Clinical Measures Of Fatigue In Pd
A systematic critique of rating scales for diagnosis and severity of PD fatigue used pre-determined criteria for Recommended, Suggested, or Listed, depending on the quality of data. The FSS met the necessary criteria to be recommended for both diagnostic screening and severity measurement., The Multidimensional Fatigue Inventory was designated as recommended for rating fatigue severity, and may be more sensitive to change with interventions than the FSS. For diagnostic screening only, two other scales were recommended: Functional Assessment of Chronic Illness TherapyFatigue Scale and Parkinson Fatigue Scale . Since the MDS review article, the Modified Fatigue Impact Scale has been validated in a study involving 100 PD patients. This scale involves evaluation of cognitive as well as physical and social functioning.
What Causes Fatigue In People Living With Parkinson’s Disease
There exists many causes that interact with one another and are responsible for fatigue. Some of these causes can be treated and others cannot:
- The decrease in neurotransmitters associated with Parkinsons disease. The levels of dopamine and serotonin, which usually regulate movement and mood, decrease as neurons disappear.
- Medications to treat conditions such as insomnia, anxiety, muscle pain and spasms, as well as allergies.
- Medications taken to control the motor symptoms of the disease.
- Low blood pressure or orthostatic hypotension which are characteristics of Parkinsons disease and which are aggravated by antiparkinsonian drugs.
- Involuntary muscle contractions , slow movements , muscle stiffness and tremors.
- Lack of exercise which can fuel the vicious cycle of low energy.
Mental fatigue can also be exacerbated by difficulty concentrating, memorizing, or performing cognitive tasks.
People living with Parkinsons disease often use these phrases to describe their fatigue:
- I have no energy
- I am unable to do anything
- I am not able to motivate myself
- I feel overwhelmed
Out of the many medical conditions, lack of sleep and aging can be the cause of fatigue. In general, the fatigue associated with Parkinsons disease improves with antiparkinsonian treatments, but does not go away completely.
Your neurologist can help you determine the cause of your fatigue and eventually find the best treatment.
What Causes Fatigue In Parkinson’s
The precise mechanisms that cause fatigue are unclear but research suggests that any neurological disorder which involves the basal ganglia area of the brain is likely to be associated with significant fatigue. This includes Parkinsons.
In some cases Parkinsons medication may be a factor, for example dopaminergic medications may affect sleep and so add to fatigue. Dosage and timing of medication may also affect energy levels.
Fatigue may be linked to other Parkinsons symptoms, for example depression. With depression there is usually also fatigue, as well as loss of motivation, a general lack of interest and difficulty in sleeping. It is important that these symptoms are recognised as they are very treatable, and overcoming them can reduce fatigue.
If you experience tremor, rigidity or dyskinesia your muscles will have to work harder in order to carry out simple movements or tasks which can mean muscles fatigue more quickly and easily. Slowness of movement may also increase fatigue by making activities and tasks more prolonged and effortful.
You may have sleep problems and poor quality sleep tends to lead to excessive day-time sleepiness and a tendency to nap. Although sleepiness is a separate symptom to fatigue, it clearly adds to the problem and fatigue is hard to overcome if you are sleepy.
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Pragmatic Management Of Fatigue In Pd
Treatment approaches focused on fatigue in PD are faced with 2 main limitations: lack of clear insight into its pathophysiology and mechanisms, and probably its multifactorial nature . Therefore, as stated by Kluger and Friedman, contemporary treatment of fatigue in PD is limited to an empirical approach based on plausible hypotheses .
How Is Fatigue Treated
Although fatigue is common in Parkinsons, it has often been rather neglected by doctors. There are numerous causes of fatigue that are unrelated to Parkinsons but these still need to be recognised for treatment to be successful.
You should first talk with your doctor or specialist to let them know how fatigue affects you and what changes you have noticed over recent months. They will then carry out any tests they feel are appropriate.
Medication: If your doctor suspects that your Parkinsons treatment is a factor they may recommend a change in medication so that symptoms are better managed, which should give you more energy.
Sleep: It is important to understand the reasons for poor sleep and to treat symptoms that disturb your sleep pattern. For example tremor, stiffness or restless legs may interrupt your sleep, or you may need to use the toilet at night. Your doctor will be able to suggest ways to manage these symptoms and so improve your sleep and reduce fatigue.
See also: Apathy.
Lifestyle: Advice to improve fitness through regular daily exercise may be useful. Depending on where you live, you may be referred to an occupational therapist or physiotherapist specially trained in the management of fatigue who can suggest a personal programme of activity and relaxation. In some countries your doctor may refer you to specialist community teams who help people manage chronic fatigue syndrome and can advise on fatigue disorders.
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Causes Of Fatigue In Parkinsons Disease
Many of the symptoms of PD, including slow movement, muscle stiffness, depression, and changes to sleep quality can cause or worsen the symptom of fatigue.
- Akinesia Fatigue may be caused by akinesia . People experiencing akinesia find it challenging to accomplish simple tasks, requiring significantly more energy to get through the daily activities.
- Muscle fatigue Many of the symptoms of PD that affect the muscles, like stiffness, cramping, tremor, and difficulty starting movement, put extra stress on the muscles, causing fatigue. In addition, some people with PD experience muscle atrophy, in which the muscles shrink and weaken due to lack of use. Muscle atrophy decreases a persons stamina and endurance, contributing to the sense of fatigue.
- Depression Depression is another common non-motor symptom of PD, occurring in approximately 40% of people with PD. Depression can cause fatigue, adding to a sense of low energy or lack of motivation.
- Sleep disturbance PD often causes changes in sleep cycles, which can add to a sense of fatigue during the day.
- Medications Some of the medications used to treat PD, including dopamine agonists, can cause fatigue as a side effect. Others may cause insomnia as a side effect, leading to daytime fatigue.1,2
Assessing Fatigue In Parkinsons Disease
There is no single standard for assessing fatigue. As a subjective experience, like the symptom of pain, the person experiencing fatigue can best describe the impact it is having on their life. Fatigue is generally discussed during a physical exam and health history. Patients experiencing fatigue should talk to their doctor about their experience of fatigue, including what times of day symptoms are worse, how long fatigue symptoms last, and how fatigue is impacting their life. The physician can discuss treatments for depression or difficulties sleeping. In addition, the physician may ask for a sleep study to analyze problems with sleep.1
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Treating Fatigue In Parkinsons Disease
There are currently few treatments available that directly alleviate fatigue, which can make it difficult to treat. However, people with PD who experience fatigue should talk to their doctor as changes in their current medications may help relieve fatigue. Complementary therapies, such as acupuncture or massage, may help improve symptoms of fatigue. In addition, there are several lifestyle approaches that can help manage fatigue, including:
Risk Factors Of Fatigue In Idiopathic Parkinsons Disease In A Polish Population
1Chair and Clinic of Neurology, Pomeranian Medical University, Unii Lubelskiej 1, 71-252 Szczecin, Poland
2Department of Biochemistry and Medical Chemistry, Pomeranian Medical University, Powstaców Wielkopolskich 72, 70-111 Szczecin, Poland
3Medicinkliniken, Länssjukhuset Ryhov, 551 85 Jönköping, Sweden
Introduction. Fatigue syndrome is one of the nonmotor symptoms in Parkinsons disease . The aim of the study was assessment of prevalence of fatigue syndrome in PD and answering the question what are the independent risk factors connected with intensity of fatigue in PD. Methods. 114 patients with idiopathic PD were enrolled. The fatigue was assessed according to the Fatigue Severity Scale . We analyzed associations between fatigue and sex, age, education, duration and severity of the disease, everyday activity, intensity of the main symptoms, treatment, presence of dyskinesias and fluctuations, depression and excessive sleep during the day, and presence of pain and nycturia. Results. The fatigue syndrome was detected in 57.9% of patients. The score in the FSS was 1 to 7 points, 4.3 average. Greater fatigue intensity correlated with higher total daily levodopa equivalent dose. Patients with moderate depression had significantly greater fatigue.. Fatigue syndrome affects 57.9% of patients with PD. Use of higher LED and presence of moderate depression are independent risk factors of greater intensity of fatigue.
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Potentials Ways To Reduce Fatigue
- Exercise. It may seem counterintuitive get moving if youre feeling fatigued however, the right kind and the right amount of exercise can significantly reduce fatigue. Experiment. Sometimes just getting out the door for a walk in the fresh air can reduce fatigue.
- Talk to your doctor if you think you may be depressed. Its possible that an anti-depressant could reduce fatigue.
- Plan your time. Identify when you tend to have the most energy throughout the day and plan to get your most important jobs done then.
- Be realistic, but still do something. If youre feeling extra exhausted on a certain day, dont put pressure on yourself to accomplish everything you planned. Do somethingbecause accomplishing something will give you an energy boost but be realistic about what youre capable of doing.
- Delegate. Its not easy. You may have concerns about being a burden to others. Most people will be thrilled to help. Let them.
- Organize and declutter. Opening up spacephysically, emotionally, mentally and logisticallycan help you reduce stress and as a result reduce feelings of fatigue.
- Connect with others. We know that when you feel wiped out that the last thing you want to do is attend a support group meeting or event, but connecting with others in a positive way has the potential to not only make you feel supported and encouraged and loved, but it may very well give you the exact bump in energy that you need.
Insights Into Fatigue From Other Disorders
Although perceived fatigue is probably similar among different illnesses, there may be disease-specific differences. Both similarities and differences may provide insights into fatigue pathophysiology. Similarities in fatigue would be compatible with a hypothesis of shared mechanisms, and thus the possibility of similar interventions. The high prevalence of fatigue in medical and psychiatric disorders points either to some very generalized mechanisms or a limitation in the brains ability to distinguish perceptions. We limited our review of other disorders with prominent fatigue, but excluded chronic fatigue syndrome because of its frequent association with psychiatric disorders such as personality disorders and post-traumatic stress disorder that might confound physiological interpretations.
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Fatigue In Parkinson’s Disease Is Associated With Lower Diastolic Blood Pressure
- IOS Press
- Fatigue is a common debilitating symptom in Parkinson’s disease . A novel research study has found that fatigue symptoms in PD are associated with small but persistent reductions in diastolic blood pressure throughout the day.
Fatigue is a common debilitating symptom in Parkinson’s disease . A novel research study has found that fatigue symptoms in PD are associated with small but persistent reductions in diastolic blood pressure throughout the day, report scientists in the Journal of Parkinson’s Disease.
PD is a slowly progressive disorder that affects movement, muscle control and balance. It is the second most common age-related neurodegenerative disorder affecting about 3% of the population by the age of 65 and up to 5% of individuals over 85 years of age. Fatigue is a disabling non-motor symptom that affects about half of all individuals with PD. A 2015 systematic review on this topic confirmed the absence of high quality evidence supporting any particular PD fatigue treatment.
Investigators conducted a cross-sectional study research assessment of 35 people with PD recruited from the Ann Arbor Veterans Affairs Health System, all of whom wore a 24-hour blood pressure monitor to track their blood pressure hourly while they were at home. Researchers asked participants about the presence of fatigue symptoms and grouped them into two categories: those with fatigue and those without.
S You Can Take To Reduce Fatigue
If you are feeling fatigued and exhausted all the time, what can you do about it?
First and most importantly, speak to your doctor about how much the fatigue disturbs you. Does it undermine your daily activities? Does it make it more difficult to attend clinic visits or rehabilitation appointments? Does it feed into your emotional life? Does it undermine your coping ability? Once you speak to your doctor about your fatigue, your doctor might also recommend the following steps:
- Engage in regular physical exercise, including the use of weights to increase muscle strength. Studies show that physical exercise combats both physical and mental fatigue.
- Consider taking anti-depressant medication. Although fatigue is not caused by depression, depression can worsen fatigue . Treating depression if it is present might allow you to overcome fatigue with exercise or some other treatment.
- Consider trying stimulants like Ritalin , normally prescribed for attention deficit-hyperactivity disorder or Provigil , prescribed for sleep apnea, as an adjunct for depression and as a palliative treatment in end of life care. Some doctors have reported that these drugs may help certain Parkinson’s patients.
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Codebook Development And Validation
Transcripts of the semi-structured interviews from Phase 2 were analyzed by researchers trained in qualitative research methods . Analysis was blinded to response on the PFS16 or any other part of the FTF screener. NVivo 12 Pro was used to develop a codebook of common themes. Themes were refined by repeated, iterative discussion between researchers until a single standardized codebook was developed. Researchers then categorized themes into three domains based on results of Phase 1: physical, cognitive, and emotional aspects of fatigue these domains were developed from review of the online journaling components of Phase 1. The Phase 2 codebook was validated by application to the Phase 3 open-ended question on fatigue. As mentioned above, individuals using a dopamine agonist or with significant sleepiness/depression were excluded from phase 2. In order to ensure transferability of the codes between the two cohorts, in turn, in Phase 3 individuals reporting SCOPA-SLEEP5, GDS> 5, or use of a dopamine agonist were excluded from this analysis. Responses were classified into one or more themes, which were then tabulated. We compared theme frequency by gender for both Phase 2 and Phase 3.
This study was performed in accordance with the Declaration of Helsinki. This study and the Fox Insight study are approved by the New England Institutional Review Board, and online consent is obtained from each participant at enrollment.
Why Do Parkinsons Patients Have Trouble Sleeping
Despite having daytime tremors, Parkinsons patients do not shake in their sleep. However, both Parkinsons disease itself and the medications used to treat it can give rise to a number of sleep problems that lead to insomnia and excessive daytime sleepiness.
Patients with motor symptoms may have trouble adjusting sleeping positions to get comfortable. Others may experience distressing nocturnal hallucinations when trying to fall asleep. These may be a result of medications or cognitive impairment.
In turn, excessive daytime sleepiness may occur as a consequence of sleeping poorly at night. It may also be triggered by medications. Parkinsons patients who suffer from EDS may be at a higher risk of accidents and unable to safely carry out activities such as operating a motor vehicle.
Since insomnia frequently goes hand-in-hand with anxiety and depression, it may be a contributing factor to sleep problems in people with Parkinsons disease. For that reason, doctors often look for mental health disorders in people with Parkinsons disease who have sleep problems.
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Methylphenidate Use For Fatigue In Parkinsons
Methylphenidate , better known by its brand name, Ritalin, is popular for its use in the treatment of children with ADHD. It was FDA approved in the 1950s and became increasingly prescribed in the 1990s. MP has since been used for other disorders, including narcolepsy, refractory depression and fatigue caused by medical and neurological disorders.
Fatigue in Parkinsons is a common problem encountered by one-third to one-half of people with the disease. Parkinsons fatigue is often unrelated to the disease severity and overall motoric disability. Medications used to treat the motor symptoms of Parkinsons typically do not improve fatigue, and treatment specific to fatigue is lacking.
MP is a psychostimulant which has seen an increase in off-label use to treat Parkinsons fatigue. MP works by decreasing the reuptake of neurotransmitters, like dopamine and norepinephrine, thus making them available longer in the synaptic cleft where the chemicals can act on the receiving brain cells.
Based on their clinical experience, many physicians are recommending that patients try MP for Parkinsons fatigue, especially when quality of life is greatly impacted.
MP is an old drug that may have newer uses it may have potential to help people with Parkinsons. As with all medications, discuss the risks and benefits of MP with your neurologist and other healthcare team members before deciding if it is right for you.
How To Talk To Your Doctor
If you want to talk to your doctor about medications or any other concerns you have, we put together a great video with great strategies for making the most out of your time together. You can watch the video here, and be sure to check out all of the videos we have on our YouTube channel and subscribe so youre the first to know when we share something new.
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