Saturday, March 25, 2023

Does Parkinson’s Disease Cause Fatigue

What Causes Parkinson’s Disease

Fatigue and Sleepiness in 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 Parkinson’s. Scientists still do not know what causes cells that produce dopamine to die.

People with Parkinson’s 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 Parkinson’s, 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 Parkinson’s 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.

Wait There’s A Drug For That

There might be. Medications can help you fight fatigue include:

  • Modafinil was designed for to treat the sleep disorder narcolepsy, but it can also help people with many other medical conditions feel more energized and alert.
  • Amantadine is an antiviral also used for Parkinson’s that might help you reduce your fatigue. The dopamine agonists pergolide and cabergolide, and the MAO inhibitor selegiline may also help you.
  • ADHD meds like Ritalin are not just for kids they’re currently being researched in the context of Parkinson’s-related fatigue, so ask your doctor about them.

Codebook Development And Validation

Transcripts of the semi-structured interviews from Phase 2 were analyzed by researchers trained in qualitative research methods . Analysis was blinded to response on the PFS16 or any other part of the FTF screener. NVivo 12 Pro was used to develop a codebook of common themes. Themes were refined by repeated, iterative discussion between researchers until a single standardized codebook was developed. Researchers then categorized themes into three domains based on results of Phase 1: physical, cognitive, and emotional aspects of fatigue these domains were developed from review of the online journaling components of Phase 1. The Phase 2 codebook was validated by application to the Phase 3 open-ended question on fatigue. As mentioned above, individuals using a dopamine agonist or with significant sleepiness/depression were excluded from phase 2. In order to ensure transferability of the codes between the two cohorts, in turn, in Phase 3 individuals reporting SCOPA-SLEEP5, GDS> 5, or use of a dopamine agonist were excluded from this analysis. Responses were classified into one or more themes, which were then tabulated. We compared theme frequency by gender for both Phase 2 and Phase 3.

This study was performed in accordance with the Declaration of Helsinki. This study and the Fox Insight study are approved by the New England Institutional Review Board, and online consent is obtained from each participant at enrollment.

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Tips For A Better Sex Life With Parkinsons Disease

  • Communicate: Be open with your partner about your feelings and discuss your physical needs. If the topic of sex causes upset or arguments, it might be worth seeing a sex therapist.
  • Consider changing your medication: If your medication is having an impact on your sex life, talk to your doctor about an alternative treatment. Your sex life is important, so it should be given as much attention and care as your general health and wellbeing.
  • Be open with your doctor: Don’t be afraid to talk about sex with your doctor that’s what your healthcare team is there for, and they will have dealt with these types of concerns before.
  • Deal with fatigue and depression: Depression and fatigue can negatively impact your sex life, so look at ways of treating these symptoms. A combination of therapy and antidepressant medications may help, so talk to your doctor.

What Are The Primary Motor Symptoms Of Parkinsons Disease


There are four primary motor symptoms of Parkinsons disease: tremor, rigidity, bradykinesia and postural instability . Observing two or more of these symptoms is the main way that physicians diagnose Parkinsons.

It is important to know that not all of these symptoms must be present for a diagnosis of Parkinsons disease to be considered. In fact, younger people may only notice one or two of these motor symptoms, especially in the early stages of the disease. Not everyone with Parkinsons disease has a tremor, nor is a tremor proof of Parkinsons. If you suspect Parkinsons, see a neurologist or movement disorders specialist.




Postural Instability

Walking or Gait Difficulties


Vocal Symptoms

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Association Between Fatigue And Quality Of Life In Parkinsons Disease

To determine the relationship between the perception of fatigue and quality of life, a canonical correlation analysis was conducted using the fatigue scales as the criterion variables and quality of life measures as the predictor variables. The range of correlation within the fatigue scales was r=0.86 to 0.85 and r=0.74 to 0.82 among the quality of life variables. The highest correlated predictor variables was between the PDQ-39SI and NMSQ measures. Omission of either variable did not change the results these two variables were therefore retained. The multivariate analyses produced four discriminant functions, of which the first was significant, F=13.24, p=0.0005 based on Roys greatest-root test. The correlation between the two sets of variables was Rc=0.98, indicating a high degree of relationship between the predictor and criterion variables. The squared canonical correlation which represented the proportion of the variance in the canonical variate of the fatigue scales that can be explained by the canonical variate of the quality of life variables was 96%.

Table 1 Canonical loadings for the fatigue and quality of life in the Parkinson group

Michael J Fox Has Long Been The Face Of Parkinsons Disease Which Affects At Least 1 Million People In The United States And 5 Million Worldwide Making It The Leading Movement

Now 55, Fox was diagnosed with Parkinsons in his 20s, which is considered early onset, and has fought for a cure for many years. As Fox has continued acting since being diagnosed, viewers would notice physical symptoms however, one of the most debilitating symptoms is not noticeable in movements. Its fatigue.

Creighton researchers are collaborating with colleagues from other institutions to explore this unexplored aspect of the disease, through the wide lens of physical therapy, exercise science, pharmacy, neurology and biomechanics.

What theyve found has shed light on mobility issues experienced by people with Parkinsons disease, and has opened doors to future research and possible novel treatment options.

Parkinsons is a lot more than a tremor. Its a movement disorder thats degenerative and chronic. Parkinsons afflicts more people than multiple sclerosis, muscular dystrophy and Lou Gehrigs disease combined.

The hallmarks of the disease in terms of motor symptoms are slowness, rigidity and tremor however, other symptoms are often present as well, such as fatigue, dementia, depression and psychosis.

Although people think of Parkinsons as a disease of the central nervous system, it is also a disease of the autonomic nervous system, which controls bodily functions that are not consciously directed, such as the heart beating, digestive process and breathing.

Dopamine also affects motivation.

A major limitation is the disease progresses despite medication.

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How To Talk To Your Doctor

If you want to talk to your doctor about medications or any other concerns you have, we put together a great video with great strategies for making the most out of your time together. You can watch the video here, and be sure to check out all of the videos we have on our YouTube channel and subscribe so youre the first to know when we share something new.

Triggers And Alleviating Factors For Fatigue In Parkinsons Disease

Pain and Fatigue in Parkinson Disease – 2019 Parkinson Educational Symposium
  • Roles Conceptualization, Data curation, Formal analysis, Writing original draft, Writing review & editing

    Affiliation Department of Neurology, University of Pittsburgh, Pittsburgh, PA, United States of America

  • Roles Conceptualization, Data curation, Formal analysis, Writing review & editing

    Affiliation Department of Neurology, University of Pittsburgh, Pittsburgh, PA, United States of America

  • Roles Conceptualization, Writing review & editing

    Affiliation Department of Neurology, Duke University, Durham, NC, United States of America

  • Roles Conceptualization, Writing review & editing

    Affiliation Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States of America

  • Roles Conceptualization, Project administration, Writing review & editing

    Affiliation Columbia University School of Social Work, New York, NY, United States of America

  • Roles Conceptualization, Funding acquisition, Project administration, Writing review & editing

    Affiliation The Michael J. Fox Foundation for Parkinsons Research, New York, NY, United States of America

  • Roles Conceptualization, Writing review & editing

    Affiliation Department of Neurology, University of Toronto, Toronto, Ontario, Canada

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Treating Fatigue Associated With Parkinsons

There is still much work to be done in figuring out the specific causes of fatigue in PD in order to arrive at more effective treatment options. However, there are some things that you and your loved ones can try to help manage fatigue caused by Parkinsons.

One member offered this advice for those who feel overwhelmed by fatigue: It is really difficult for others to understand how often someone with Parkinsons gets tired My approach is one day at a time.

Talk To Your Doctor About Antidepressants

People with Parkinson’s disease suffer from depression at higher rates than the general population and feeling hopeless, helpless, angry, apathetic, and no longer enjoying the things you used to are some of the symptoms. Fatigue, too, is a very common symptom of depression. If you think you may be depressed, mention this to your doctor. Antidepressants, most commonly SSRIs or tricyclic antidepressants, may be the answer for you.

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Types Of Parkinson’s Pain

Most of the time, discomfort in muscles and joints is secondary to the motor features of Parkinsons lack of spontaneous movement, rigidity, and abnormalities of posture what is known as musculoskeletal pain. The most commonly painful sites are the back, legs, and shoulders and it is usually more predominant on the side more affected by parkinsonism.

But there are many other categories of pain associated with Parkinsons disease. Radicular or neuropathic pain is experienced as a sharp pain that can start in the neck or lower back with radiation to arm or leg respectively and is often associated with numbness or tingling, or a sensation of coolness in the affected limb. It is usually secondary to a pinched nerve due to something like a slipped disc.

Dystonia related pain occurs as its name suggests, at times of dystonia most often experienced in the foot, neck or face and arm at different points in the dosing schedule, particularly the off phase when there is not enough dopamine replacement but can uncommonly also occur at peak-dose times. It can be one of the most painful symptoms those with Parkinsons can face.

Akathisia pain is experienced as restlessness, a subjective inner urge to move, an inability to stay still and the inherent feelings of discomfort that it brings. It is primarily experienced in the lower limbs and can often be relieved by walking around.

Diagnosis Of Parkinsons Disease

How Do Tremor And Parkinsons Disease Differ

A number of disorders can cause symptoms similar to those of Parkinson’s disease. People with Parkinson’s-like symptoms that result from other causes are sometimes said to have parkinsonism. While these disorders initially may be misdiagnosed as Parkinson’s, certain medical tests, as well as response to drug treatment, may help to distinguish them from Parkinson’s. 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 Parkinson’s disease. Diagnosis is based on a person’s medical history and a neurological examination. Improvement after initiating medication is another important hallmark of Parkinson’s disease.

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Parkinsons Disease And Sex: What You Need To Know

There is no reason why you cannot continue to have a healthy sex life with Parkinson’s disease. However, studies suggest that around 70 to 80% of those with PD experience sexual dysfunction. These common sexual problems are believed to result from Parkinson’s medication side-effects and psychological issues.

Men and women experience different issues when it comes to Parkinsons disease and sex. In men, common problems include erectile dysfunction, lower sex drive, premature ejaculation and inability to orgasm. Women may experience pain during intercourse, as well as lack of sexual arousal, inability to orgasm and reduced lubrication.

In addition, the motor symptoms of Parkinson’s disease can create physical challenges during sex. Many people with PD experience slowed movement and rigidity that makes any movement difficult. Tremors and involuntary movement can also occur during sexual activity.

Evaluation Of Sleep Hygiene Program: Sleep Diary

Monitoring the effectiveness of behavior changes is best done by keeping a diary. The table below depicts a sample diary that could be kept by the bedside and filled out upon arising by the patient or caregiver. If daytime sleepiness and napping are problems, items can be added to record the number, time, and duration of napping episode. The diary can be carried with the patient.

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Pathophysiology Of Fatigue In Pd

Most of the evidence suggests that fatigue is an intrinsic symptom to the pathobiological substrate of PD rather than a secondary or reactive phenomenon. For instance, it may precede motor symptoms in a substantial number of patients with PD. In most patients, fatigue did not correlate with PD duration or motor disability,, although some studies indicated that it worsened with underlying disease progression., , However, the interpretation of fatigue in PD is significantly confounded by its clustering with depression, anxiety, sleep disturbances, and apathy. Although it was present in over a onehalf of nondepressed patients with PD and in at least onethird of drugnaive patients in the initial motor stage of the disease, fatigue in PD was related to the severity of depressive symptoms., Fatigue was 1 of the diagnostic criteria for a Diagnostic and Statistical Manual of Mental Disorders, 4th editionbased diagnosis of both major depressive episode and generalized anxiety disorder. However, it is still not clear whether the observed overlaps of fatigue with affective disorders and apathy reflect a diagnostic bias or common pathophysiological mechanisms. A concept of primary fatigue and secondary fatigue has been proposed. In general, it is distinguishable from other related symptoms, such as depression, apathy, and sleepiness, suggesting that fatigue in patients with PD is largely a primary symptom and is not secondary to mood disorders, sleep alterations, or medications.

Risk Factors Of Fatigue In Idiopathic Parkinsons Disease In A Polish Population

Fatigue in Parkinson’s

Monika Gob-Janowska

1Chair and Clinic of Neurology, Pomeranian Medical University, Unii Lubelskiej 1, 71-252 Szczecin, Poland

2Department of Biochemistry and Medical Chemistry, Pomeranian Medical University, Powstaców Wielkopolskich 72, 70-111 Szczecin, Poland

3Medicinkliniken, Länssjukhuset Ryhov, 551 85 Jönköping, Sweden


Introduction. Fatigue syndrome is one of the nonmotor symptoms in Parkinsons disease . The aim of the study was assessment of prevalence of fatigue syndrome in PD and answering the question what are the independent risk factors connected with intensity of fatigue in PD. Methods. 114 patients with idiopathic PD were enrolled. The fatigue was assessed according to the Fatigue Severity Scale . We analyzed associations between fatigue and sex, age, education, duration and severity of the disease, everyday activity, intensity of the main symptoms, treatment, presence of dyskinesias and fluctuations, depression and excessive sleep during the day, and presence of pain and nycturia. Results. The fatigue syndrome was detected in 57.9% of patients. The score in the FSS was 1 to 7 points, 4.3 average. Greater fatigue intensity correlated with higher total daily levodopa equivalent dose. Patients with moderate depression had significantly greater fatigue.. Fatigue syndrome affects 57.9% of patients with PD. Use of higher LED and presence of moderate depression are independent risk factors of greater intensity of fatigue.

1. Introduction

2. Methods


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Pragmatic Management Of Fatigue In Pd

Treatment approaches focused on fatigue in PD are faced with 2 main limitations: lack of clear insight into its pathophysiology and mechanisms, and probably its multifactorial nature . Therefore, as stated by Kluger and Friedman, contemporary treatment of fatigue in PD is limited to an empirical approach based on plausible hypotheses .

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I am a very active person, but deep fatigue must be addressed with rest. Taking a day to rest is not in my nature. It makes me feel like a sloth. Yet, when deep fatigue hits me, the best remedy is to do just that take the day off! I limit myself to one day of physical rest, very rarely two days . I also find that the mind must rest with the body. Getting the mind to a quiet place is the practice of meditation, in whatever form suits the moment. At the height of deep fatigue, meditation can be very difficult, but not impossible. At times, it has taken me four hours to quiet my mind and body to get rejuvenating rest.

But there is a caution here: Be wary of using rest as an excuse to procrastinate. In another column, Ill address the link of scenario looping to set-shifting issues and difficulty initiating new tasks. Basically, getting off the sofa can be problematic if I stay there too long. Perhaps this seems contradictory to my history as a highly active person, but that is the nature of PDs nonmotor effects. Once off the sofa, I make myself shift into a physical task, followed by a short rest and then some type of mental task. There is always some resistance to overcome to do this to get off the sofa but the rest is absolutely necessary to stop the deep fatigue.

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