Long-Term Fatigue Following Transient Ischemic Attack: A Prospective Cohort Study

By definition, patients with transient ischemic attack (TIA) should not have residual symptoms beyond 24 hours. However, preliminary evidence indicates lasting challenges such as fatigue. It is unknown who develops fatigue, and the extent. This knowledge is required to develop evidence-based support for patients. We aimed to explore fatigue up to 12 months after TIA and determine what characterizes patients who experience pathologic fatigue.

This is a prospective cohort study including patients with TIA diagnosed at a specialized stroke unit. Fatigue was measured using Multidimensional Fatigue Inventory (MFI-20) and Fatigue Severity Scale at 14 days (baseline) and 3, 6, and 12 months after discharge. The association between candidate prognostic factors and fatigue at 12 months was tested using linear regression models. We compared model performances using likelihood ratio (LR).

We included 354 patients, of which 287 provided baseline responses (mean age 70.0 ± 11.1, 42.5% female). At baseline and 3, 6, and 12 months, the mean level of general fatigue on MFI was 12.3 ± 4.6, 11.9 ± 4.6, 11.4 ± 4.5, and 11.1 ± 4.5 and the proportion with pathologic fatigue (≥12 on the MFI-20 General Fatigue) was 61.3%, 53.5%, 54.0%, and 53.8%, respectively. The prevalence of acute infarction was evenly distributed between patients who reported fatigue and those who did not. Previous anxiety/depression was twice as common in the group that reported fatigue. The model including baseline level of fatigue, sex, age, and acute infarction was able to explain variability in the reported data to a statistical significantly higher extent, compared with the model only including sex, age, and acute infarction (p < 0.001, LR = 387.30).

Pathologic fatigue is common up to 12 months after TIA diagnosis. If patients report fatigue within 14 days after discharge, it is likely that this remains until 12 months. We found no indication of an association between the presence of acute ischemic lesions and fatigue. The prevalence of previous anxiety/depression was higher in the group that reported fatigue.

The study is part of the Life After Stroke Cohort (ClinicalTrials.gov: NCT05234528). Registered February 1, 2022. First patient included February 2, 2022.