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15.02.2015

Mental fatigue impairs emotion regulation, what causes extreme fatigue after eating - .

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Rating on separate items on the Mental Fatigue Scale for controls and brain injured subjects. Correlation with age and rating on MFS for healthy controls and subjects with long-lasting mental fatigue after brain injury. Correlation between Mental Fatigue Scale and information processing speed (Digit Symbol-Coding).5.
The figure illustrates levels and fluctuations in mental fatigue measured with the MFS after TBI and variations over time.
The green line represents a full recovery while the blue and red lines represent impaired recovery in terms of the mental energy levels. If this state is not restored completely, there will be an impaired extracellular glutamate clearing with slightly increased extracellular glutamate levels, slight astrocyte swelling and impaired glucose uptake. But for people fighting their fatigue after brain injury day after day, fatigue is a major problem.
Wright, Patterns of fatigue and its correlates over the first 2 years after traumatic brain injury.
Johansson, Long-Lasting Mental Fatigue After Recovery from Meningitis or Encephalitis - A Disabling Disorder Hypothetically Related to Dysfunction in the Supporting Systems of the Brain in Essential Notes in Psychiatry, V. Azouvi, Subjective fatigue, mental effort, and attention dificits after severe traumatic brain injury. Ponsford, Selective attention deficits and subjective fatigue following traumatic brain injury.
This post-injury mental fatigue is characterized by limited energy reserves to accomplish ordinary daily activities. Persons who have not experienced this extreme exhaustion which may appear suddenly, and without previous warning during mental activity, do not understand the problem. This is especially difficult to understand as the fatigue may appear even after seemingly trivial mental activities which, for uninjured persons, are regarded as relaxing and pleasant, as reading a book or having a conversation with friends.
A normal, well-functioning, brain performs mental activities simultaneously throughout the day, but after a brain injury, it takes greater energy levels to deal with cognitive and emotional situations.In this chapter, we highlight mental fatigue after TBI. In the case of long-lasting mental fatigue, it could be the only factor that keeps people from returning to the full range of activities that they pursued prior to their injury with work, studies and social activities. We describe mental fatigue and suggest diagnostic criteria and we also give a theoretical explanation for this.
At the end of the chapter, we discuss treatment strategies and give some examples of possible therapeutic alternatives which may alleviate the mental fatigue.Normally, the brain works in an energy-efficient manner and prominent energy reserves are present. After brain injury, some of these systems are down-regulated, and when mental energy requirements are high the physiological processes do not function to their full capacity; these cease to function efficiently with a resultant energy loss. However it is difficult to arrive at any clear figure as to how common fatigue or, in particular, mental fatigue is. There is no correlation between persistent fatigue and severity of the primary injury, age of the person at injury or time since injury [7, 8].
For those suffering from fatigue 3 months after the accident the fatigue remained relatively stable during longer periods [9]. Mental fatigue is not a separate diagnostic entityMental fatigue is not an illness, rather it represents a mental sequel, probably due to a disturbance of higher brain functions, either physical or psychological in origin.
Typical characteristics of mental fatigueA typical characteristic of pathological mental fatigue after TBI is that the mental exhaustion becomes pronounced during sensory stimulation or when cognitive tasks are performed for extended periods without breaks. There is a drain of mental energy upon mental activity in situations in which there is an invasion of the senses with an overload of impressions, and in noisy and hectic environments.


Another typical feature is a disproportionally long recovery time needed to restore the mental energy levels after being mentally exhausted. The mental fatigue is also dependent on the total activity level as well as the nature of the demands of daily activities.
The fatigue can appear very rapidly and, when it does, it is not possible for the affected person to continue the ongoing activity.
For most people, fatigue subsides after a period of time while, for others, this pathological fatigue persists for several months or years even after the brain injury has healed.
Interestingly, however is that as many as 30% of family or friends interpreted fatigue as laziness [9].Theories as to the mechanisms accounting for mental fatigue including our own theory, suggest that cognitive activities require more resources and are more energy-demanding after brain injury than usual [13, 14]. Thus, more extensive neural circuits are used in TBI victims compared to controls during a given mental activity [15]. Our hypothesis implies that such dysfunction could underlie the mental fatigue at the cellular level.
Assessment of mental fatigueThere is an abundance of scales for assessing fatigue in general and several of these scales are designed for use in different diseases [21, 22]. The scales include questions relating to feelings of fatigue, perceived impact on activities, affective feelings and mental or cognitive effects.
We decided to construct this scale since we were not able to find an assessment scale adapted to mental fatigue. The questions concern the following: fatigue in general, lack of initiative, mental fatigue, mental recovery, concentration difficulties, memory problems, slowness of thinking, sensitivity to stress, increased tendency to become emotional, irritability, sensitivity to light and noise, decreased or increased sleep as well as 24-hour symptom variations. The exemplified alternatives can help the person to respond in a similar way despite the present state of fatigue or emotional state.
We have, in our studies worked with participants with mental fatigue lasting for six months or periods greater than six months.
Mental fatigue and connection to cognitive functionsIt has been proposed that subjective mental fatigue after TBI or mild TBI correlates to poor performance in attention tests and reduced processing speed [13, 27, 29-34]. Mental fatigue and connection to emotional functionsIn the population of TBI victims, depression is elevated although there is a wide variation in frequency, depending on methodological differences [35-37]. In our studies, we have included participants who complained of mental fatigue after TBI and we excluded subjects affected by major depression, as it was our intention to explore the mental fatigue component. With a factor analysis, the items were separated into a mental fatigue component and a depression and anxiety component. Irritability was placed in the depression-anxiety component and the other three items in the mental fatigue component. With an analysis using the new components, we found that by adjusting the mental fatigue component this removed the difference observed between the brain injured subjects and controls in the depression-anxiety component. However, by removing the depression-anxiety component this did not have an effect on the difference observed between the brain injured subjects and controls in the mental fatigue component.In this subject sample, we were able to demonstrate that a significant effect on the difference observed between the brain injured subjects and controls in the scores for depression can result in an overestimation if the effect of the mental fatigue component is not taken into consideration. This indicates that mental fatigue and depression must be treated as separate constructs and it is also important to make this distinction for the purposes of therapeutic strategies.6. Definition and diagnostic criteria for long-lasting mental fatigueThe diagnostic criteria for posttraumatic brain syndrome include most of the symptoms that are often present along with mental fatigue.
However, we suggest mental fatigue to be a central symptom after a brain injury reflecting an inefficient support to the neuronal networks.Mental fatigue is a lack of mental energy with impaired cognitive, emotional and sensory functioning. If the person becomes more mentally fatigued, the sleep will most often become worse, and if the person rests for some days the sleep can become improved again. The emotional load may increase the severity of the fatigue, but if mental fatigue exists, it will remain even once the emotional components, as depression or anxiety have been treated.


For many people, there is an increased risk of doing too much and becoming even more fatigued.
When mental fatigue is present, it is important to adapt work as well as daily activities to levels that the brain can manage. Treatment studies for alleviating mental fatigueWhen mental fatigue becomes a prolonged problem, it is essential to be able to alleviate the symptoms.
We have reported on significantly reduced mental fatigue after treatment using the mindfulness-based stress reduction (MBSR) program [40, 41]. We have also reported on possible therapeutic strategies to reduce mental fatigue by means of pharmacological treatments, using neurostimulant substances as methylphenidate [42] which affects dopamine and norepinephrine signaling.
MindfulnessThe MBSR program was tested on TBI and stroke victims suffering from long-term mental fatigue [40]. MBSR is a clinically-effectivemethod for a wide range of conditions as stress, depression, pain, and fatigue after cancer, with the potential to help individuals to cope with their difficulties [44-47].
Cullen 2011 [51] and these include gentle Hatha yoga with an emphasis on mindful awareness of the body, a body scan designed to systematically, region by region, cultivate an awareness of the body without the tensing and relaxing of muscle groups associated with progressive relaxation, and sitting meditation with an awareness of the breath as well as a systematic widening of the field of awareness to include all four foundations of mindfulness: awareness of the body, feeling tone, mental states and mental contents. We found a significantly reduced mental fatigue after the MBSR program and participants improved their processing speed significantly compared to control on waitlist [40]. However, after TBI, a short MBSR program over a 4-week period did not result in any cognitive or emotional changes [55].The results demonstrate that mindfulness practice may be a therapeutic method well-suited to subjects suffering from mental fatigue after brain injury. One reason why MBSR was effective may be that this treatment offers strategies to better handle stressful situations appropriately and economize with mental energy. Guidelines for use of methylphenidate for deficits of attention and processing speed after TBI have been suggested [64], while no such guidelines exist for fatigue following TBI. In an open randomized study, methylphenidate significantly improved mental fatigue dose-dependently as assessed with the MFS [42]. However, it is important to note that pain can hide posttraumatic brain injury symptoms or mental fatigue which is not always connected to the actual pain. We also found that there was no interaction between the pain and the mental fatigue in those participants treated with methylphenidate. These findings indicate that, not only is it necessary to treat patients for the pain for which they are primarily referred to the clinic, but also for the mental fatigue, if present.
Further studies are needed, with a larger number of patients and, in particular longer treatment periods as mental fatigue may be long-lasting. These drugs were shown to have the effect of both alleviating mental fatigue and increasing information processing speed.8.
ConclusionsMental fatigue can become a prolonged and distressing problem after TBI having considerable effect on life and wellbeing.
It is important to acknowledge and assess mental fatigue when discussing the options regarding therapeutic methods as the mental fatigue has been the result of a TBI.
It is not possible to improve the mental energy with training in order to perform more mental activities.
The problem is that, for most persons suffering from long-term mental fatigue after TBI, the activity levels are close to the threshold of what they are able to sustain.
A combination with neurostimulants and mindfulness may be a good therapeutic strategy.In the future, research is warranted for early treatment with the intention to reduce the development of long-term mental fatigue.



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