Influence of Disease Severity on Fatigue in Patients with Parkinson's Disease Is Mainly Mediated by Symptoms of Depression

Abstract

Purpose: Fatigue is a frequent non-motor complaint of patients with Parkinson's disease (PD). Despite increasing knowledge on fatigue, the factors leading to its development are still not recognised. The aim of this investigation was to test, using structural equation modelling, the hypothesis that the influence of disease severity on fatigue is mediated by symptoms of depression in patients with PD. Method: The sample consisted of 190 PD patients (93 men, 48.9%, mean age 68.2 ± 9.3 years, mean disease duration 6.4 ± 4.7 years) recruited from hospitals and outpatient clinics in the East Slovakia region. The Multidimensional Fatigue Inventory, the Hospital Anxiety and Depression Scale and the Unified Parkinson's Disease Rating Scale were used. LISREL was used to analyse the data. Results: Disease severity was directly associated with symptoms of depression (β = 0.26) and directly affected fatigue in terms of increased levels of general fatigue (β = 0.35), physical fatigue (β = 0.22), reduced activity (β = 0.31) and mental fatigue (β = 0.29), but did not directly influence reduced motivation. Symptoms of depression mediated the impact of disease severity on general fatigue (β = 0.25), on reduced activity (β = 0.31) and on mental fatigue (β = 0.28), but not on physical fatigue. Reduced motivation was not mediated, but directly influenced by more symptoms of depression (β = 0.82). Discussion: Since increased symptoms of depression mediate the impact of disease severity on three domains of fatigue in PD patients, disease management should focus on the treatment of PD and symptoms of depression.

Paraquat and psychological stressor interactions as pertains to Parkinsonian co-morbidity

“…Not only does co-morbid depressive illness pose a major threat to quality of life among PD patients, there is evidence to suggest that depression can actually influence the severity and clinical management of PD motor symptoms – and perhaps even affect the progression of the underlying neurodegenerative process ( Backer, 2000 , Smith et al., 2002 , Metz et al., 2005 , Kibel and Drenjancević-Perić, 2008 , Pålhagen et al., 2008 , Smith et al., 2008 , Hemmerle et al., 2012 , van Dijk et al., 2013 ). The current findings are consistent with a growing number of reports suggesting that environmental toxicants, and pesticides in particular, may play a role in the development of not only motor impairment, but also non-motor symptoms that are often evident in PD ( McDowell and Chesselet, 2012 , Freire and Koifman, 2012 ).…”

Assessment of fatigue in Parkinson′s disease: Indian perspective

“…It is used to evaluate the effect of fatigue on routine activities as exercise, physical functioning, performance of duties, responsibilities, and interference with routine family and social life. [11]…”

Clinical evaluation of fatigue in Japanese patients with Parkinson's disease

“…Past studies have indicated that many factors, including depression, excessive daytime sleepiness, sleep disturbance, motor symptoms, PD duration, and female gender are related to fatigue in PD (Karlsen et al 1999;Alves et al 2004;Havlikova et al 2008;Okuma et al 2009;Beiske et al 2010;Valko et al 2010;Kummer et al 2011;Metta et al 2011;Van Dijk et al 2013). In our study, demographic features, such as gender, age, age of disease onset, and PD duration had little influence on fatigue.…”