From the Guidelines
Cognitive fatigue in post-concussive syndrome can persist for several weeks to months, with approximately 80-90% of individuals recovering within 3-6 months, but in some cases, it can last for a year or longer. The duration of cognitive fatigue is influenced by various factors, including age, injury severity, previous concussions, and pre-existing conditions 1. A study published in 2023 found that predictors of postconcussive symptoms included preinjury psychological issues, loss of consciousness, and having no recall of receiving information regarding brain injury from the ED 1. Another study found that female gender, previous psychiatric history, GCS score of <15, etiology of assault, and alcohol intoxication were associated with prolonged symptoms and worse outcomes in recovery 1.
- Management of cognitive fatigue includes a gradual return to cognitive activities with scheduled rest breaks, limiting screen time, and practicing good sleep hygiene.
- Medications such as amantadine or methylphenidate may be prescribed in some cases to help manage severe symptoms, though these should only be used under medical supervision.
- Cognitive behavioral therapy can also be beneficial in managing cognitive fatigue.
- It is essential to note that the prolonged fatigue occurs because concussion disrupts normal brain energy metabolism and neurotransmitter function, requiring time for neural pathways to heal and reorganize 1.
- A Class III study by Ponsford et al found that three or more postconcussive symptoms were reported in 18.7% of the participants, most frequently fatigue (17.2%) and forgetfulness (14.6%) 1.
- The study by Kraus et al found that RPQ symptoms, health service utilization, and 5 indicators of social disruption or function were found to be higher in the mTBI group, indicating significant morbidity in this cohort, and these problems may persist for at least 6 months 1.
From the Research
Duration of Cognitive Fatigue in Post-Concussive Syndrome
- The duration of cognitive fatigue in post-concussive syndrome can vary significantly among individuals, with some experiencing symptoms for months to years after the initial injury 2, 3.
- Studies have shown that while most symptoms of concussion resolve within days to weeks, a minority of individuals may experience persistent symptoms, including cognitive fatigue, for an extended period 2, 4.
- The median duration of symptoms such as fatigue has been reported to be around 16 days, although nearly 20% of children still complained of fatigue one month after injury 4.
- Cognitive symptoms, including fatigue, may be present throughout the recovery period, with some individuals experiencing persistent cognitive fatigue for several months or even years after the injury 3, 4.
- Factors such as a high early symptom burden, history of multiple concussions, psychiatric conditions, and younger age may increase the risk of developing persistent cognitive fatigue in post-concussive syndrome 2.
- Treatment approaches, including cognitive behavioral therapy and pharmacologic interventions like amantadine, may be effective in managing cognitive fatigue and other symptoms in post-concussive syndrome, although more research is needed to fully understand their effects 5, 6.