Fatigue after traumatic brain injury: Association with neuroendocrine, sleep, depression and other factors.
OBJECTIVE
Define associations between post-traumatic brain injury (TBI) fatigue and abnormalities in neuroendocrine axes, sleep, mood, cognition and physical functioning.


METHODS
Survey.


METHODS
Large community hospital-based rehabilitation centre.


METHODS
Convenience sample of 119 individuals at least 1 year post-TBI.


METHODS
Multidimensional Assessment of Fatigue (MAF); Fatigue Severity Scale (FSS); neuroendocrine assessments-growth hormone (GH) reserve, thyroid, cortisol and testosterone levels; visual analogue pain rating; Pittsburgh Sleep Quality Index; Beck Depression Inventory-II; Disability Rating Scale; Craig Handicap Assessment and Reporting Technique; Neurobehavioural Functioning Inventory.


RESULTS
Fifty-three per cent reported fatigue on the MAF and one-third on the FSS; 65% were found to have moderate/severe GH deficiency; 64% had adrenal insufficiency (low fasting cortisol); 12% had central hypothyroidism; and 15% of men had testosterone deficiency. Pituitary dysfunction did not correlate with fatigue or other symptoms. Predictors of MAF total scores were female gender, depression, pain and self-assessed memory deficits. Predictors of FSS scores were depression, self-assessed motor deficits and anti-depressant usage.


CONCLUSIONS
Robust correlates of fatigue were gender, depression, pain and memory and motor dysfunction. Investigation of post-TBI fatigue should include screening for depression, pain and sleep disturbance. There was no correlation between pituitary dysfunction and fatigue; however, the relatively high prevalence of hypothyroidism and adrenal dysfunction suggests screening for these hormone deficiencies.
PM&R, San Jose, CA, USA.
Jeffrey
J
Englander
Tamara
T
Bushnik
Jean
J
Oggins
Laurence
L
Katznelson
D000293:Adolescent; D000328:Adult; D000368:Aged; D001930:Brain Injuries / Q000097:blood / Q000150:complications / Q000503:physiopathology*; D003866:Depressive Disorder / Q000097:blood / Q000209:etiology / Q000503:physiopathology*; D004185:Disability Evaluation; D005221:Fatigue / Q000097:blood / Q000209:etiology / Q000503:physiopathology*; D005260:Female; D006306:Health Surveys; D019382:Human Growth Hormone / Q000097:blood / Q000172:deficiency; D006801:Humans; D006854:Hydrocortisone / Q000097:blood / Q000172:deficiency; D008297:Male; D008875:Middle Aged; D009490:Neurosecretory Systems / Q000503:physiopathology*; D010147:Pain Measurement; D012720:Severity of Illness Index; D012893:Sleep Wake Disorders / Q000097:blood / Q000209:etiology / Q000503:physiopathology*; D011795:Surveys and Questionnaires; D013739:Testosterone / Q000097:blood / Q000172:deficiency; D013963:Thyroid Hormones / Q000097:blood / Q000172:deficiency; D055815:Young Adult
D013963:Thyroid Hormones; D019382:Human Growth Hormone; D013739:Testosterone; D006854:Hydrocortisone