Asthenia: Definition and Clinical Significance
Asthenia refers to a state of weakness, lack of energy, or loss of strength that is subjective in nature and not necessarily related to physical exertion. 1
Definition and Characteristics
- Asthenia comes from the Greek word "ασθένεια" (a: privation, without; sthénos: vigor, force), meaning absence of strength, vigor, or force 1
- It is a subjective symptom that presents as a static feeling of weakness that may not be directly related to effort 2
- Asthenia is different from weakness, dizziness, or dyspnea, though patients often confuse these symptoms 1
Classification by Duration
- Prolonged fatigue: when asthenia lasts for more than one month 1
- Chronic fatigue: when asthenia persists for more than six months 1
- Chronic fatigue syndrome: a specific diagnosis of exclusion representing 0.2-0.7% of asthenia cases 1
Clinical Presentation
- Asthenia manifests with increased fatigue and exhaustion that persists even after rest 3
- Common accompanying symptoms include:
Epidemiology and Impact
- Asthenia is a frequent complaint in primary care, accounting for approximately 30% of ambulatory consultations 1
- Chronic fatigue represents up to 10% of these cases 1
- The high frequency of this symptom carries significant social and economic costs 1
Types of Asthenia
- Primary or functional asthenia (idiopathic chronic fatigue) 4
- Chronic fatigue syndrome (an immune-mediated disease) 5
- Senile asthenia syndrome: a geriatric syndrome characterized by age-associated decrease in physiological reserve and functions of many body systems, including cognitive functions 3
- Asthenia can be further classified as neuromuscular and/or cognitive and mental fatigue 4
Common Causes
- Depression is the most common cause of asthenia, representing approximately half of all cases 1
- Asthenia is often part of cardiovascular diseases and cerebrovascular pathology 3
- Stress can contribute significantly to asthenic disorders 5
- Post-COVID asthenia has been recognized as a specific form 3
Diagnostic Approach
- It is crucial to differentiate between various types of asthenia and identify underlying causes 1
- Up to 20% of patients with asthenia remain without a specific diagnosis 1
- The diagnosis of chronic fatigue syndrome is made by exclusion using the international consensus criteria from 1994 1
Management Considerations
- The most effective treatment for asthenia is addressing the underlying cause 1
- For asthenic conditions with cognitive dysfunction, combination therapy approaches may be beneficial 4
- In cases of cardiovascular disease, senile asthenia syndrome, or post-COVID asthenia, certain medications like citicoline have shown positive effects 3