Fatigue in Parkinson's disease: A systematic review and meta‐analysis

Abstract

We conducted a systematic review and meta‐analysis aimed at establishing robust prevalence estimates and identifying clinical correlates of fatigue in PD. From 2,459 titles and abstracts, we selected 44 relevant studies (n = 7427 patients). Overall, the meta‐analysis showed a prevalence of fatigue of 50% in PD. This prevalence estimate, however, was significantly moderated by study heterogeneity in measurement scales and cut‐off thresholds. In contrast, demographic features, disease severity, cognitive impairment, and depression did not moderate prevalence estimates. Moreover, fatigue prevalence did not differ between de novo and treated PD patients. Compared to nonfatigued patients, fatigued patients had sligthly higher age (1.44 years), disease duration (0.93 years), l‐dopa equivalent daily dose (50.89 units), UPDRS‐III (4.99 points), and H & Y (0.33 points), as well as risk of comorbid depression (risk ratio = 1.89) and had a little lower MMSE score (–0.66 points). Fatigue was moderately associated with apathy (Hedges' g = 0.55), anxiety (Hedges' g = 0.67), daytime somnolence (Hedges' g = 0.43), sleep disturbances (Hedges' g = 0.66), and poorer quality of life (Hedges' g = 1.23). Our analyses suggest that fatigue is a frequent, independent nonmotor symptom in PD appearing early and persisting throughout the disease course, and that establishing uniform diagnostic criteria for PD‐related fatigue is critical. In addition, several nonmotor symptoms appear to be associated with fatigue and negatively impact quality of life. Pharmacological and nonpharmacological interventions targeting fatigue and associated symptoms may improve quality of life in patients with PD. © 2018 International Parkinson and Movement Disorder Society

Subjective memory decline in Parkinson's disease patients with and without fatigue

“…Fatigue, as assessed by validated clinical criteria, was identified in 25% of our sample, which is roughly half of that reported in a recent meta-analysis [2]. However, the primary studies collected to estimate the meta-analytic pooled fatigue prevalence used measurement scales (e.g., Parkinson Fatigue Scale [e-22], Fatigue Severity Scale [e-23]) rather than clinical diagnostic criteria as we did here.…”

“…Fatigue in Parkinson's Disease (PD) has been described as a significantly diminished energy level or an increased perception of effort that are disproportionate to attempted activities or to general activity level [1]. It occurs in around 50% of PD patients [2] and may even manifest in premotor stages of disease [3], leading to negative impact on activities of daily living [4] and quality of life [5]. Specific diagnostic criteria for defining PD-related fatigue have been recently proposed to facilitate coverage of fatigue-related disability claims and appropriate selection of participants for clinical trials [1].…”

Development of an instrument to assess oral hygiene ability in older adults: The oral hygiene ability instrument

“…This group of patients requires careful follow-up, however, as the disease may change rapidly. 37 In the group of essentially healthy older adults, some of whom had poor oral hygiene, we also found loneliness, poor social support, changed dietary habits and lost motivation to take care of their oral hygiene. This shows the importance of an instrument to capture problems associated with oral hygiene at an early stage.…”

“…All had problems with gripping and muscle fatigue, but all were well‐educated in the importance of oral hygiene and had found ways to cope by using an electric toothbrush with a large grip, sitting down during brushing, and brushing when their medication had reached full effect. This group of patients requires careful follow‐up, however, as the disease may change rapidly . In the group of essentially healthy older adults, some of whom had poor oral hygiene, we also found loneliness, poor social support, changed dietary habits and lost motivation to take care of their oral hygiene.…”

Distinct large-scale networks are associated with motor and nonmotor symptoms in Parkinson’s disease

“…Although fatigue, anxiety, depression, and apathy are separate nonmotor domains, there is considerable overlap between their symptomatology. Significant correlation exists between fatigue and anxiety, apathy, and depression (Skorvanek et al, 2015;Friedman et al, 2016;Siciliano et al, 2018). Apathy and depression share features such as anhedonia, blunted affect, and negative emotions (Pagonabarraga et al, 2015).…”