Fatigue in Parkinson's disease: concepts and clinical approach

Nassif, Daniel; Pereira, Joäo Santos

doi:10.1111/psyg.12302

Cited by 33 publications

(27 citation statements)

References 81 publications

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“…Some studies found that the cerebellum played an important role in action control and motor learning, which may be involved in the model of central fatigue (36). In addition, a previous study reported that fatigue is associated with dopaminergic dysfunction within the basal ganglia in PD patients (9). Additionally, the neuroimaging study also demonstrated that SCA3 patients had dopaminergic dysfunction (6).…”

Section: Discussionmentioning

confidence: 98%

“…SCA3 has a wide range of clinical manifestations, and cerebellar ataxia is the core symptom, including progressive dysarthria, unstable walking and hand clumsiness (4). In addition, other symptoms, including extra-cerebellar signs and non-motor symptoms, are also reported in SCA3 patients, such as parkinsonism, pyramidal signs, oculomotor deficits, dystonia, cognitive impairment, fatigue, sleep disorders, and psychiatric changes (5–9). A majority of non-ataxia symptoms appear insidiously and are often underestimated in clinical practice.…”

Section: Introductionmentioning

confidence: 99%

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Extra-Cerebellar Signs and Non-motor Features in Chinese Patients With Spinocerebellar Ataxia Type 3

Yuan

Hou

et al. 2019

Front. Neurol.

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Objectives: Our study attempted to systematically explore the prevalence of extra-cerebellar signs and non-motor symptoms, such as anxiety, depression, fatigue, excessive daytime sleepiness (EDS) and sleep disturbances in a cohort of Chinese patients with spinocerebellar ataxia type 3 (SCA3), and further investigated the correlations between non-motor symptoms and clinical characteristics in SCA3 patients. Methods: This study included 68 molecular-proven SCA3 patients. Extra-cerebellar signs were evaluated with the Inventory of Non-Ataxia Symptoms (INAS). The INAS count indicated the number of non-ataxia signs in each patient. The severity of ataxia, fatigue, EDS, sleep quality, anxiety, and depression were assessed using the Scale for the assessment and rating of ataxia (SARA), Fatigue Severity Scale (FSS), Epworth Sleepiness Scale (ESS), Pittsburgh Sleep Quality Index (PSQI), Hamilton Anxiety Rating Scale (HAMA), and the Hamilton Depression Rating Scale (HAMD) (24 items), respectively. Results: Extra-cerebellar signs were detected in 91.2% of all SCA3 patients and the mean total INAS count was 2.72 ± 1.88. Rigidity was the most frequent extra-cerebellar sign (47.1%, N = 32). Sensory symptoms (2.9%, N = 2) and chorea (5.9%, N = 4) were rare, and myoclonus (0%) was not found in this cohort. High frequencies of sleep disturbances (64.7%), fatigue (52.9%), depression (48.5%), and anxiety (42.6%) were detected in SCA3 patients. The Spearman correlation indicated that the HAMD score was associated with the CAG repeat length and HAMA score, while the PSQI score was correlated with the SARA and FSS score. In addition, multivariate linear regression analysis showed that the CAG repeat length, age of onset, sleep disturbances and depression were significant predictors of fatigue in SCA3 patients. Conclusions: Our study indicates that the vast majority of SCA3 patients display extra-cerebellar signs. Except for EDS, anxiety, depression, fatigue and impaired sleep quality are present in SCA3 patients. The CAG repeat length, age of onset, sleep disturbances and depression are predictors of fatigue in SCA3 patients.

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Section: Discussionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

Extra-Cerebellar Signs and Non-motor Features in Chinese Patients With Spinocerebellar Ataxia Type 3

Yuan

Hou

et al. 2019

Front. Neurol.

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“…Until now, a treatment for fatigue in SCA3 patients has not yet been reported. However, standardized treatment for fatigue in PD patients does exist, inclusive of a balanced medication regime targeting movement disorder (e.g., dopaminergic agents) and depression (e.g., psychostimulants and antidepressants) combined with a rehabilitation program (e.g., cognitive behavior therapy and graded exercise) (5). Furthermore, research has demonstrated that pharmacological (modafinil) and non-pharmacological (respiratory exercise and repetitive transcranial magnetic stimulation) management may be possible treatment options for fatigue in ALS patients (43).…”

Section: Discussionmentioning

confidence: 99%

“…Fatigue, which is clinically defined as difficulty in the initiation of or sustainment of voluntary mental and physical activities (4), is a subjective experience and common in neurodegenerative disorders such as Parkinson's disease (PD) and amyotrophic lateral sclerosis (ALS) (5)(6)(7)(8)(9)(10)(11)(12). As a common symptom, fatigue was found to have great impact on the quality of life in PD (13)(14)(15)(16).…”

Section: Introductionmentioning

confidence: 99%

Ataxic Severity Is Positively Correlated With Fatigue in Spinocerebellar Ataxia Type 3 Patients

Yang

Chen

et al. 2020

Front. Neurol.

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Background: Spinocerebellar ataxia type 3 (SCA3) is an inherited form of ataxia that leads to progressive neurodegeneration. Fatigue is a common non-motor symptom in SCA3 and other neurodegenerative diseases, such as Parkinson's disease (PD) and amyotrophic lateral sclerosis (ALS). Although risk factors to fatigue in these diseases have been thoroughly studied, whether or not fatigue can affect clinical phenotypes has yet to be investigated. Methods: Ninety-one molecularly confirmed SCA3 patients and 85 age-and sex-matched controls were recruited for this study. The level of fatigue was measured using the 14-item Fatigue Scale (FS-14), and the risk factors to fatigue and how fatigue correlates with clinical phenotypes were studied using multivariable linear regression models. Results: We found that the severity was significantly higher in the SCA3 group than in the control group (9.30 ± 3.04% vs. 3.94 ± 2.66, P = 0.000). Daytime somnolence (β = 0.209, P = 0.002), severity of ataxia (β = 0.081, P = 0.006), and poor sleep quality (β = 0.187, P = 0.037) were found to have a positive relationship with fatigue. Although fatigue had no relationship with age at onset or ataxic progression, we found that it did have a positive relationship with the severity of ataxia (β = 7.009, P = 0.014). Conclusions: The high level of fatigue and the impact of fatigue on the clinical manifestation of SCA3 patients suggest that fatigue plays a large role in the pathogenesis of SCA3, thus demonstrating the need for intervention and treatment options in this patient cohort.

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“…Fatigue in Parkinson's disease (PD) has a lifetime prevalence of more than 50% [1], and is a significant contributor to decline in health-related quality of life (HR-QOL) [2]. Despite the breadth of this problem, fatigue in PD remains poorly understood, and there are few effective therapies [3]. The etiology of fatigue in PD is likely multifactorial, including underlying neurodegeneration, other non-motor problems that may manifest as, or be comorbid with, fatigue (sleep problems, depression, apathy), and the effects of PD medications [3]; many patients also experience idiopathic fatigue or fatigue of unknown cause.…”

Section: Introductionmentioning

confidence: 99%

Understanding the Lexicon of Fatigue in Parkinson’s Disease

Mantri

Klawson

Albert

et al. 2020

JPD

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Background: Fatigue in Parkinson's disease (PD) is multifaceted and associated with reduced quality of life. In turn, the language used by people with PD to describe fatigue is variable and poorly understood. We sought to elucidate the lexicon of fatigue using a qualitative grounded theory approach. Objective: The objective of this study was to understand how patients with PD describe fatigue. Methods: A pre-study phase of online journaling (Phase 1) provided information regarding topics of importance to patients. Following this, two independent samples of fatigued subjects were studied. Individuals with PD participated in a telephone interview (Phase 2); interview transcripts were analyzed to develop a detailed codebook. To ensure trustworthiness of the findings, an online survey (Phase 3) was administered to individuals with self-reported PD participating in the online study Fox Insight. The survey included the following question: "How do you define fatigue? Please provide your definition in the space below." The codebook developed from Phase 2 was applied to the Phase 3 responses. Results: Fifteen individuals participated in Phase 2 and 413 individuals completed Phase 3. Fatigue was subdivided into three domains: cognitive, emotional, and physical. Nearly all individuals experienced more than one domain of fatigue. The most common themes included tiredness, lack of energy, and negative motivation. Conclusion: Fatigue in PD is multidimensional. Questionnaires that only assess the physical impact of fatigue may not be adequate to capture the broad range of experiences of fatigue among people with PD.

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Fatigue in Parkinson's disease: concepts and clinical approach

Cited by 33 publications

References 81 publications

Extra-Cerebellar Signs and Non-motor Features in Chinese Patients With Spinocerebellar Ataxia Type 3

Extra-Cerebellar Signs and Non-motor Features in Chinese Patients With Spinocerebellar Ataxia Type 3

Ataxic Severity Is Positively Correlated With Fatigue in Spinocerebellar Ataxia Type 3 Patients

Understanding the Lexicon of Fatigue in Parkinson’s Disease

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