Predictors of cognitive and physical fatigue in post-acute mild–moderate traumatic brain injury

ABSTRACT

Post-traumatic fatigue (PTF) is a common, disabling, and often chronic symptom following traumatic brain injury (TBI). Yet, the impact of chronic cognitive and physical fatigue and their associations with psychiatric, sleep, cognitive, and psychosocial sequelae in mild–moderate TBI remain poorly understood. Sixty Veterans with a history of mild–moderate TBI and 40 Veteran controls (VC) were administered the Modified Fatigue Impact Scale, a validated measure of TBI-related cognitive and physical fatigue as well as measures of neuropsychiatric, psychosocial, sleep, and objective cognitive functioning. Compared to VC, TBI Veterans endorsed significantly greater levels of cognitive and physical fatigue. In TBI, psychiatric symptoms, sleep disturbance, and post-traumatic amnesia (PTA) were associated with both cognitive and physical fatigue, while loss of consciousness (LOC) and poor attention/processing speed were related to elevations in cognitive fatigue only. In regression analyses, anxiety, sleep disturbance, and LOC significantly predicted cognitive fatigue, while only post-traumatic stress symptoms and PTA contributed to physical fatigue. Cognitive and physical fatigue are problematic symptoms following mild–moderate TBI that are differentially associated with specific injury and psychiatric sequelae. Findings provide potential symptom targets for interventions aimed at ameliorating fatigue, and further underscore the importance of assessing and treating fatigue as a multi-dimensional symptom following TBI.

KEYWORDS:

• Post-traumatic fatigue
• traumatic brain injury
• psychiatric symptoms
• sleep quality
• cognition

Acknowledgements

We would like to thank Russell Kim for data collection and entry as well as the Veterans who kindly participated in this study.

Disclosure statement

No potential conflict of interest was reported by the authors.

Notes

1 MANCOVA results remained significant for cognitive and physical fatigue (p’s < .001) in the mild TBI group (n = 50) when moderate TBI participants were excluded from analyses.

2 All significant correlations (Table 3) remained statistically significant in the mild TBI group (n = 50) when moderate TBI participants were removed from the analyses.

Additional information

Funding

This work was supported by the Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development [VA CSR&D CDA-2-065-S (DMS)], [CX000842-01A2 & 829-CDMH-13858 (LDW)]; and the Department of Defense [LDW: W81XWH-10-2-0169].