Does Parkinson’s Disease Cause Fatigue

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I am a very active person, but deep fatigue must be addressed with rest. Taking a day to rest is not in my nature. It makes me feel like a sloth. Yet, when deep fatigue hits me, the best remedy is to do just that — take the day off! I limit myself to one day of physical rest, very rarely two days . I also find that the mind must rest with the body. Getting the mind to a quiet place is the practice of meditation, in whatever form suits the moment. At the height of deep fatigue, meditation can be very difficult, but not impossible. At times, it has taken me four hours to quiet my mind and body to get rejuvenating rest.

But there is a caution here: Be wary of using rest as an excuse to procrastinate. In another column, I’ll address the link of scenario looping to set-shifting issues and difficulty initiating new tasks. Basically, getting off the sofa can be problematic if I stay there too long. Perhaps this seems contradictory to my history as a highly active person, but that is the nature of PD’s nonmotor effects. Once off the sofa, I make myself shift into a physical task, followed by a short rest and then some type of mental task. There is always some resistance to overcome to do this — to get off the sofa — but the rest is absolutely necessary to stop the deep fatigue.

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Fatigue In Parkinsons Disease Associates With Lower Ambulatory Diastolic Blood Pressure

Article type: Research Article

Affiliations: Department of Neurology, University of Michigan, Ann Arbor, MI, USA | Veterans Affairs Ann Arbor Health System and GRECC, Ann Arbor, MI, USA | University of Michigan Morris K. Udall Center of Excellence for Parkinson’s Disease Research, Ann Arbor, MI, USA | Department of Radiology, Division of Nuclear Medicine, University of Michigan, Ann Arbor, MI, USA

Correspondence: Correspondence to: Vikas Kotagal, MD MS, Building 14, North Campus Research Center, 2800 Plymouth Road, Ann Arbor MI, 48109, USA. Tel.: +1 734 936 9010; Fax: +1 734 615 4991; E-mail: .

Keywords: Autonomic symptoms, blood pressure, fatigue, hypotension, Parkinson’s disease

DOI: 10.3233/JPD-191579

Journal: Journal of Parkinson’s Disease, vol. 9, no. 3, pp. 575-581, 2019

Abstract

Fatigue In Parkinson’s Disease Is Associated With Lower Diastolic Blood Pressure

Date:

IOS Press

Summary:

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.

Story Source:

Risk Factors Of Fatigue In Idiopathic Parkinsons Disease In A Polish Population Monika Go??b-Janowska

1Chair and Clinic of Neurology, Pomeranian Medical University, Unii Lubelskiej 1, 71-252 Szczecin, Poland

2Department of Biochemistry and Medical Chemistry, Pomeranian Medical University, Powsta?ców Wielkopolskich 72, 70-111 Szczecin, Poland

3Medicinkliniken, Länssjukhuset Ryhov, 551 85 Jönköping, Sweden

Abstract

Introduction. Fatigue syndrome is one of the nonmotor symptoms in Parkinson’s 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.

1. Introduction

2. Methods

Fatigue In Parkinsons Disease: Report From A Multidisciplinary Symposium

A summary of a symposium in October, 2014, reviewing what is known about the diagnosis and treatment of fatigue, its physiology, and what we might learn from other disorders in which fatigue figures prominently, and concluding with focused recommendations to enhance understanding and treatment of fatigue in Parkinson’s disease.

Parkinsons Disease Education Consortium 2018 Research Program Overview

This work was undertaken as part of the Michael J Fox Foundation’s Parkinson’s Disease Education Consortium 2018 research program. The PDEC objective relevant to the present analysis was to understand how individuals with PD experience fatigue.

The PDEC 2018 research program undertook a mixed-methods approach that involved three phases , each of which built on prior phases. Initial phases were aimed at in-depth analysis in a small sample, before expanding to a larger cohort of people with PD. Phase 1 was an online journaling activity, in which an online moderator interacted with individuals with PD via a series of structured activities. Phase 2 involved semi-structured telephone interviews with a different set of participants. Phase 3 involved deployment of a survey to the Fox Insight study cohort. Each of these phases is detailed further below. Participants provided informed consent to each phase separately.

Fig.1

Flow chart of study recruitment phases.

Association Between Fatigue And Quality Of Life In Parkinsons Disease

To determine the relationship between the perception of fatigue and quality of life, a canonical correlation analysis was conducted using the fatigue scales as the criterion variables and quality of life measures as the predictor variables. The range of correlation within the fatigue scales was r?=???0.86 to 0.85 and r?=???0.74 to 0.82 among the quality of life variables. The highest correlated predictor variables was between the PDQ-39SI and NMSQ measures. Omission of either variable did not change the results; these two variables were therefore retained. The multivariate analyses produced four discriminant functions, of which the first was significant, F?=?13.24, p?=?0.0005 based on Roy’s greatest-root test. The correlation between the two sets of variables was Rc?=?0.98, indicating a high degree of relationship between the predictor and criterion variables. The squared canonical correlation which represented the proportion of the variance in the canonical variate of the fatigue scales that can be explained by the canonical variate of the quality of life variables was 96%.

Table 1 Canonical loadings for the fatigue and quality of life in the Parkinson groupFull size image

Triggers And Alleviating Factors For Fatigue In Parkinsons Disease

• Roles Conceptualization, Data curation, Formal analysis, Writing – original draft, Writing – review & editing

  Affiliation Department of Neurology, University of Pittsburgh, Pittsburgh, PA, United States of America

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• Roles Conceptualization, Data curation, Formal analysis, Writing – review & editing

  Affiliation Department of Neurology, University of Pittsburgh, Pittsburgh, PA, United States of America

  ?

• Roles Conceptualization, Writing – review & editing

  Affiliation Department of Neurology, Duke University, Durham, NC, United States of America

  ?

• Roles Conceptualization, Writing – review & editing

  Affiliation Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States of America

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• Roles Conceptualization, Project administration, Writing – review & editing

  Affiliation Columbia University School of Social Work, New York, NY, United States of America

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• Roles Conceptualization, Funding acquisition, Project administration, Writing – review & editing

  Affiliation The Michael J. Fox Foundation for Parkinson’s Research, New York, NY, United States of America

  ?

• Roles Conceptualization, Writing – review & editing

  Affiliation Department of Neurology, University of Toronto, Toronto, Ontario, Canada

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Understanding The Lexicon Of Fatigue In Parkinsons Disease

Article type: Research Article

Affiliations: Department of Neurology, Duke University, Durham, NC, USA | Department of Behavioral and Community Health Sciences, University of Pittsburgh, Pittsburgh, PA, USA | The Edmond J Safra Program in Parkinson’s disease, Toronto Western Hospital, University of Toronto, Toronto, Ontario, USA | Department of Neurology, University of Pittsburgh, Pittsburgh, PA, USA | Tuck School of Business, Dartmouth College, Hanover, NH, USA | Michael J. Fox Foundation, New York, NY, USA | Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA

Correspondence: Correspondence to: Sneha Mantri, MD, MS, 932 Morreene Rd, DUMC 3333, Durham NC 27705, USA. Tel.: +1 919 684 1947; E-mail: .

Keywords: Fatigue, Parkinson’s disease, qualitative research

DOI: 10.3233/JPD-202029

Journal: Journal of Parkinson’s Disease, vol. 10, no. 3, pp. 1185-1193, 2020

Abstract

What Are The Primary Motor Symptoms Of Parkinsons Disease

There are four primary motor symptoms of Parkinson’s disease: tremor, rigidity, bradykinesia and postural instability . Observing two or more of these symptoms is the main way that physicians diagnose Parkinson’s.

It is important to know that not all of these symptoms must be present for a diagnosis of Parkinson’s disease to be considered. In fact, younger people may only notice one or two of these motor symptoms, especially in the early stages of the disease. Not everyone with Parkinson’s disease has a tremor, nor is a tremor proof of Parkinson’s. If you suspect Parkinson’s, see a neurologist or movement disorders specialist.

Tremors

Read more about Parkinson’s tremors

Rigidity

Bradykinesia

mask-like expression of the face

Postural Instability

Walking or Gait Difficulties

episodes of freezing

Dystonia

Dystonia

Vocal Symptoms

Fatigue In Parkinsons Disease And Potential Interventions

This abstract of a literature review discusses the measurement and pathophysiology of fatigue and fatigability.  There rare no evidence-based treatments available.  Several pilot studies are reviewed on the effects of pharmacological agents and exercise.  These provide some insights on the design of future larger clinical trials. Fee for full article at IOS Press.

The Critical Difference Between Sleepiness And Fatigue

Fatigue is a physical or psychological feeling where people feel weary and exhausted and lacking energy. EDS is about needing and having the urge to sleep.

Fatigue is something that people can experience along with EDS; however, people who experience fatigue on its own—the feeling of being tired and out of energy— do not also necessarily fall asleep when sedentary, as people who experience EDS often do.

It is estimated that EDS affects up to 50% to 75% of people living with Parkinson’s and fatigue is estimated to affect 40% to 60%. Fatigue, however, is more likely to go undiagnosed.

Because the terms fatigue and sleepiness are so heavily linked, and sometimes used interchangeably, research has concluded that fatigue and EDS should be assessed separately in people with Parkinson’s so that we can improve our understanding of their overlapping physiology.

With that knowledge, researchers from the University Hospital of Zurich, Switzerland designed a study to determine the overlap between fatigue and EDS and then associate them with other motor and non-motor symptoms as well as dopaminergic medication.

In their study of 88 outpatients, the researchers found that 72% experienced fatigue or EDS and just under half experienced both. Some of the key findings of the study include:

Potential Ways To Reduce Excessive Daytime Sleepiness

• Assess the underlying cause
• Improve nocturnal sleep through medications, cognitive behavioral therapy, diet, light therapy and more
• Evaluate all medicines being taken—some have hypersomnia as a side effect—and adjust as needed
• If taking dopaminergic medications, consider dose adjustment
• Watch consumption of alcohol or sleep-inducing foods/ingredients
• Experiment with caffeine

The Relationship Between Parkinsons Disease And Sleep

It’s unclear whether poor sleep causes parkinsonian symptoms to worsen or whether worsening parkinsonian symptoms cause poor sleep. In many cases it’s likely a case of bidirectionality, with each one exacerbating the other.

Fragmented sleep and sleep deprivation appear to leave the brain more vulnerable to oxidative stress, which has been tied to the development of Parkinson’s disease. Parkinson’s disease is not usually diagnosed until individuals have developed sufficient motor symptoms, by which time a significant portion of brain cells have already been damaged. If poor sleep quality or having sleep disorders foreshadows the development of parkinsonian symptoms, these could be useful in early diagnosis of the disease.

More research is needed to clarify the multifaceted relationship between Parkinson’s disease and sleep. A better understanding of this connection may offer medical experts the unique opportunity to screen at-risk individuals and perhaps delay the onset of the disease.

Parkinsons Disease And Sex Issues: Libido Sex Drive Emma-Marie Smith

Parkinson’s disease and sex is a complicated topic. No matter your age, gender or relationship status, sex plays a significant part in many people’s lives. Sexual desire does not go away with a diagnosis of Parkinson’s disease, and most people are perfectly able to continue having intimate relationships. However, you may experience changes to your libido or physical ability during sex. As with all Parkinsonian symptoms, it helps to be prepared so that you’re aware of your options. With this in mind, here’s what to expect from Parkinson’s disease and sex.

Parkinsons Sleep Problems: Diagnosis And Treatment

Parkinson’s disease is chronic and progressive, meaning it tends to get worse over time. However, there are treatment options that can help manage symptoms and allow patients to get more restful sleep.

The simplest way to start sleeping better with Parkinson’s disease is by adopting healthy sleep habits. Sleep hygiene tips for Parkinson’s disease sufferers include:

• Sticking to regular bedtimes
• Following a consistent bedtime routine with soothing activities such as listening to music or reading a calming book
• Getting regular exercise, preferably early in the day
• Getting adequate exposure to light, whether outdoors or through light therapy
• Avoiding long naps and naps late in the day
• Creating a cool, dark, and comfortable sleeping environment
• Restricting bedtime activities to sex and sleep only
• Turning off screens an hour before bedtime
• Reducing liquid intake before bedtime
• Avoiding caffeine, alcohol, and tobacco
• Eating a healthy diet and avoiding large meals at night

Light therapy, exercise, and deep brain stimulation have been successfully used to improve overall sleep quality and to treat specific conditions, such as REM sleep behavior disorder, in patients with Parkinson’s disease. Cognitive behavioral therapy for insomnia has proven effective at reducing insomnia in healthy adults, although further research is needed on the effects of CBT in patients with Parkinson’s disease.

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Tips For A Better Sex Life With Parkinsons Disease

• Communicate: Be open with your partner about your feelings and discuss your physical needs. If the topic of sex causes upset or arguments, it might be worth seeing a sex therapist.
• Consider changing your medication: If your medication is having an impact on your sex life, talk to your doctor about an alternative treatment. Your sex life is important, so it should be given as much attention and care as your general health and wellbeing.
• Be open with your doctor: Don’t be afraid to talk about sex with your doctor – that’s what your healthcare team is there for, and they will have dealt with these types of concerns before.
• Deal with fatigue and depression: Depression and fatigue can negatively impact your sex life, so look at ways of treating these symptoms. A combination of therapy and antidepressant medications may help, so talk to your doctor.

Parkinsons Disease And Sex: What You Need To Know

There is no reason why you cannot continue to have a healthy sex life with Parkinson’s disease. However, studies suggest that around 70 to 80% of those with PD experience sexual dysfunction. These common sexual problems are believed to result from Parkinson’s medication side-effects and psychological issues.

Men and women experience different issues when it comes to Parkinson’s disease and sex. In men, common problems include erectile dysfunction, lower sex drive, premature ejaculation and inability to orgasm. Women may experience pain during intercourse, as well as lack of sexual arousal, inability to orgasm and reduced lubrication.

In addition, the motor symptoms of Parkinson’s disease can create physical challenges during sex. Many people with PD experience slowed movement and rigidity that makes any movement difficult. Tremors and involuntary movement can also occur during sexual activity.

Why Do Parkinsons Patients Have Trouble Sleeping

Despite having daytime tremors, Parkinson’s patients do not shake in their sleep. However, both Parkinson’s 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. Parkinson’s 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 Parkinson’s disease. For that reason, doctors often look for mental health disorders in people with Parkinson’s disease who have sleep problems.

Evaluation Of Sleep Hygiene Program: Sleep Diary

Monitoring the effectiveness of behavior changes is best done by keeping a diary.  The table below depicts a sample diary that could be kept by the bedside and filled out upon arising by the patient or caregiver.  If daytime sleepiness and napping are problems, items can be added to record the number, time, and duration of napping episode. The diary can be carried with the patient.

What Should Fatigue Mean For Your Daily Schedule

Parkinson’s disease patients frequently notice that they’re more physically competent during certain parts of the day — symptoms are typically less bothersome right after taking medication than as your dose is about to “run out”. They may then schedule their more active daily tasks around the time during which they function best. While this makes sense, concentrated bursts of activity can also leave you feeling exhausted. Schedule periods of rest right after you have been active to reduce fatigue.

Treatment For Parkinsons Disease And Sex Issues

Treatment for erectile dysfunction in men might include medications like Viagra, as well as physical or psychological therapy. In some cases, surgical implants may also be used. Women’s sexual health in Parkinson’s is slightly more complex due to their hormonal makeup.

Treatment options for women are somewhat restricted, but they include adding lubrication and seeing a therapist. Many women find timing sex during their ON periods to be helpful.

In terms of reproductive health, there is no evidence to suggest that Parkinson’s disease causes problems with pregnancy – although there have been no studies into the safety of PD medication during pregnancy.

Parkinson’s disease and sex can be challenging, but there are plenty of treatments and solutions that can work for both men and women. It’s important to communicate with your partner and talk through any feelings you might be experiencing, especially if you’re struggling with body image or confidence issues. Navigating sex during Parkinson’s disease can be difficult for partners, too, so remember to keep the dialogue open in your relationship.

article references

APA ReferenceSmith, E. . Parkinson’s Disease and Sex Issues: Libido, Sex Drive, HealthyPlace. Retrieved on 2021, August 11 from https://www.healthyplace.com/parkinsons-disease/effects/parkinsons-disease-and-sex-issues-libido-sex-drive

Methylphenidate Use For Fatigue In Parkinsons Non-Motor Symptoms

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 Parkinson’s is a common problem encountered by one-third to one-half of people with the disease. Parkinson’s fatigue is often unrelated to the disease severity and overall motoric disability. Medications used to treat the motor symptoms of Parkinson’s 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 Parkinson’s 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 Parkinson’s 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 Parkinson’s. 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.

Treatment For Fatigue In Parkinson’s Disease

At least one-third of people with Parkinson’s disease complain about fatigue. It is unclear what treatment is best to reduce fatigue in people with Parkinson’s disease.

We reviewed the medical literature up to April 2015, and found 11 studies that included a total of 1817 people. Nine studies investigated the effects of medication on fatigue. Two studies investigated the effects of exercise on fatigue. We found no studies that investigated the effect of cognitive-behavioural therapy.

We found that doxepin , a drug to treat depression, may reduce fatigue. We found that rasagiline , an anti-Parkinson drug, reduced or slowed down the progression of physical fatigue. Most drugs were safe; however, levodopa-carbidopa may cause nausea.

We found no evidence that exercise reduces fatigue in Parkinson’s disease.

Based on the current evidence, it is not clear what treatment is most effective to treat fatigue in people with Parkinson’s disease. Future studies should investigate the effect of cognitive-behavioural therapy on fatigue in people with Parkinson’s disease.

Factors contributing to subjective fatigue in people with idiopathic Parkinson’s disease are not well known. This makes it difficult to manage fatigue effectively in PD.

To evaluate the effects of pharmacological and non-pharmacological interventions, compared to an inactive control intervention, on subjective fatigue in people with PD.

Fatigue Sleep Difficulties And Restless Legs

Although Parkinson’s is classified as a movement disorder, it can affect people in various different ways. Sometimes the non-movement symptoms can be more troublesome and can have a bigger impact on the daily life of someone living with Parkinson’s.

Some of the more common non-movement symptoms of Parkinson’s are:

• Fatigue
• Restless legs

Financial Disclosures For The Past 12 Months

SM receives research support from the Michael J Fox Foundation , the Parkinson Foundation and Cerevel Therapeutics, was a paid consultant to MJFF, is a study site investigator for a study sponsored by Neuraly Rho, is a study site sub-investigator for a study sponsored by Biogen, and is contracted with Deep Brain Innovations, LLC. MD was an employee of the sponsor, MJFF, at the time this work was done. CK is an employee of MJFF. CM was a paid consultant for Acorda Therapeutics, on the advisory board of Denali therapeutics, received honoraria for teaching from EMD Serono, a steering committee member for MJFF Grants Canadian Institutes of Health Research, Parkinson’s Foundation , National Institutes of Health , International Parkinson and Movement Disorders Society, and is contracted with Grey Matter Technologies. LC receives research support from MJFF, has received travel payment from MJFF to MJFF conferences, is a paid consultant to MJFF, receives research support from the UPMC Competitive Medical Research Fund, is study site investigator for a study sponsored by Biogen, is a site sub-investigator for a study sponsored by Voyager, received payment from Elsevier , and receives royalties from Wolters Kluwel . All other authors have no financial disclosures.

Physiology And Biomarkers For Fatigue In Pd

The physiology underlying fatigue symptoms in PD is unknown, whereas much is known about the mechanisms of motor fatigability. The only published study of physiological differences between fatigued and nonfatigued PD patients found no measurable differences in oxygen utilization during exercise,54 but some studies have suggested that exercising improves fatigue.15,17,55,56 Whether fatigue fluctuates with motor fluctuations was looked at in one study.57 Subjects were assessed during their off, whereas all other studies used the subjects’ experience over a preceding time interval of weeks. Eighty-eight percent of their subjects were fatigued, and fatigue increased with motor ”off.” Too few subjects were nonfatigued to determine how often fatigue occurred only during motor ”off.” The physiological implications are unclear, as many other nonmotor symptoms also increased during the ”off” period.

Insights Into Fatigue From Other Disorders

Although perceived fatigue is probably similar among different illnesses,32 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 brain’s 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.

Sleep Disturbances In Parkinson’s Disease

In general, research seems to indicate that people with Parkinson’s disease have more sleep disruptions than similarly aged people without the disease.  The most commonly reported sleep-related problems are the inability to sleep through the night and difficulty returning to sleep after awakening, generally referred to as maintenance insomnia.  Unlike many older adults, patients with Parkinson’s disease often find that they have no trouble initiating sleep, but often wake up within a few hours and find sleeping through the rest of the night to be difficult. People with Parkinson’s disease also report daytime sleepiness, nightmares, vivid dreams, nighttime vocalizations, leg movements/jerking while asleep, restless legs syndrome, inability to or difficulty turning over in bed, and awakenings to go to the bathroom.

 Although all the reasons for these sleep changes are unknown, potential explanations include reactions to/side effects of medications and awakening due to symptoms such as pain, stiffness, urinary frequency, tremor, dyskinesia, depression and/or disease effects on the internal clock. 

Talk To Your Doctor About Antidepressants

People with Parkinson’s disease suffer from depression at higher rates than the general population — and feeling hopeless, helpless, angry, apathetic, and no longer enjoying the things you used to are some of the symptoms. Fatigue, too, is a very common symptom of depression. If you think you may be depressed, mention this to your doctor. Antidepressants, most commonly SSRIs or tricyclic antidepressants, may be the answer for you.

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 person’s 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

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: