Journal of Rehabilitation Medicine 51-7 | Page 30

J Rehabil Med 2019; 51: 499–505 ORIGINAL REPORT VISION-RELATED SYMPTOMS AFTER ACQUIRED BRAIN INJURY AND THE ASSOCIATION WITH MENTAL FATIGUE, ANXIETY AND DEPRESSION* Märta BERTHOLD LINDSTEDT, MD 1 , Jan JOHANSSON, PhD 2 , Jan YGGE, MD 2 and Kristian BORG, MD 1 From the 1 Department of Clinical Science, Division of Rehabilitation Medicine, Danderyd Hospital, and 2 Department of Clinical Neuroscience, Eye and Vision, Karolinska Institutet, Stockholm, Sweden Background: Brain injury causes multiple symptoms. Among these, visual disturbances are common; 50– 70% of patients experience some change in vision after injury/illness. Other very common and disab- ling symptoms are fatigue, anxiety and depression. This study examines whether levels of fatigue, anx- iety and depression are increased if the patients also experience vision disorders. Materials and Methods: A total of 123 patients en- rolled in day care rehabilitation unit for medium-to- severe brain injury completed questionnaires about self-experienced fatigue, anxiety, depression and self-experienced level and type of visual disturban- ces. Symptoms of fatigue, anxiety and depression were compared with the occurrence of visual distur- bances. Analyses were performed using binary logis- tic regression. Results: An association was found between visual symptoms and fatigue, but not between visual symp- toms and anxiety/depression. However, some visual symptoms, such as glare, blurred vision and reading difficulties, showed great differences between pa- tients with or without anxiety/depression. Conclusion: Vision rehabilitation may be a tool for mitigating fatigue after acquired brain injury. Key words: vision disorder; mental fatigue; anxiety; depres- sion; traumatic brain injury; stroke. Accepted May 17, 2019; Epub ahead of print Jun 5, 2019 J Rehabil Med 2019; 51: 499–505 Correspondence address: Märta Berthold Lindstedt, Division of Rehabi- litation Medicine, Danderyd Hospital, blg 60 fl.3, SE-18288 Stockholm, Sweden. E-mail: [email protected] A cquired brain injury (ABI) is known to give rise to a diversity of symptoms that interact with everyday life and reduce abilities for social com- munication and work. Among these, mental fatigue, depression and anxiety stand out as both common and important, causing poor functional outcome (1, 2). The prevalence of fatigue, anxiety and depression after ABI differ in different studies but are always high; a range of 21–71% for fatigue (1, 3, 4), 17–29% for anxiety (5), and 23–50% for depression (6, 7). Many reports have also shown associations between these symptoms *This article has been handled and decided upon by Chief-Editor Henk Stam LAY ABSTRACT Brain injury causes multiple symptoms. Among these, visual disturbances are common; 50–70% of patients experience some change in their vision after injury/ill- ness. Other very common and disabling symptoms are fatigue, anxiety and depression. This study discusses whether the levels of fatigue, anxiety and depression are increased if the patients also experience vision dis- orders. A total of 123 patients enrolled in a day care re- habilitation unit for medium-to-severe brain injury com- pleted questionnaires about self-experienced fatigue, anxiety, depression and self-experienced level and type of vision disturbances. Symptoms of fatigue, anxiety and depression were compared with the occurrence of visual disturbances. There was an association between visual disturbances and fatigue, but not between visual disturbances and anxiety/depression. How­ ever, some visual symptoms, such as glare, blurred vision and reading difficulties, showed great differences between patients with or without anxiety/depression. In conclu- sion, vision rehabilitation may be a tool for mitigating fatigue after acquired brain injury. (8, 9) and the treatment of these symptoms plays an important role in neuro-rehabilitation. A neuro-rehabilitation assessment describes the patient’s functional deficits after ABI, but there is no common knowledge of how different symptoms interact. Considering the importance of managing mental fatigue, depression and anxiety in the rehabilitation process, a relevant question is: are there co-existing factors that untreated could potentially worsen these symptoms? Vision is a key sensory-motor modality for activities such as reading, mobility and social interaction. The visual system is complex and widely distributed in the brain (10) and is therefore susceptible to injury after ABI. Studies show that 50–75% of patients experience visual dysfunction after ABI (11–13). The visual disturbances may manifest as a loss of visual field, photophobia, double vision, different types of ocular motor disturbances and visual vertigo (12, 14). The basic visual functions are the foundation for higher visual cognitive abilities, social interactions and motor skills and may influence mental fatigue, depression and anxiety (15). Mental fatigue is a multi-factorial symptom and vision deficits may be one of the causes. The interference of reduced ocular motor control may affect reading and This is an open access article under the CC BY-NC license. www.medicaljournals.se/jrm Journal Compilation © 2019 Foundation of Rehabilitation Information. ISSN 1650-1977 doi: 10.2340/16501977-2570