Fatigue Affects a Third of TIA Survivors Years After Attack, Study Finds

More than one in three people who survive a transient ischemic attack, often called a mini-stroke, report substantial fatigue years after the event, and the symptom shows no clear tendency to fade with time since the attack, according to a new study from Umeå University in Sweden. The research team, led by Gustaf Sievert Magaard and Xiaolei Hu, designed the study as an observational, cross-sectional survey conducted in an outpatient setting. Participants were divided into three groups: 299 people experiencing a first-ever TIA, 54 people with recurrent TIA, and 78 people whose TIA was accompanied by stroke.

Fatigue was measured with the Fatigue Assessment Scale, while symptoms of depression and anxiety were assessed using the Hospital Anxiety and Depression Scale. Daily functioning and social participation were captured with the Stroke Impact Scale. In the first-ever TIA group, the average fatigue score was 21.8, with a standard deviation of 5.2, and 35 percent of participants scored above the fatigue cut-off.

Notably, when the researchers stratified participants by the time elapsed since their TIA, fatigue levels did not differ materially across strata spanning up to thirteen years. The authors emphasize that this is a cross-sectional comparison, meaning different individuals were compared at different time points rather than the same people being tracked over time, so the data cannot establish whether fatigue persists within individuals or whether it follows a fluctuating course. Fatigue scores were nonetheless meaningfully lower in the first-ever TIA group than in the two comparison groups.

Participants with recurrent TIA averaged 23.9, with a standard deviation of 5.7, and those with TIA accompanied by stroke averaged 23.8, with a standard deviation of 6.5, both significantly higher than the first-ever group at p less than 0.05. To identify which factors were linked to fatigue among people with a first-ever TIA, the team performed multivariable linear regression analyses, a statistical approach that estimates the independent contribution of each variable while accounting for the others. Depressive symptoms showed the strongest association, with a regression coefficient of 6.8 and a 95 percent confidence interval spanning 3.5 to 10.1, at p less than 0.001.

Severe sleep problems also carried substantial weight: participants in category 4 had a coefficient of 3.9, with a confidence interval of 0.9 to 6.8 and p equal to 0.010, while those in category 5, the most severe tier, had a coefficient of 5.9, with a confidence interval of 2.2 to 9.6 and p equal to 0.002. Cardiovascular comorbidities also emerged as significant correlates. Atrial fibrillation was associated with an increase of 2.1 points, with a confidence interval of 0.3 to 3.9 and p equal to 0.02, and heart disease more broadly was associated with an increase of 1.8 points, with a confidence interval of 0.2 to 3.4 and p equal to 0.03.

These associations held after adjustment for the other variables in the model, indicating that the association between cardiac comorbidity and fatigue was independent of mood and sleep disturbances. The functional consequences of fatigue were equally striking. Higher fatigue scores were associated with reduced performance in activities of daily living, with a coefficient of 0.15, a confidence interval of 0.07 to 0.22, and p less than 0.001, as well as lower social participation, with a coefficient of 0.06, a confidence interval of 0.02 to 0.10, and p equal to 0.004.

The authors caution that the cross-sectional design cannot determine whether fatigue causes functional decline, whether reduced activity and social withdrawal amplify fatigue, or whether shared underlying mechanisms drive both. The response rate of 25 percent also raises the possibility that participants who chose to respond differ systematically from those who did not, potentially biasing the estimates in unknown directions. Longitudinal studies, the researchers argue, are needed to disentangle the temporal relationships between fatigue, comorbidities, and functioning after TIA.

Fatigue affected more than one-third of first-ever TIA survivors in this cohort and showed no material variation across time strata reaching back more than a decade. The authors suggest that early identification and management of fatigue, together with treatment of related conditions such as depression, sleep disorders, atrial fibrillation, and heart disease, may improve functioning in this population.

Subject of Research: Fatigue after transient ischemic attack: cross-sectional associations with comorbidities, activities of daily living and social participation

Article Title: Fatigue after transient ischemic attack: cross-sectional associations with comorbidities, activities of daily living and social participation

Article References: Magaard, G., Öhberg, F., Liv, P., Sörlin, A., Stålnacke, B.-M., & Hu, X. (2026). Fatigue after transient ischemic attack: cross-sectional associations with comorbidities, activities of daily living and social participation. Frontiers in Neurology, 17, Article 1870184. https://doi.org/10.3389/fneur.2026.1870184

Image Credits: AI Generated

DOI: 10.3389/fneur.2026.1870184

Keywords: Fatigue, transient, ischemic, attack, cross-sectional, associations, comorbidities, activities, daily, living, social, participation