenomena requires an individual approach to diagnosis and treatment.

Conclusion. The symptoms of pathological fatigue are most common and least specific in patients with mild poststroke neurological deficit. Apathy may be also associated with depression or develop on its own. Further investigation of mechanisms for the development of poststroke pathological fatigue and apathy is important for developing effective methods to correct these abnormalities.

About the Authors

M. A. Kutlubaev
G.G. Kuvatov Republican Clinical Hospital, Ufa, Bashkortostan 132, Dostoevsky St., Ufa 450005, Republic of Bashkortostan
Russian Federation

L. R. Akhmadeeva
Bashkir State Medical University, Ministry of Health of Russia, Ufa, Bashkortostan 3, Lenin St., Ufa 450000, Republic of Bashkortostan
Russian Federation


1. Скворцова ВИ, Концевой ВА, Петрова ЕА, Савина МА. Депрессия и парадепрессивные расстройства при церебральном инсульте: эпидемиология, патогенез и факторы риска. Журнал неврологии и психиатрии им. С.С. Корсакова. 2009;109;4–10. [Skvortsova VI, Kontsevoi VA, Petrova EA, Savina MA. Depression and predepression disorders in cerebral stroke: epidemiology, pathogenesis and risk factors. Zhurnal nevrologii i psikhiatrii im. S.S. Korsakova. 2009;109;4–10. (In Russ.)].

2. Кутлубаев МА. Ахмадеева ЛР. Постинсультная усталость. Журнал неврологии и психиатрии им. С.С. Корсакова. 2010;110(4 Прил. 2):60–6. [Kutlubaev MA. Akhmadeeva LR. Post-stroke fatigue. Zhurnal nevrologii i psikhiatrii im. S.S. Korsakova. 2010;110(4 suppl. 2):60–6. (In Russ.)] .

3. Кутлубаев МА, Ахмадеева ЛР. Постинсультная апатия. Журнал неврологии и психиатрии им. С.С. Корсакова. 2012;112:99–102. [Kutlubaev MA, Akhmadeeva LR. Posttroke apathy. Zhurnal nevrologii i psikhiatrii im. S.S. Korsakova. 2012;112:99–102. (In Russ.)].

4. Hackett ML, Pickles K. Part I: frequency of depression after stroke: an updated systematic review and meta-analysis of observational studies. Int J Stroke. 2014 Dec;9(8):1017–25. doi: 10.1111/ijs.12357. Epub 2014 Aug 12.

5. Парфенов ВА. Постинсультная депрессия: распространенность, патогенез, диагностика и лечение. Неврология, нейропсихиатрия, психосоматика. 2012;4(4):84–8. [Parfenov VA. Poststroke depression: prevalence, pathogenesis, diagnosis, and treatment . Nevrologiya, neiropsikhiatriya, psikhosomatika = Neurology, Neuropsychiatry, Psychosomatics. 2012;4(4):84–8. (In Russ.)]. DOI: http://dx.

6. Вознесенская ТГ. Депрессия при цереброваскулярных заболеваниях. Неврология, нейропсихиатрия и психосоматика. 2009;1(2):9–12. [Voznesenskaya TG. Depression in cerebrovascular diseases. Nevrologiya, neiropsikhiatriya, psikhosomatika = Neurology, Neuropsychiatry, Psychosomatics. 2009;1(2):9–12. (In Russ.)]. DOI:

7. Старчина ЮА. Постинсультная депрессия: научно обоснованные подходы к выбору ерапии. Неврология, нейропсихиатрия, психосоматика. 2012;4(1):116–20. [Starchina YuA. Post-stroke depression: scientifically substantiated approaches to choosing therapy. Nevrologiya, neiropsikhiatriya, psikhosomatika = Neurology, Neuropsychiatry, Psychosomatics. 2012;4(1):116–20. (In Russ.)]. DOI:

8. -374

9. Kutlubaev MA, Duncan FH, Mead GE. Biological correlates of post-stroke fatigue: a systematic review. Acta Neurol Scand. 2012 Apr;125(4):219–27. doi: 10.1111/j.1600- 0404.2011.01618.x. Epub 2011 Nov 10.

10. Caeiro L, Ferro JM, Costa J. Apathy secondary to stroke: a systematic review and etaanalysis. Cerebrovasc Dis. 2013;35(1):23–39. doi: 10.1159/000346076. Epub 2013 Feb 14.

11. Бикбулатова ЛФ, Кутлубаев МА, Ахмадеева ЛР. Шкала оценки усталости (перевод на русский язык) адаптация и оценка психометрических свойств в стационарах клиник неврологии и терапии. Медицинский вестник Башкортостана. 2012;(7):37–42. [Bikbulatova LF, Kutlubaev MA, Akhmadeeva LR. Rating scale of fatigue (translated into Russian language) adaptation and evaluation of psychometric properties in hospitals, clinics of neurology and therapy. Meditsinskii vestnik Bashkortostana. 2012;(7):37–42. (In Russ.)].

12. Starkstein SE, Fedoroff JP, Price TR, et al. Apathy following cerebrovascular lesions. Stroke. 1993 Nov;24(11):1625–30.

13. Salvadori E, Pasi M, Poggesi A, et al. Predictive value of MoCA in the acute phase of stroke on the diagnosis of mid-term cognitive impairment. J Neurol. 2013 Sep;260(9):2220–7. doi: 10.1007/s00415-013-6962-7. Epub 2013 May 29.

14. Kutlubaev MA, Mead GE. Fatigue after stroke. In The Behavioral and Cognitive Neurology of Stroke. Godefroy O, editor. 2nd Ed. Cambridge University Press; 2013. P. 375–86.

15. Kutlubaev MA, Hackett ML. Part II: predictors of depression after stroke and impact of depression on stroke outcome: an updated systematic review of observational studies. Int J Stroke. 2014 Dec;9(8):1026–36. doi: 10.1111/ijs.12356. Epub 2014 Aug 26.

16. Хасанова ДР, Житкова ЮВ. Применение эсциталопрама для профилактики индрома депрессии и когнитивных нарушений в остром периоде инсульта. Неврология, нейропсихиатрия, психосоматика. 2013;5(S2):16–22. [Khasanova DR, Zhitkova YuV. Use of escitalopram to prevent depression and cognitive impairments in the acute phase of stroke. Nevrologiya, neiropsikhiatriya, psikhosomatika = Neurology, Neuropsychiatry, Psychosomatics. 2013;5(S2):16–22. (In Russ.)]. DOI: 2354

17. Хасанова ДР, Житкова ЮВ, Сафиуллина АА. Эффективность вальдоксана в профилактике и лечении постинсультной депрессии. Неврология, нейропсихиатрия, психосоматика. 2012;4(3):48–54. [Khasanova DR, Zhitkova YuV, Safiullina AA. Efficacy of valdoxan in the prevention and treatment of post-stroke depression. Nevrologiya, neiropsikhiatriya, psikhosomatika = Neurology, Neuropsychiatry, Psychosomatics. 2012;4(3):48–54. (In Russ.)]. DOI: 2012-403

18. Mead GE, Hsieh CF, Lee R, et al. Selective serotonin reuptake inhibitors for stroke recovery: a systematic review and meta-analysis. Stroke. 2013 Mar;44(3):844–50. doi: 10.1161/STROKEAHA.112.673947. Epub 2013 Jan 29.

19. Huijts M, Duits A, Staals J, van Oostenbrugge RJ. Association of vitamin B12 deficiency with fatigue and depression after lacunar stroke. PLoS One. 2012;7(1):e30519. doi: 10.1371/journal.pone.0030519. Epub 2012 Jan 20.

20. Huijts M, van Oostenbrugge RJ, Rouhl RP, et al. Effects of vitamin B12 supplementation n cognition, depression, and fatigue in patients with lacunar stroke. Int Psychogeriatr. 2013 Mar;25(3):508–10. doi: 10.1017/S1041610212001925. Epub 2012 Nov 19.

21. Kane I, Lindley R, Lewis S, Sandercock P; IST-3 Collaborative Group. Impact of stroke syndrome and stroke severity on the process of consent in the Third International Stroke Trial. Cerebrovasc Dis. 2006;21(5–6):348–52. Epub 2006 Feb 15.

For citation:

Kutlubaev M.A., Akhmadeeva L.R. The symptoms of pathological fatigue, apathy, and depression in patients after stroke. Neurology, Neuropsychiatry, Psychosomatics. 2015;7(2):16-21. (In Russ.)

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