title: 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.
authors.affiliation: a Research and Psychology Services , VA San Diego Healthcare System (VASDHS) , San Diego , CA , USA.|b School of Medicine, Department of Psychiatry , University of California San Diego , San Diego , CA , USA.|c Center of Excellence for Stress and Mental Health, VASDHS , San Diego , CA , USA.
authors.forename: Dawn M
authors.initials: DM
authors.lastname: Schiehser
authors.affiliation: a Research and Psychology Services , VA San Diego Healthcare System (VASDHS) , San Diego , CA , USA.|b School of Medicine, Department of Psychiatry , University of California San Diego , San Diego , CA , USA.|c Center of Excellence for Stress and Mental Health, VASDHS , San Diego , CA , USA.
authors.forename: Lisa
authors.initials: L
authors.lastname: Delano-Wood
authors.affiliation: a Research and Psychology Services , VA San Diego Healthcare System (VASDHS) , San Diego , CA , USA.|b School of Medicine, Department of Psychiatry , University of California San Diego , San Diego , CA , USA.|c Center of Excellence for Stress and Mental Health, VASDHS , San Diego , CA , USA.
authors.forename: Amy J
authors.initials: AJ
authors.lastname: Jak
authors.affiliation: a Research and Psychology Services , VA San Diego Healthcare System (VASDHS) , San Diego , CA , USA.|b School of Medicine, Department of Psychiatry , University of California San Diego , San Diego , CA , USA.|c Center of Excellence for Stress and Mental Health, VASDHS , San Diego , CA , USA.
authors.forename: Karen L
authors.initials: KL
authors.lastname: Hanson
authors.affiliation: a Research and Psychology Services , VA San Diego Healthcare System (VASDHS) , San Diego , CA , USA.
authors.forename: Scott F
authors.initials: SF
authors.lastname: Sorg
authors.affiliation: a Research and Psychology Services , VA San Diego Healthcare System (VASDHS) , San Diego , CA , USA.|b School of Medicine, Department of Psychiatry , University of California San Diego , San Diego , CA , USA.|c Center of Excellence for Stress and Mental Health, VASDHS , San Diego , CA , USA.
authors.forename: Henry
authors.initials: H
authors.lastname: Orff
authors.affiliation: d San Diego State University Joint Doctoral Program in Clinical Psychology , University of California San Diego , San Diego , CA , USA.
authors.forename: Alexandra L
authors.initials: AL
authors.lastname: Clark
mesh_terms: D000328:Adult; D001008:Anxiety Disorders / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology*; D001924:Brain Concussion / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology; D000070642:Brain Injuries, Traumatic / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology*; D060825:Cognitive Dysfunction / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology*; D003866:Depressive Disorder / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology*; D005221:Fatigue / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008297:Male; D005222:Mental Fatigue / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology; D008875:Middle Aged; D011379:Prognosis; D012893:Sleep Wake Disorders / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology*; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology*; D014481:United States; D014728:Veterans
keywords: Post-traumatic fatigue; cognition; psychiatric symptoms; sleep quality; traumatic brain injury