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.
What Causes Parkinsons Disease
Parkinsons disease occurs when nerve cells in the basal ganglia, an area of the brain that controls movement, become impaired and/or die. Normally, these nerve cells, or neurons, produce an important brain chemical known as dopamine. When the neurons die or become impaired, they produce less dopamine, which causes the movement problems of Parkinsons. Scientists still do not know what causes cells that produce dopamine to die.
People with Parkinsons also lose the nerve endings that produce norepinephrine, the main chemical messenger of the sympathetic nervous system, which controls many functions of the body, such as heart rate and blood pressure. The loss of norepinephrine might help explain some of the non-movement features of Parkinsons, such as fatigue, irregular blood pressure, decreased movement of food through the digestive tract, and sudden drop in blood pressure when a person stands up from a sitting or lying-down position.
Many brain cells of people with Parkinsons contain Lewy bodies, unusual clumps of the protein alpha-synuclein. Scientists are trying to better understand the normal and abnormal functions of alpha-synuclein and its relationship to genetic mutations that impact Parkinsons disease and Lewy body dementia.
Fatigue Sleep Difficulties And Restless Legs
Although Parkinsons 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 Parkinsons.
Some of the more common non-movement symptoms of Parkinsons are:
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Treatment For Fatigue In Parkinsons Disease
At least one-third of people with Parkinsons disease complain about fatigue. It is unclear what treatment is best to reduce fatigue in people with Parkinsons 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 Parkinsons disease.
Based on the current evidence, it is not clear what treatment is most effective to treat fatigue in people with Parkinsons disease. Future studies should investigate the effect of cognitive-behavioural therapy on fatigue in people with Parkinsons disease.
Factors contributing to subjective fatigue in people with idiopathic Parkinsons 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.
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How Does Fatigue Manifest Itself In People Living With Parkinson’s Disease
Fatigue manifests itself differently depending on the individual:
- Constant feeling of being overwhelmed and lacking energy that does not go away after a good nights sleep.
- It is different from drowsiness which is associated with lack of sleep, and apathy, which is a state of emotional indifference.
- Fatigue usually develops early in the disease, and may even appear before the first motor symptoms.
- Fluctuating from day to day, even hour to hour.
- Physical or mental.
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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.
Diagnosis Of Parkinsons Disease
A number of disorders can cause symptoms similar to those of Parkinsons disease. People with Parkinsons-like symptoms that result from other causes are sometimes said to have parkinsonism. While these disorders initially may be misdiagnosed as Parkinsons, certain medical tests, as well as response to drug treatment, may help to distinguish them from Parkinsons. Since many other diseases have similar features but require different treatments, it is important to make an exact diagnosis as soon as possible.
There are currently no blood or laboratory tests to diagnose nongenetic cases of Parkinsons disease. Diagnosis is based on a persons medical history and a neurological examination. Improvement after initiating medication is another important hallmark of Parkinsons disease.
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How Do I Take Care Of Myself
If you have Parkinsons disease, the best thing you can do is follow the guidance of your healthcare provider on how to take care of yourself.
- Take your medication as prescribed. Taking your medications can make a huge difference in the symptoms of Parkinson’s disease. You should take your medications as prescribed and talk to your provider if you notice side effects or start to feel like your medications aren’t as effective.
- See your provider as recommended. Your healthcare provider will set up a schedule for you to see them. These visits are especially important to help with managing your conditions and finding the right medications and dosages.
- Dont ignore or avoid symptoms. Parkinsons disease can cause a wide range of symptoms, many of which are treatable by treating the condition or the symptoms themselves. Treatment can make a major difference in keeping symptoms from having worse effects.
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 ownthe 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 Parkinsons 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 Parkinsons 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:
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Procedures And Data Collection
Patients were assessed during the on phase using the Unified PD Rating Scale , the Hoehn & Yahr staging of PD and the Mini-Mental State Exam . HY stages were also estimated for the off phase from patient-reported history and medical records. The inter-rater concordance among study assessors for UPDRS and HY ratings was 0.85. UPDRS part III was used as an overall measure of parkinsonism. In addition, the following symptomatic profile scores were calculated: axial/postural/gait impairments , rest tremor , postural tremor , rigidity and limb bradykinesia .
The Functional Assessment of Chronic Illness TherapyFatigue scale was used to measure fatigue. To ease interpretation relative to other variables, FACIT-F scores were reversed in this study . Sleep quality was assessed with the Pittsburgh Sleep Quality Index, daytime sleepiness by the Epworth Sleepiness Scale, depression and anxiety with the Hospital Depression and Anxiety Scale, and pain by the Pain scale of the Nottingham Health Profile . All patient-reported scales were completed during the on phase, and their reliabilities were 0.71.
Patients classified as fatigued according to the Energy scale of the NHP were asked whether their fatigue typically was worse when on or off, if their motor symptoms were worse when they experienced fatigue, and whether they had experienced fatigue prior to the onset of motor PD symptoms.
Working With Your Healthcare Provider To Manage Fatigue
If you are experiencing fatigue, ask yourself the following questions. Record the answers in a notebook or on your smartphone, and bring this information to your next doctors appointment.
When do I feel fatigued? How long do my feelings of fatigue last each day? Does my fatigue change with my PD symptoms? Does my fatigue change with the time that I take my medications? On a scale of one to ten, how fatigued am I in the morning, around noon, and in the afternoon?
The answers to these questions can help you and your doctor work together to identify possible causes of the fatigue you are experiencing. To understand and address it, and to rule out non-Parkinsons causes, your healthcare provider will take a complete health history and do a physical exam. Sometimes problems not associated with PD, such as anemia, can explain the fatigue. If necessary, Parkinsons medications can be adjusted.
The Parkinsons Foundation is committed to better understanding how to help people with PD overcome Fatigue. In 2017, we provided funding to two researchers studying fatigue.
Hengyi Rao, Ph.D. at University of Pennsylvania is studying Multi-modal Neuroimaging of Fatigue in Parkinsons Disease.
Milton Biagioni, M.D. at New York University is studying Remotely Supervised Transcranial Direct Current Stimulation for At-home Treatment of Fatigue and Cognitive Slowing in Parkinsons Disease.
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Stages Of Parkinsons Disease
Because Parkinsons disease develops over time, there are various stages that help identify how symptoms have progressed and what should be expected next.
Generally, doctors follow a set of five stages as outlined below:
The beginning stage of Parkinsons disease sometimes doesnt show any signs at all. If symptoms are noticeable, theyre usually tremors and affect one side of the body. The symptoms usually dont affect your daily routine, but they should be taken seriously and brought to the attention of your doctor, if they havent already.
During this stage, the disease starts to affect your whole body. The tremors and stiffness cause routine activities to take a little longer to complete, and your overall movement starts to be affected. Your posture and facial expressions may should start to change, which can impact your ability to walk at a normal pace or communicate like you used to.
This stage features a worsening of all the symptoms that started to progressively deteriorate in stage 2, but you also start to experience a loss of balance and coordination, as well as how quick your reflexes are. As these symptoms start to come into the fold, people with the disease start to fall more, which can cause their own injuries and debilitations. Activities like getting out of bed, eating, and getting dressed start to get more difficult.
Managing Fatigue And Parkinsons Disease
If you are living with Parkinsons disease , you might often feel run down, out of energy, or even a bone-deep kind of tired that isnt relieved with rest. Those feelings of intense tiredness are known as fatigue a symptom that affects at least 50 percent of those with Parkinsons.
Many MyParkinsonsTeam members experience fatigue. I didnt know it was caused by PD. I just thought I was getting lazy, said one self-proclaimed chronic napper.
Im getting a better understanding of fatigue reading other PD patients stories and knowing Iâm more normal than I thought, wrote another member, relieved.
How Does This Condition Affect My Body
Parkinsons disease causes a specific area of your brain, the basal ganglia, to deteriorate. As this area deteriorates, you lose the abilities those areas once controlled. Researchers have uncovered that Parkinsons disease causes a major shift in your brain chemistry.
Under normal circumstances, your brain uses chemicals known as neurotransmitters to control how your brain cells communicate with each other. When you have Parkinsons disease, you dont have enough dopamine, one of the most important neurotransmitters.
When your brain sends activation signals that tell your muscles to move, it fine-tunes your movements using cells that require dopamine. Thats why lack of dopamine causes the slowed movements and tremors symptoms of Parkinson’s disease.
As Parkinson’s disease progresses, the symptoms expand and intensify. Later stages of the disease often affect how your brain functions, causing dementia-like symptoms and depression.
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
Journal: Journal of Parkinson’s Disease, vol. 10, no. 3, pp. 1185-1193, 2020
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Who Does It Affect
The risk of developing Parkinsons disease naturally increases with age, and the average age at which it starts is 60 years old. Its slightly more common in men or people designated male at birth than in women or people designated female at birth .
While Parkinsons disease is usually age-related, it can happen in adults as young as 20 .
Imaging Of Fatigue In Pd
Motor symptoms in PD result from nigrostriatal dopaminergic denervation, but dopaminergic dysfunction does not appear to be related to fatigue in PD. In the ELLDOPA cohort, 49 levodopa-naive PD patients with fatigue had similar âCIT striatal dopamine transporter uptake as 82 PD patients without fatigue. Another study showed no difference in 18F-dopa uptake between 10 fatigued PD subjects and 10 nonfatigued PD subjects.,
Serotonin transporter uptake has been reported to be reduced in chronic fatigue syndrome,, suggesting that nondopaminergic pathways may be involved in PD fatigue. Pavese et al. compared serotonergic transporter uptake ligand 11C-DASB) in seven PD subjects with fatigue and eight PD subjects without fatigue. Serotonin transporter binding in the caudate, putamen, ventral striatum, insula, and thalamus was decreased in the fatigued patients. The relationship of the cholinergic system to PD fatigue has not been investigated. The autonomic nervous system may also be involved in PD fatigue. One study found that pressor responses in norepinephrine and dobutamine infusion tests were greater and MIBG cardiac uptake was decreased in PD subjects with fatigue compared with those without fatigue.,
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How Is It Treated And Is There A Cure
For now, Parkinsons disease is not curable, but there are multiple ways to manage its symptoms. The treatments can also vary from person to person, depending on their specific symptoms and how well certain treatments work. Medications are the primary way to treat this condition.
A secondary treatment option is a surgery to implant a device that will deliver a mild electrical current to part of your brain . There are also some experimental options, such as stem cell-based treatments, but their availability often varies, and many aren’t an option for people with Parkinsons disease.
Tip: Maximize Energy And Endurance
Try to identify and reduce the major sources of stress and fatigue in your daily routine.
- Exercise regularly to build endurance and stamina.
- Keep mentally active. Boredom often leads to fatigue.
- Schedule adequate time for rest and sleep in your daily routine.
- Plan the highest level of activity and the most difficult daily tasks at times you are well rested and medications are working well.
- Take frequent breaks.
- Know your limits. Forcing too many activities into one time period will cause fatigue.
- Get help when needed. Delegate or hire help for tasks you find particularly stressful or tiring.
- Involve Your Team. Consult with an occupational therapist for an assessment and individual recommendations for energy conservation and enhancement.
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