Is Fatigue A Symptom Of Parkinson’s

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

Fatigue In Parkinsons Disease

Fatigue is a common but under-recognized problem for people with Parkinsons disease . Fatigue can be defined as an unpleasant sensation of lacking energy, making the performance of routine activities, physical or mental, a strain. People with PD may experience physical fatigue, mental fatigue, or both. Fatigue in PD is not the same as the feeling you might get at the end of a hard days work. It is not necessarily something that goes away with rest. When people with PD are asked about fatigue, they use phrases such as, I feel run down, I am out of energy, I am unable to do anything, I cant get motivated.

Fatigue in Parkinsons;Brochure

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Fatigue is common in PD

Fatigue and Depression

There is a large overlap between fatigue and other problems in PD, especially depression and sleep disorders. People with fatigue are more likely to be depressed and people who are depressed are more likely to be fatigued, but there is nonetheless a large group of PD patients who are fatigued but not depressed. Depression in PD typically responds to antidepressant treatment, and depression-related fatigue may improve with such treatment.

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Fatigue and Sleep disorders

Causes of Fatigue

Symptoms Of Parkinsons Disease

Symptoms of Parkinsons Disease may include physical or motor symptoms and non-motor symptoms.

The early physical or motor symptoms of PD include:

• stiffness
• slow or reduced movement size e.g. slow walking, small writing or micrographia, masking of the face, soft voice
• tremor at rest

Motor symptoms start on one side of the body.

The early non-motor symptoms are varied and may include:

• loss of sense smell
• sleep disturbance
• constipation
• problems with memory, planning, etc
• bladder problems e.g. frequency, urgency, incontinence
• pain

Having some of the signs listed above does not mean the person has PD as they are very common with ageing, however if they have 2 or more, then they should consider discussing them with their doctor.

As PD progresses and there are fewer dopamine producing cells in the brain, motor and non-motor changes become more pronounced. Worsening symptoms cause greater disturbance to the persons function making them increasingly dependent on others for their everyday activities. Motor symptoms by now affect both sides of the body.

The following are some of the more disruptive changes in mid to late PD.

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Other Typical Symptoms Of Parkinson’s

Tremor is;an uncontrollable movement that affects a part of the body. A Parkinsons tremor typically starts in the hand before spreading to affect the rest of the arm, or down to the foot on the same side of the body.;

There is no cure for a tremor, but there are ways to manage the symptom with support from a specialist or Parkinsons nurse.

Slowness of movement also known as bradykinesia may mean that it takes someone with;Parkinson’s;longer to do things. For example, they might struggle with coordination, walking may become more like a shuffle or;walking speed may slow down.;

Everyday tasks, such as paying for items at a check-out or walking to a bus stop, might take;longer to do.

Parkinsons causes stiff muscles, inflexibility and cramps. This can make certain tasks such as writing, doing up buttons or tying shoe laces, hard to do. Rigidity can stop muscles from stretching and relaxing. It can be particularly noticeable, for example, if you;struggle to turn over or get in and out of bed.

Symptoms and the rate at which they develop will vary from person to person. The most important thing to do if youre worried you have Parkinsons is to speak to your GP.;

Depression Severity Is An Independent Risk Factor For Dopaminergic Drug Non

As shown in Table;, the Spearman rank order correlation coefficients revealed significant correlations between fatigue remission rate and age, onset age, and depression severity. Other factors including sex, education, LEDD, disease severity and cognitive functioning were not associated with the fatigue remission rate.

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Stooping Or Hunching Over

Are you not standing up as straight as you used to? If you or your family or friends notice that you seem to be stooping, leaning or slouching when you stand, it could be a sign of Parkinson’s disease .

What is normal?If you have pain from an injury or if you are sick, it might cause you to stand crookedly. Also, a problem with your bones can make you hunch over.

Independent Risk Factors Related To Fatigue

As shown in Table;, the univariate logistic regression revealed that longer disease duration, a greater disease severity , depression and sleep disturbances were associated with fatigue . Other clinical variables, including gender, age onset age, education, LEDD and MoCA score were not significantly associated with fatigue.

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Is Parkinsons Disease Inherited

Scientists have discovered gene mutations that are associated with Parkinsons disease.

There is some belief that some cases of early-onset Parkinsons disease disease starting before age 50 may be inherited. Scientists identified a gene mutation in people with Parkinsons disease whose brains contain Lewy bodies, which are clumps of the protein alpha-synuclein. Scientists are trying to understand the function of this protein and its relationship to genetic mutations that are sometimes seen in Parkinsons disease and in people with a type of dementia called Lewy body dementia.

Several other gene mutations have been found to play a role in Parkinsons disease. Mutations in these genes cause abnormal cell functioning, which affects the nerve cells ability to release dopamine and causes nerve cell death. Researchers are still trying to discover what causes these genes to mutate in order to understand how gene mutations influence the development of Parkinsons disease.

Scientists think that about 10% to 15% of persons with Parkinsons disease may have a genetic mutation that predisposes them to development of the disease. There are also environmental factors involved that are not fully understood.

Other Rarer Types Of Hallucinations Include:

• Auditory: hearing voices or music that are not really there.
• Olfactory: smelling things that are not really there.
• Tactile: feeling something touching your skin that is not really there.
• Illusion: seeing things differently than they actually are, such as wallpapers that seem to jump or move.

Hallucinations and delusions may sometimes be caused by issues separate from Parkinsons, such as stress, dehydration, bladder infection or general infection. They may also be exacerbated when certain symptoms of Parkinsons are worse, such as constipation.

Parkinsons-specific and other medications can cause hallucinations as a side effect and other cognitive symptoms such as dementia may also contribute to Parkinsons-related hallucinations or delusions.

Delusions are less common in people with Parkinsons than visual hallucinations but can be harder to manage and live with.

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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.

Extraction Of Region Of Interest Data

To extract region of interest data we used a standard object map in MNI space. The standard object map contained regions defined for caudate nucleus, putamen, ventral striatum, thalamus and median raphe. These regions of interest had been freehand-traced using ANALYZE 8.1 software onto the single subject MRI in MNI space available in SPM. The same standard object map was applied to each spatially normalized image of 18F-dopa Ki or 11C-DASB BPND and corresponding ADD images. Visual inspection of each plane for both images was made to ensure correct placement of the object regions over the correspondent structures. After applying target regions to structures, 18F-dopa Ki and 11C-DASB BPND values were quantified using ANALYZE 8.1. 18F-dopa Ki and 11C-DASB BPND values obtained from the different regions of interest were averaged over both hemispheres for statistical analysis.

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There Are Different Types Of Incontinence That People With Parkinsons May Experience Such As:

• Urge incontinence: a frequent and urgent need to use the toilet.
• Stress incontinence: usually occurs in the presence of some kind of physical stressor such as coughing.
• Nocturia: the need to get up multiple times in the night to use the toilet.

Learn more about changes you can make to your diet and lifestyle to help manage an overactive bladder, as well as treatments to discuss with your doctor and other healthcare professionals with our Overactive Bladder Worksheet.

Many incontinence issues can be addressed by therapy with an incontinence specialist, practicing exercises such as Kegels on a daily basis and by taking certain medications.

Parkinsons can present a variety of problems related to swallowing, ranging from minor complaints when swallowing pills to severe difficulty chewing tough foods like steak and hard pieces of bread. Swallowing issues are important to address because of the potential risk of aspiration pneumonia. Aspiration pneumonia is caused when saliva, liquids or food is breathed into the lungs instead of being swallowed into the esophagus and stomach.

Many swallowing issues can be easily addressed with specific swallowing exercises and minor changes in diet. It is a good idea to consult with a licensed speech-language pathologist to identify problem areas and improve swallowing ability through intentional exercises.

There Are Different Ways To Address Mood Changes Including:

• Taking medications
• Changing medications that have mood-related side effects
• Exercising regularly

Identify mood triggers, add positive energy into your daily life and provide a way to talk with your doctor and healthcare team about treating depression with the help of our Depression Worksheet.

Parkinsons can have many different effects on your sleep, including trouble falling or staying asleep, vivid dreams, waking up frequently during the night and excessive sleepiness during the day. Like other non-motor symptoms, sleep problems can appear before the motor symptoms.

An estimated 30% of people with Parkinsons experience some combination of insomnia and sleep fragmentation . Studies have shown people with Parkinsons have different sleep patterns and that their deepest periods of sleep during the night are shorter and interrupted more often than people without Parkinsons. Often this is made worse by medications that may wear off in the night, causing tremor, painful stiffness or other symptoms to return and disrupt your sleep.

Anxiety, depression nighttime sweating and trouble moving in bed are other non-motor symptoms of Parkinsons that can make getting a good sleep difficult. Fragmented sleep is also exacerbated by how often some people with Parkinsons find themselves waking up often during the night to use the toilet because of the changes in the bladder that come with Parkinsons.

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Can Parkinsons Disease Be Prevented

Unfortunately, no. Parkinsons disease is long-term disease that worsens over time. Although there is no way to prevent or cure the disease , medications may significantly relieve your symptoms. In some patients especially those with later-stage disease, surgery to improve symptoms may be an option.

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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How Is Parkinsons Disease Treated

There is no cure for Parkinsons disease. However, medications and other treatments can help relieve some of your symptoms. Exercise can help your Parkinsons symptoms significantly. In addition, physical therapy, occupational therapy and speech-language therapy can help with walking and balance problems, eating and swallowing challenges and speech problems. Surgery is an option for some patients.

Managing Fatigue With Parkinsons

Do you or a loved one with Parkinsons disease feel physically or mentally exhausted? This could be fatigue a feeling of deep tiredness that has no apparent explanation, and does not improve with rest. About half of people with Parkinsons disease report that fatigue is a major problem, and a third say it is their single most disabling symptom.

Fatigue is common early in the course of PD, but it can occur at any point and can happen whether movement symptoms are mild or severe. It is sometimes confused with other symptoms that can make a person sleepy or tired, like sleep disturbances or pain. Fatigue also is a symptom of depression, but a person can be fatigued without being depressed. Stress can make fatigue worse.

No specific mechanism has been shown to cause fatigue in PD. It may be that motor symptoms like tremor and stiffness contribute to making muscles tired. But fatigue has other causes too. Its important to identify and treat illnesses or medications not related to PD that cause fatigue.

The extreme exhaustion that comes with fatigue can lead people to reduce their hours at work or retire, or avoid social activities. Understanding fatigue as a symptom of PD and finding ways to cope with it are essential to maintaining a good quality of life.

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Understanding The Lexicon Of Fatigue In Parkinsons Disease

Article type: Research Article

Authors: Mantri, Snehaa; * | Klawson, Emilyb | Albert, Stevenb | Nabieva, Karinac | Lepore, Madelined | Kahl, Stephene | Daeschler, Margaretf | Mamikonyan, Eugeniag | Kopil, Catherinef | c | Chahine, Lana M.d

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 Parkinsons 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, Parkinsons disease, qualitative research

DOI: 10.3233/JPD-202029

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

Abstract

Subjects And Demographic Data

This was an observational cross-sectional study. Two hundred and twenty-two PD patients, diagnosed according to the UK PD Brain Bank criteria , were recruited between December 2012 and April 2014 from the outpatient Department of Neurology of the First Affiliated Hospital of China Medical University . Patients with other forms of parkinsonism were excluded. Patients with dementia or fatigue related to a disease other than PD were excluded . All patients enrolled in the study gave written informed consent. The Ethics Review Board of First Affiliated Hospital of China Medical University approved the protocol of the study. Demographic data were collected for all PD patients. The total amount of dopaminergic medication was expressed as the levodopa equivalent daily dosage , which was determined using methods previously reported in a systematic review of LEDD .

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