Retrospective analysis of the relationship between post-stroke fatigue and aphasia severity.

Abstract

To characterize post-stroke fatigue in people with aphasia (PWA) and to investigate the relationship between aphasia severity and fatigue. Cross-sectional observational design. University labs or clinic setting at three institutions in the United States, occasionally in participants' homes. Adults with chronic post-stroke aphasia (n=73), English reported as primary language before stroke onset (mean age = 59.4 years; 61.6% male; mean time post onset = 44.4 months). Aphasia severity, as measured by the Western Aphasia Battery-Revised (WAB-R), ranged from severe to very mild (scores of 14.7 to 100), with the majority (over 68%) presenting with mild to moderate impairment (scores 76-100). Not applicable. The WAB-R was used to measure aphasia severity (Aphasia Quotient). The Multidimensional Assessment of Fatigue (MAF) measured post-stroke fatigue using the Global Fatigue Index (GFI), consisting of four dimensions: severity, distress, interference, and timing. Participants reported moderate ratings of fatigue across all MAF dimensions, with substantial individual variability. Bayesian regression showed that higher WAB-R scores were associated with greater fatigue (β = 0.31, 95% CI: 0.06, 0.55), but age and gender were not. Participants with milder aphasia reported greater post-stroke fatigue than those with more severe impairments. These findings suggest that compensatory cognitive demands and elevated communication expectations that are associated with milder language deficits may contribute to increased fatigue burden. Results emphasize the need for routine fatigue screening across all aphasia severity levels and support reconceptualizing mild aphasia as potentially involving substantial hidden costs.