Interventions for fatigue in Parkinson's disease

Elbers, Roy G.; Verhoef, John; Wegen, Erwin E. H. van; Berendse, Henk W.; Kwakkel, Gert

doi:10.1002/14651858.cd010925

Cited by 13 publications

(35 citation statements)

References 18 publications

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“…54 Mendonca et al investigated the effect of methylphenidate on fatigue scores in 34 patients with PD. 52,55 While methylphenidate significantly lowered both FSS and MFI scores after 6 weeks of treatment, 55 there were no statistically significant differences between the methylphenidate and placebo groups after 6 weeks of treatment. 52 There is also concern for abuse in PD patients with methylphenidate, especially those with impulse control problems and those on dopamine agonists already.…”

Section: Stimulants/wake-promoting Agentsmentioning

confidence: 89%

“…52,55 While methylphenidate significantly lowered both FSS and MFI scores after 6 weeks of treatment, 55 there were no statistically significant differences between the methylphenidate and placebo groups after 6 weeks of treatment. 52 There is also concern for abuse in PD patients with methylphenidate, especially those with impulse control problems and those on dopamine agonists already. 55 Three studies included in the Cochrane review looked at modafinil, a wake-promoting agent thought to act through the dopamine and noradrenergic systems, possibly through orexin/ hypocretin pathways.…”

Section: Stimulants/wake-promoting Agentsmentioning

confidence: 89%

“…Postuma et al studied the effect of caffeine at 100 mg twice a day for 3 weeks and then at 200 mg twice a day for 3 weeks. 52,54 At the end of the study, there was no difference between caffeine and placebo groups in terms of fatigue, sleepiness, or depression. Caffeine did not cause increased side effects compared to placebo, but it resulted in a clinically significant improvement in Unified PD Rating Scale scores.…”

Section: Stimulants/wake-promoting Agentsmentioning

confidence: 93%

“…55 Three studies included in the Cochrane review looked at modafinil, a wake-promoting agent thought to act through the dopamine and noradrenergic systems, possibly through orexin/ hypocretin pathways. 33,56 When pooled together, there was no statistically significant difference found between modafinil and placebo on fatigue impact, 52 though there was more of an effect in depressed patients (and it slightly improved their depression). Pooled data did show a clinically significant decrease in Epworth Sleepiness Scale (ESS) scores, although objective sleepiness measures (sleep latency and maintenance of wakefulness) were unchanged.…”

Section: Stimulants/wake-promoting Agentsmentioning

confidence: 94%

“…52 Unfortunately, the number of randomized, controlled, clinical trials on PD-related fatigue reported in the literature is limited, especially those with fatigue as a primary outcome measure. Typically, fatigue is reported as a secondary outcome.…”

Section: How Is Fatigue Managed In Pd?mentioning

confidence: 99%

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Managing fatigue in patients with Parkinson's disease: a patient-focused perspective

Ridder¹,

Chou²

2016

JPRLS

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Section: Stimulants/wake-promoting Agentsmentioning

confidence: 89%

Section: Stimulants/wake-promoting Agentsmentioning

confidence: 89%

Section: Stimulants/wake-promoting Agentsmentioning

confidence: 93%

Section: Stimulants/wake-promoting Agentsmentioning

confidence: 94%

Section: How Is Fatigue Managed In Pd?mentioning

confidence: 99%

See 3 more Smart Citations

Managing fatigue in patients with Parkinson's disease: a patient-focused perspective

Ridder¹,

Chou²

2016

JPRLS

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Diagnosis and Treatment of Parkinson Disease

Armstrong

Okun

2020

JAMA

1,926

1,357

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ImportanceParkinson disease is the most common form of parkinsonism, a group of neurological disorders with Parkinson disease–like movement problems such as rigidity, slowness, and tremor. More than 6 million individuals worldwide have Parkinson disease.ObservationsDiagnosis of Parkinson disease is based on history and examination. History can include prodromal features (eg, rapid eye movement sleep behavior disorder, hyposmia, constipation), characteristic movement difficulty (eg, tremor, stiffness, slowness), and psychological or cognitive problems (eg, cognitive decline, depression, anxiety). Examination typically demonstrates bradykinesia with tremor, rigidity, or both. Dopamine transporter single-photon emission computed tomography can improve the accuracy of diagnosis when the presence of parkinsonism is uncertain. Parkinson disease has multiple disease variants with different prognoses. Individuals with a diffuse malignant subtype (9%-16% of individuals with Parkinson disease) have prominent early motor and nonmotor symptoms, poor response to medication, and faster disease progression. Individuals with mild motor-predominant Parkinson disease (49%-53% of individuals with Parkinson disease) have mild symptoms, a good response to dopaminergic medications (eg, carbidopa-levodopa, dopamine agonists), and slower disease progression. Other individuals have an intermediate subtype. For all patients with Parkinson disease, treatment is symptomatic, focused on improvement in motor (eg, tremor, rigidity, bradykinesia) and nonmotor (eg, constipation, cognition, mood, sleep) signs and symptoms. No disease-modifying pharmacologic treatments are available. Dopamine-based therapies typically help initial motor symptoms. Nonmotor symptoms require nondopaminergic approaches (eg, selective serotonin reuptake inhibitors for psychiatric symptoms, cholinesterase inhibitors for cognition). Rehabilitative therapy and exercise complement pharmacologic treatments. Individuals experiencing complications, such as worsening symptoms and functional impairment when a medication dose wears off (“off periods”), medication-resistant tremor, and dyskinesias, benefit from advanced treatments such as therapy with levodopa-carbidopa enteral suspension or deep brain stimulation. Palliative care is part of Parkinson disease management.Conclusions and RelevanceParkinson disease is a heterogeneous disease with rapidly and slowly progressive forms. Treatment involves pharmacologic approaches (typically with levodopa preparations prescribed with or without other medications) and nonpharmacologic approaches (such as exercise and physical, occupational, and speech therapies). Approaches such as deep brain stimulation and treatment with levodopa-carbidopa enteral suspension can help individuals with medication-resistant tremor, worsening symptoms when the medication wears off, and dyskinesias.

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Interventions for fatigue in Parkinson's disease

Elbers

Verhoef

Wegen

et al. 2015

Cochrane Database of Systematic Reviews

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Based on the current evidence, no clear recommendations for the treatment of subjective fatigue in PD can be provided. Doxepin may reduce the impact of fatigue on ADL and fatigue severity; however, this finding has to be confirmed in high quality studies. Rasagiline may be effective in reducing levels of physical fatigue in PD. No evidence was found for the effectiveness of levodopa-carbidopa, memantine, caffeine, methylphenidate, modafinil or exercise. Studies are needed to investigate the effect of exercise intensity on exercise capacity and subjective fatigue. Future studies should focus on interventions that address the maladaptive behavioural or cognitive aspects of fatigue in people with PD. Characteristics, such as severity and nature of perceived fatigue and underlying mood disorders should be considered to identify responders and non-responders when studying interventions for fatigue. The development of a core-set of self-report fatigue questionnaires with established responsiveness and known minimal important difference values will facilitate the interpretation of change in fatigue scores.

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Interventions for fatigue in Parkinson's disease

Cited by 13 publications

References 18 publications

Managing fatigue in patients with Parkinson's disease: a patient-focused perspective

Managing fatigue in patients with Parkinson's disease: a patient-focused perspective

Diagnosis and Treatment of Parkinson Disease

Interventions for fatigue in Parkinson's disease

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Interventions for fatigue in Parkinson's disease

Cited by 13 publications

References 18 publications

Managing fatigue in patients with Parkinson&#39;s disease: a patient-focused perspective

Managing fatigue in patients with Parkinson&#39;s disease: a patient-focused perspective

Diagnosis and Treatment of Parkinson Disease

Interventions for fatigue in Parkinson's disease

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Managing fatigue in patients with Parkinson's disease: a patient-focused perspective

Managing fatigue in patients with Parkinson's disease: a patient-focused perspective