Post-stroke fatigue and its consequences in young adults: The Norwegian Stroke in the Young Study II

Fatigue is a prevalent and disabling consequence of ischemic stroke in young adults, yet its multifactorial nature and impact on recovery remain underexplored. This study investigates predictors of post-stroke fatigue and association with return to work (RTW) and other variables at a one-year follow-up (1y-FU) after ischemic stroke.

We analysed data from 130 patients aged 15-49 years with MRI-confirmed acute ischemic stroke enrolled in the Norwegian Stroke in Young Study II. Fatigue and cognitive symptoms were assessed using standardized self-report and clinical evaluations at 1y-FU. Multivariable logistic regression identified independent predictors of persistent fatigue, adjusting for age, sex, and stroke severity.

At 1y-FU, 50 % of patients reported persistent fatigue. Fatigue was independently associated with failure to RTW (OR 3.2, 95 % CI 1.8-5.6), migraine without aura (OR 2.1, 95 % CI 1.3-3.4), hearing difficulties (OR 2.0, 95 % CI 1.1-3.8), concentration problems (OR 2.4, 95 % CI 1.5-4.0), and pain (OR 2.6, 95 % CI 1.5-4.5). Patients with resolved fatigue were significantly more likely to RTW (65.9 %) compared to those with persistent symptoms (34.2 %, p < 0.001). Cognitive impairment at admission was common (45.9 %), and among these patients, 52.2 % reported persistent deficits at 1y-FU. Fatigue severity was not associated with educational attainment but increased with age and NIHSS score.

Fatigue affects half of young ischemic stroke survivors after 1 year, substantially hindering RTW. Novel associations with migraine, hearing and cognitive deficits, and pain suggest underrecognized contributors that may be amenable to individually targeted rehabilitation. Integration of fatigue management into early stroke rehabilitation programs, with a focus on cognitive, sensory, and pain-related domains, may help optimize vocational and functional outcomes.