Annals of Clinical and Experimental NeurologyAnnals of Clinical and Experimental NeurologyАнналы клинической и экспериментальной неврологии2075-54732409-2533Eco-Vector88210.54101/ACEN.2023.4.8ReviewsОбзорыReview ArticlePoststroke Asthenic DisorderАстеническое расстройство после инсультаhttps://orcid.org/0000-0003-1001-2024KutlubaevMansur A.КутлубаевМансур Амирович
Russian Federation

D. Sci. (Med.), Assoc. Prof., Head, Department of Neurology

д.м.н., доцент, зав. каф. неврологии

mkmed@mail.ruhttps://orcid.org/0000-0002-9769-869XAkhmetovaAlbina I.АхметоваАльбина Ильдаровна
Russian Federation

Attending Neurologist

врач-невролог

zolot55@mail.ruBashkir State Medical UniversityФГБОУ ВО «Башкирский государственный медицинский университет»Republican Clinical Hospital named after G.G. KuvatovГБУЗ «Республиканская клиническая больница им. Г.Г. Куватова»2512202317464712508202218102022Copyright ©; 2023, Kutlubaev M.A., Akhmetova A.I.Copyright ©; 2023, Кутлубаев М.А., Ахметова А.И.2023Kutlubaev M.A., Akhmetova A.I.Кутлубаев М.А., Ахметова А.И.https://creativecommons.org/licenses/by/4.0https://annaly-nevrologii.com/pathID/article/view/882

Asthenic disorders are seen in approximately half of poststroke patients. The mechanisms underlying poststroke asthenia (PSA) are related to brain connectome damage, as well as neuroinflammatory and neuroendocrine mechanisms. PSA is associated with a lack of energy, lassitude, and fatigue that do not improve after rest or sleep; it is differentiated from depression, apathy, and daytime drowsiness. Risk factors for PSA include female gender, anxiety and depressive disorders, severe neurological deficit, sleep disorders, diabetes etc. Treatment of PSA includes cognitive behavioral therapy graded physical activity, and pharmacotherapy.

Астенические расстройства отмечаются примерно у половины пациентов после инсульта. Механизмы развития постинсультной астении (ПИА) связаны с поражением коннектома головного мозга, нейровоспалительными и нейроэндокринными механизмами. Для ПИА характерны нехватка энергии, вялость, быстрая утомляемость, которые не уменьшаются после отдыха или сна; её дифференцируют с депрессией, апатией и дневной сонливостью. Факторами риска по развитию ПИА являются женский пол, тревожно-депрессивные расстройства, выраженный неврологический дефицит, нарушения сна, сахарный диабет и др. В лечении ПИА используются методы когнитивно-поведенческой терапии, дозированные физические нагрузки, фармакотерапия.

strokeastheniafatiguetirednessdepressionинсультастенияусталостьутомляемостьдепрессияЧутко Л.С., Сурушкина С.Ю. Астенические расстройства. История и современность. Журнал неврологии и психиатрии им. С.С. Корсакова. 2020;120(6):131–136. Chutko L.S., Surushkina S.Yu. Asthenic disorders. History and modernity. Zhurnal Nevrologii i Psikhiatrii imeni S.S. Korsakova. 2020;120(6):131–136. (In Russ.). DOI: 10.17116/jnevro2020120061131Chaudhuri A., Behan P.O. Fatigue in neurological disorders. Lancet. 2004;363(9413):978–988. DOI: 10.1016/S0140-6736(04)15794-2Siciliano M., Trojano L., Santangelo G. et al. Fatigue in Parkinson's disease: a systematic review and meta-analysis. Mov. Disord. 2018;33(11):1712–1723. DOI: 10.1002/mds.27461Oliva Ramirez A., Keenan A., Kalau O. et al. Prevalence and burden of multiple sclerosis-related fatigue: a systematic literature review. BMC Neurol. 2021;21(1):468. DOI: 10.1186/s12883-021-02396-1Lynch J., Mead G., Greig C. et al. Fatigue after stroke: the development and evaluation of a case definition. J. Psychosom. Res. 2007;63(5):539–544. doi: 10.1016/j.jpsychores.2007.08.004Pollock A., St George B., Fenton M., Firkins L. Top 10 research priorities relating to life after stroke — consensus from stroke survivors, caregivers, and health professionals. Int. J. Stroke. 2014;9(3):313–320. doi: 10.1111/j.1747-4949.2012.00942.xAali G., Drummond A., das Nair R., Shokraneh F. Post-stroke fatigue: a scoping review. F1000Res. 2020;9:242.DOI: 10.12688/f1000research.22880.2Cumming T.B., Packer M., Kramer S.F., English C. The prevalence of fatigue after stroke: a systematic review and meta-analysis. Int. J. Stroke. 2016;11(9):968–977. DOI: 10.1177/1747493016669861Alghamdi I., Ariti C., Williams A. et al. Prevalence of fatigue after stroke: a systematic review and meta-analysis. Eur. Stroke J. 2021;6(4):319–332. doi: 10.1177/23969873211047681Pedersen A., Almkvist E., Holmegaard L. et al. Fatigue 7 years post-stroke: predictors and correlated features. Acta Neurol. Scand. 2022; 146(3):295–303. DOI: 10.1111/ane.13665Kutlubaev M.A., Duncan F.H., Mead G.E. Biological correlates of post-stroke fatigue: a systematic review. Acta Neurol. Scand. 2012;125(4):219–227. DOI: 10.1111/j.1600-0404.2011.01618.xKunze A., Zierath D., Drogomiretskiy O., Becker K. Strain differences in fatigue and depression after experimental stroke. Transl. Stroke Res. 2014;5(5):604–611. DOI: 10.1007/s12975-014-0350-1Choi Y.H., Laaker C., Hsu M. et al. Molecular mechanisms of neuroimmune crosstalk in the pathogenesis of stroke. Int. J. Mol. Sci. 2021;22(17):9486. DOI: 10.3390/ijms22179486Wen H., Weymann K.B., Wood L., Wang Q.M. Inflammatory signaling in post-stroke fatigue and depression. Eur. Neurol. 2018;80(3–4):138–148. doi: 10.1159/000494988De Doncker W., Dantzer R., Ormstad H., Kuppuswamy A. Mechanisms of poststroke fatigue. J. Neurol. Neurosurg. Psychiatry. 2018;89(3):287–293. doi: 10.1136/jnnp-2017-316007Becker K., Kohen R., Lee R. et al. Poststroke fatigue: hints to a biological mechanism. J. Stroke Cerebrovasc. Dis. 2015;24(3):618–621. doi: 10.1016/j.jstrokecerebrovasdis.2014.10.008Booij H.A., Gaykema W.D.C., Kuijpers K.A.J. et al. Pituitary dysfunction and association with fatigue in stroke and other acute brain injury.Endocr. Connect. 2018;7(6):R223–R237. DOI: 10.1530/EC-18-0147Schaechter J., Kim M., Hightower B. et al. Disruptions in structural and functional connectivity relate to poststroke fatigue. Brain Connect. 2023;13(1):15–27. DOI: 10.1089/brain.2022.0021Zhang S., Cheng S., Zhang Z. et al. Related risk factors associated with post-stroke fatigue: a systematic review and meta-analysis. Neurol. Sci. 2021;42(4):1463–1471. DOI: 10.1007/s10072-020-04633-wShu J., Ren Y., Liu G., Wei W. Association between stroke characteristics and post-stroke fatigue: a meta-analysis. Neurol. India. 2022;70(2):676–681. doi: 10.4103/0028-3886.344612Winward C., Sackley C., Metha Z., Rothwell P.M. A population-based study of the prevalence of fatigue after transient ischemic attack and minor stroke. Stroke. 2009;40(3):757–761. DOI: 10.1161/STROKEAHA.108.527101Wang J., Li F., Xiao L. et al. Depressed TSH level as a predictor of poststroke fatigue in patients with acute ischemic stroke. Neurology. 2018;91(21):e1971–e1978. DOI: 10.1212/WNL.0000000000006534Ren W., Wu J., Wu Z. et al. Serum uric acid levels at admission could predict the chronic post-stroke fatigue. Front. Nutr. 2022;9:850355. doi: 10.3389/fnut.2022.850355Huang S., Fan H., Shi Y. et al. Immune biomarkers are associated with poststroke fatigue at six months in patients with ischemic stroke. J. Clin. Neurosci. 2022;101:228–233. DOI: 10.1016/j.jocn.2022.05.020Liu X., Wang B., Wang X. et al. Elevated plasma high-sensitivity C-reactive protein at admission predicts the occurrence of post-stroke fatigue at 6 months after ischaemic stroke. Eur. J. Neurol. 2020;27(10):2022–2030. doi: 10.1111/ene.14430Gu M., Xiao L., Wang J. et al. Obesity and poststroke fatigue: a 2-year longitudinal study. Neurol. Ther. 2021;10(2):955–969. DOI: 10.1007/s40120-021-00276-xLagogianni C., Thomas S., Lincoln N. Examining the relationship between fatigue and cognition after stroke: a systematic review. Neuropsychol. Rehabil. 2018;28(1):57–116. DOI: 10.1080/09602011.2015.1127820Riley E.A., Hart E., Preston J.L. et al. Pervasiveness of speech-language disorders and fatigue in stroke: a systematic scoping review. J. Commun. Disord. 2021;93:106145. DOI: 10.1016/j.jcomdis.2021.106145Duncan F., Kutlubaev M.A., Dennis M.S. et al. Fatigue after stroke: a systematic review of associations with impaired physical fitness. Int. J. Stroke. 2012;7(2):157–162. DOI: 10.1111/j.1747-4949.2011.00741.xTai D., Falck R.S., Davis J.C. et al. Can exercise training promote better sleep and reduced fatigue in people with chronic stroke? A systematic review. J. Sleep Res. 2022;31(6):e13675. DOI: 10.1111/jsr.13675Рахматуллин А.Р., Кутлубаев М.А., Кутлубаева Р.Ф., Озерова А.И. Социально-экономические факторы и церебральный инсульт. Журнал неврологии и психиатрии им. С.С. Корсакова. 2022;122(3 вып. 2):45–51. Rakhmatullin A.R., Kutlubaev M.A., Kutlubaeva R.F., Ozerova A.I. Socioeconomic factors and stroke. Zhurnal Nevrologii i Psikhiatrii imeni S.S. Korsakova. 2022;122(3. Vyp. 2):45–51. (In Russ.). DOI: 10.17116/jnevro202212203245Кутлубаев М.А. Клинико-патогенетические особенности поражения нервной системы при COVID-19. Журнал неврологии и психиатрии им. С.С. Корсакова. 2020;120(9):130–136. Kutlubaev M.A. Clinical and pathogenetic aspects of nervous system impairments in COVID-19. Zhurnal Nevrologii i Psikhiatrii imeni S.S. Korsakova. 2020;120(9):130–136. (In Russ.) doi: 10.17116/jnevro2020120091130Кутлубаев М.А., Ахмадеева Л.Р. Симптомы патологической усталости, апатии и депрессии у пациентов после церебрального инсульта. Неврология, нейропсихиатрия, психосоматика. 2015;7(2):16–21. 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.) DOI: 10.14412/2074-2711-2015-2-16-21Tay J., Morris R.G., Markus H.S. Apathy after stroke: Diagnosis, mechanisms, consequences, and treatment. Int. J. Stroke. 2021;16(5):510–518. doi: 10.1177/1747493021990906Петрова Е.А., Поневежская Е.В., Савина М.А., Кольцова Е.А. Постинсультная апатия. Consilium Medicum. 2020;22(9):33–37. Petrova E.A., Ponevejsky E.V., Savina M.A., Koltsova E.A. Post-stroke apathy. Consilium Medicum. 2020;22(9):33–37. doi: 10.26442/20751753.2020.9.200274Douven E., Köhler S., Schievink S.H.J. et al. Temporal associations between fatigue, depression, and apathy after stroke: results of the cognition and affect after stroke, a prospective evaluation of risks study. Cerebrovasc. Dis. 2017;44(5–6):330–337. DOI: 10.1159/000481577Chun H.Y., Ford A., Kutlubaev M.A. et al. Depression, anxiety, and suicide after stroke: a narrative review of the best available evidence. Stroke. 2022;53(4):1402–1410. doi: 10.1161/STROKEAHA.121.035499Кутлубаев М.А., Ахмадеева Л.Р. Патологическая усталость и утомляемость после инсульта. Журнал неврологии и психиатрии им. С.С. Корсакова. Спецвыпуски. 2016;116(3–2):43–47. Kutlubaev M.A., Akhmadeeva L.R. Pathological fatigue and fatigability after stroke. Zhurnal Nevrologii i Psikhiatrii imeni S.S. Korsakova. 2016;116(3–2):43–47. (In Russ.) doi: 10.17116/jnevro20161163243-47Wu S., Kutlubaev M.A., Chun H.Y. et al. Interventions for post-stroke fatigue. Cochrane Database Syst. Rev. 2015;2015(7):CD007030. DOI: 10.1002/14651858Bivard A., Lillicrap T., Krishnamurthy V. et al. MIDAS (Modafinil in Debilitating Fatigue After Stroke): a randomized, double-blind, placebo-controlled, cross-over trial. Stroke. 2017;48(5):1293–1298. doi: 10.1161/STROKEAHA.116.016293Bajorek B., Gao L., Lillicrap T. et al. Exploring the economic benefits of modafinil for post-stroke fatigue in Australia: a cost-effectiveness evaluation. J. Stroke Cerebrovasc. Dis. 2020;29(11):105213. doi: 10.1016/j.jstrokecerebrovasdis.2020.105213Wang L., Zhao X.M., Wang F.Y. et al. Effect of vitamin D supplementation on the prognosis of post-stroke fatigue: a retrospective cohort study. Front. Neurol. 2021;12:690969. DOI: 10.3389/fneur.2021.690969Dong X.L., Sun X., Sun W.M. et al. A randomized controlled trial to explore the efficacy and safety of transcranial direct current stimulation on patients with post-stroke fatigue. Medicine (Baltimore). 2021;100(41):e27504. doi: 10.1097/MD.0000000000027504Smetheram T., Amiama M.E., Hébert D. et al. Occupational therapy interventions for poststroke fatigue: a scoping review. OTJR (Thorofare N. J.). 2022;42(3):182–188. DOI: 10.1177/15394492221087968Фирилёва Ж.Е., Родичкин П.В., Бузник Г.В. Физическая реабилитация и фармакотерапия когнитивных функций и астенических расстройств у пациентов, перенесших инсульт. Обзоры по клинической фармакологии и лекарственной терапии. 2019;17(1):87–92. Firileva J.E., Rodichkin P.V., Buznik G.V. Physical rehabilitation and pharmacotherapy of cognitive functions and asthenic disorders in stroke patients. Reviews on Clinical Pharmacology and Drug Therapy. 2019;17(1):87–92. DOI: 10.7816/RCF17187-92Zedlitz A.M., Rietveld T.C., Geurts A.C., Fasotti L. Cognitive and graded activity training can alleviate persistent fatigue after stroke: a randomized, controlled trial. Stroke. 2012;43(4):1046–1051. DOI: 10.1161/STROKEAHA.111.632117Teng C.H., Phonyiam R., Davis L.L., Anderson R.A. Adaptation to poststroke fatigue in stroke survivors and their care partners: a scoping review. Disabil. Rehabil. 2023;45(13):2233–2247. DOI: 10.1080/09638288.2022.2084775Mandliya A., Das A., Unnikrishnan J.P. et al. Post-stroke fatigue is an independent predictor of post-stroke disability and burden of care: a path analysis study. Top Stroke Rehabil. 2016;23(1):1–7. DOI: 10.1080/10749357.2015.1110273MacIntosh B.J., Edwards J.D., Kang M. et al. Post-stroke fatigue and depressive symptoms are differentially related to mobility and cognitive performance. Front. Aging Neurosci. 2017;9:343. DOI: 10.3389/fnagi.2017.00343Lerdal A., Gay C.L. Acute-phase fatigue predicts limitations with activities of daily living 18 months after first-ever stroke. J. Stroke Cerebrovasc. Dis. 2017;26(3):523–531. DOI: 10.1016/j.jstrokecerebrovasdis.2016.11.130Oyake K., Otaka Y., Matsuura D. et al. Poststroke fatigue at admission is associated with independence levels of activities of daily living at discharge from subacute rehabilitation wards. Arch. Phys. Med. Rehabil. 2021;102(5):849–855. DOI: 10.1016/j.apmr.2020.10.117Ramírez-Moreno J.M., Muñoz-Vega P., Alberca S.B., Peral-Pacheco D. Health-related quality of life and fatigue after transient ischemic attack and minor stroke. J. Stroke Cerebrovasc. Dis. 2019;28(2):276–284. doi: 10.1016/j.jstrokecerebrovasdis.2018.09.046Almhdawi K.A., Jaber H.B., Khalil H.W. et al. Post-stroke fatigue level is significantly associated with mental health component of health-related quality of life: a cross-sectional study. Qual. Life Res. 2021;30(4):1165–1172. doi: 10.1007/s11136-020-02714-zBlomgren C., Samuelsson H., Blomstrand C. et al. Long-term performance of instrumental activities of daily living in young and middle-aged stroke survivors — impact of cognitive dysfunction, emotional problems and fatigue.PLoS One. 2019;14(5):e0216822. doi: 10.1371/journal.pone.0216822Tang W.K., Lu J.Y., Mok V. et al. Is fatigue associated with suicidality in stroke? Arch. Phys. Med. Rehabil. 2011;92(8):1336–1338. DOI: 10.1016/j.apmr.2011.02.018Rutkowski N.A., Sabri E., Yang C. Post-stroke fatigue: a factor associated with inability to return to work in patients < 60 years — a 1-year follow-up. PLoS One. 2021;16(8):e0255538. doi: 10.1371/journal.pone.0255538