# Increased neural responsiveness to distractors irrespective of perceptual load explains attention deficit in post‐stroke fatigue

## TL;DR

The study finds that post-stroke fatigue is linked to an inability to ignore distractions, regardless of task difficulty.

## Contribution

The study introduces a new perspective on post-stroke fatigue by linking it to impaired distractor suppression, independent of perceptual load.

## Key findings

- Fatigue severity predicts increased response slowing, especially under higher perceptual load.
- High fatigue severity correlates with increased neural responsiveness to distractors, regardless of task load.
- Impaired distractor suppression may explain various PSF symptoms like sensory overload and concentration difficulties.

## Abstract

Post‐stroke fatigue (PSF) is a prevalent symptom associated with attention deficits. However, it is currently unclear what drives these. Here we applied Load Theory of Attention to investigate the role of perceptual load in the relationship between attention, distraction and fatigue levels in PSF. Thirty‐two chronic stroke survivors performed a selective attention task of either low, medium or high perceptual load (varied through the number of relevant target features and their combinations). Neural responses to targets and distractor checkerboard flicker (vs. no flicker) were measured with frequency‐tagged EEG responses. The results showed that fatigue severity scores were predictive of response slowing, and that this slowing was increased with higher levels of perceptual load. Fatigue severity was also associated with increased neural responsiveness to distractors, specifically: EEG 10 Hz (distractor flickering frequency) power was greater in the presence (vs. absence) of distractor flicker for participants with high (vs. low) fatigue‐symptoms scores, across all levels of perceptual load in the later time period of each task trial. Overall, these results clarify the exacerbating effects of perceptual load on fatigue‐related slowing, stressing the importance of cognitive, as opposed to purely motoric, deficits. Importantly, they demonstrate that increased fatigue severity involves reduced ability to suppress neural responses to irrelevant distractors, irrespective of perceptual load on attention. An account for attention in PSF based on a specific deficit in distractor suppression that is found irrespective of task demands can explain a myriad of PSF symptoms (e.g. sensory perceptual overload, difficulties to concentrate).