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Is Fatigue A Symptom Of Parkinson’s

What Are The Symptoms Of Parkinsons Disease

Fatigue in Parkinson’s

Symptoms of Parkinsons disease and the rate of decline vary widely from person to person. The most common symptoms include:

Other symptoms include:

  • Speech/vocal changes: Speech may be quick, become slurred or be soft in tone. You may hesitate before speaking. The pitch of your voice may become unchanged .
  • Handwriting changes: You handwriting may become smaller and more difficult to read.
  • Depression and anxiety.
  • Sleeping disturbances including disrupted sleep, acting out your dreams, and restless leg syndrome.
  • Pain, lack of interest , fatigue, change in weight, vision changes.
  • Low blood pressure.

Tackling Neuropathy Fatigue And Gi Issues In Pd

While its known as a movement disorder, people who live with Parkinsons disease experience many non-movement, or non-motor, symptoms too though not all of them are related to the disease. Peripheral neuropathy, or nervous system damage, fatigue and GI issues are common PD challenges that can also stem from other causes. Working with your doctor to identify the source of your symptoms is key to effective treatment.

This article is based on the Parkinsons Foundation Expert Briefing series Symptom Management: Is it PD, Medication or Aging? Exploring Non-motor Symptoms: Neuropathy, Fatigue, GI Issues presented by Ellen Walter, Nurse Practitioner, Cleveland Clinic, and Steven Swank, Clinical Pharmacist, University of Kansas Medical Center. Both organizations are Parkinsons Foundation Centers of Excellence.

Causes of neuropathy, fatigue and impaired gastrointestinal function during the course of PD can be wide-ranging and include everything from normal aging to medication side effects.

With any health challenge, its recommended to log symptoms. This can help your doctor rule out potential causes. When did symptoms start? Are there any patterns?

Stooping Or Hunching Over

Are you not standing up as straight as you used to? If you or your family or friends notice that you seem to be stooping, leaning or slouching when you stand, it could be a sign of Parkinson’s disease .

What is normal?If you have pain from an injury or if you are sick, it might cause you to stand crookedly. Also, a problem with your bones can make you hunch over.

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Assessing Fatigue In Parkinsons Disease

There is no single standard for assessing fatigue. As a subjective experience, like the symptom of pain, the person experiencing fatigue can best describe the impact it is having on their life. Fatigue is generally discussed during a physical exam and health history. Patients experiencing fatigue should talk to their doctor about their experience of fatigue, including what times of day symptoms are worse, how long fatigue symptoms last, and how fatigue is impacting their life. The physician can discuss treatments for depression or difficulties sleeping. In addition, the physician may ask for a sleep study to analyze problems with sleep.1

Subjects And Demographic Data

Parkinsons disease symptoms: Signs of the brain condition ...

This was an observational cross-sectional study. Two hundred and twenty-two PD patients, diagnosed according to the UK PD Brain Bank criteria , were recruited between December 2012 and April 2014 from the outpatient Department of Neurology of the First Affiliated Hospital of China Medical University . Patients with other forms of parkinsonism were excluded. Patients with dementia or fatigue related to a disease other than PD were excluded . All patients enrolled in the study gave written informed consent. The Ethics Review Board of First Affiliated Hospital of China Medical University approved the protocol of the study. Demographic data were collected for all PD patients. The total amount of dopaminergic medication was expressed as the levodopa equivalent daily dosage , which was determined using methods previously reported in a systematic review of LEDD .

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Potential Ways To Reduce Excessive Daytime Sleepiness

  • Assess the underlying cause
  • Improve nocturnal sleep through medications, cognitive behavioral therapy, diet, light therapy and more
  • Evaluate all medicines being takensome have hypersomnia as a side effectand adjust as needed
  • If taking dopaminergic medications, consider dose adjustment
  • Watch consumption of alcohol or sleep-inducing foods/ingredients
  • Experiment with caffeine

Symptoms Of Parkinsons Disease

Symptoms of Parkinsons Disease may include physical or motor symptoms and non-motor symptoms.

The early physical or motor symptoms of PD include:

  • stiffness
  • slow or reduced movement size e.g. slow walking, small writing or micrographia, masking of the face, soft voice
  • tremor at rest

Motor symptoms start on one side of the body.

The early non-motor symptoms are varied and may include:

  • loss of sense smell
  • sleep disturbance
  • constipation
  • problems with memory, planning, etc
  • bladder problems e.g. frequency, urgency, incontinence
  • pain

Having some of the signs listed above does not mean the person has PD as they are very common with ageing, however if they have 2 or more, then they should consider discussing them with their doctor.

As PD progresses and there are fewer dopamine producing cells in the brain, motor and non-motor changes become more pronounced. Worsening symptoms cause greater disturbance to the persons function making them increasingly dependent on others for their everyday activities. Motor symptoms by now affect both sides of the body.

The following are some of the more disruptive changes in mid to late PD.

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Clinical Measures Of Fatigue In Pd

A systematic critique of rating scales for diagnosis and severity of PD fatigue used pre-determined criteria for Recommended, Suggested, or Listed, depending on the quality of data. The FSS met the necessary criteria to be recommended for both diagnostic screening and severity measurement., The Multidimensional Fatigue Inventory was designated as recommended for rating fatigue severity, and may be more sensitive to change with interventions than the FSS. For diagnostic screening only, two other scales were recommended: Functional Assessment of Chronic Illness TherapyFatigue Scale and Parkinson Fatigue Scale . Since the MDS review article, the Modified Fatigue Impact Scale has been validated in a study involving 100 PD patients. This scale involves evaluation of cognitive as well as physical and social functioning.

Treatment For Fatigue In Parkinson’s Disease

Fatigue in Parkinson’s

At least one-third of people with Parkinson’s disease complain about fatigue. It is unclear what treatment is best to reduce fatigue in people with Parkinson’s disease.

We reviewed the medical literature up to April 2015, and found 11 studies that included a total of 1817 people. Nine studies investigated the effects of medication on fatigue. Two studies investigated the effects of exercise on fatigue. We found no studies that investigated the effect of cognitive-behavioural therapy.

We found that doxepin , a drug to treat depression, may reduce fatigue. We found that rasagiline , an anti-Parkinson drug, reduced or slowed down the progression of physical fatigue. Most drugs were safe however, levodopa-carbidopa may cause nausea.

We found no evidence that exercise reduces fatigue in Parkinson’s disease.

Based on the current evidence, it is not clear what treatment is most effective to treat fatigue in people with Parkinson’s disease. Future studies should investigate the effect of cognitive-behavioural therapy on fatigue in people with Parkinson’s disease.

Factors contributing to subjective fatigue in people with idiopathic Parkinsons disease are not well known. This makes it difficult to manage fatigue effectively in PD.

To evaluate the effects of pharmacological and non-pharmacological interventions, compared to an inactive control intervention, on subjective fatigue in people with PD.

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Managing Fatigue With Parkinsons

Do you or a loved one with Parkinsons disease feel physically or mentally exhausted? This could be fatigue a feeling of deep tiredness that has no apparent explanation, and does not improve with rest. About half of people with Parkinsons disease report that fatigue is a major problem, and a third say it is their single most disabling symptom.

Fatigue is common early in the course of PD, but it can occur at any point and can happen whether movement symptoms are mild or severe. It is sometimes confused with other symptoms that can make a person sleepy or tired, like sleep disturbances or pain. Fatigue also is a symptom of depression, but a person can be fatigued without being depressed. Stress can make fatigue worse.

No specific mechanism has been shown to cause fatigue in PD. It may be that motor symptoms like tremor and stiffness contribute to making muscles tired. But fatigue has other causes too. Its important to identify and treat illnesses or medications not related to PD that cause fatigue.

The extreme exhaustion that comes with fatigue can lead people to reduce their hours at work or retire, or avoid social activities. Understanding fatigue as a symptom of PD and finding ways to cope with it are essential to maintaining a good quality of life.

What Is The Outlook For Persons With Parkinsons Disease

Although there is no cure or absolute evidence of ways to prevent Parkinsons disease, scientists are working hard to learn more about the disease and find innovative ways to better manage it, prevent it from progressing and ultimately curing it.

Currently, you and your healthcare teams efforts are focused on medical management of your symptoms along with general health and lifestyle improvement recommendations . By identifying individual symptoms and adjusting the course of action based on changes in symptoms, most people with Parkinsons disease can live fulfilling lives.

The future is hopeful. Some of the research underway includes:

  • Using stem cells to produce new neurons, which would produce dopamine.
  • Producing a dopamine-producing enzyme that is delivered to a gene in the brain that controls movement.
  • Using a naturally occurring human protein glial cell-line derived neurotrophic factor, GDNF to protect dopamine-releasing nerve cells.

Many other investigations are underway too. Much has been learned, much progress has been made and additional discoveries are likely to come.

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Insights Into Fatigue From Other Disorders

Although perceived fatigue is probably similar among different illnesses, there may be disease-specific differences. Both similarities and differences may provide insights into fatigue pathophysiology. Similarities in fatigue would be compatible with a hypothesis of shared mechanisms, and thus the possibility of similar interventions. The high prevalence of fatigue in medical and psychiatric disorders points either to some very generalized mechanisms or a limitation in the brains ability to distinguish perceptions. We limited our review of other disorders with prominent fatigue, but excluded chronic fatigue syndrome because of its frequent association with psychiatric disorders such as personality disorders and post-traumatic stress disorder that might confound physiological interpretations.

How Can I Help Myself

WEBINAR: Get expert advice on managing Parkinsons pain ...

The general rule is to keep as mentally and physically active as possible. The following suggestions may be helpful:

Daily activities:

  • Plan your most vigorous activities around when your medication is most effective. You may find keeping a diary to track your symptoms and medication helps with timing when you are likely to be more mobile and energetic.
  • Learn how to pace yourself, taking regular short rests and periods in which to relax throughout the day.
  • If tasks are complicated or likely to take time, break them down into smaller stages so that you can rest between each stage. Share tasks if you live with someone and make use of labour saving devices such as a dishwasher or microwave.
  • Recognise your limitations, identify the priorities of the day and get to know your energy reserves.
  • Plan your major activities in advance and ensure that you have time for recovery afterwards. For instance, if you have a big social function such as a wedding, rest more in the days leading up to the event and also plan to have a few restful days afterwards.


  • if you work, talk with your employer to see if you can take regular short breaks, even if its only to make a drink or talk with colleagues

Diet and exercise:

Sleep and rest:

Content last reviewed: May 2018

General wellbeing:

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Depression Is An Independent Risk Factor For Dopaminergic Drug Non

Depression is another prominent non-motor symptom in PD . Fatigue in PD is often associated with depression, using a logistic regression model, we further demonstrated that depression was the only independent factor for the efficacy of dopaminergic medication in treating fatigue in PD patients, which might imply crosstalk between depression, fatigue and dopamine insufficiency.

What Is Parkinsons Disease

Parkinsons disease is a nervous system disease that affects your ability to control movement. The disease usually starts out slowly and worsens over time. If you have Parkinsons disease, you may shake, have muscle stiffness, and have trouble walking and maintaining your balance and coordination. As the disease worsens, you may have trouble talking, sleeping, have mental and memory problems, experience behavioral changes and have other symptoms.

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Is Parkinsons Disease Inherited

Scientists have discovered gene mutations that are associated with Parkinsons disease.

There is some belief that some cases of early-onset Parkinsons disease disease starting before age 50 may be inherited. Scientists identified a gene mutation in people with Parkinsons disease whose brains contain Lewy bodies, which are clumps of the protein alpha-synuclein. Scientists are trying to understand the function of this protein and its relationship to genetic mutations that are sometimes seen in Parkinsons disease and in people with a type of dementia called Lewy body dementia.

Several other gene mutations have been found to play a role in Parkinsons disease. Mutations in these genes cause abnormal cell functioning, which affects the nerve cells ability to release dopamine and causes nerve cell death. Researchers are still trying to discover what causes these genes to mutate in order to understand how gene mutations influence the development of Parkinsons disease.

Scientists think that about 10% to 15% of persons with Parkinsons disease may have a genetic mutation that predisposes them to development of the disease. There are also environmental factors involved that are not fully understood.

Other Rarer Types Of Hallucinations Include:

Fatigue in Parkinson Disease
  • Auditory: hearing voices or music that are not really there.
  • Olfactory: smelling things that are not really there.
  • Tactile: feeling something touching your skin that is not really there.
  • Illusion: seeing things differently than they actually are, such as wallpapers that seem to jump or move.

Hallucinations and delusions may sometimes be caused by issues separate from Parkinsons, such as stress, dehydration, bladder infection or general infection. They may also be exacerbated when certain symptoms of Parkinsons are worse, such as constipation.

Parkinsons-specific and other medications can cause hallucinations as a side effect and other cognitive symptoms such as dementia may also contribute to Parkinsons-related hallucinations or delusions.

Delusions are less common in people with Parkinsons than visual hallucinations but can be harder to manage and live with.

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Fatigue: The Silent Symptom Of Parkinsons Disease

A 2013 survey by the Parkinsons disease Foundation identified fatigue as the most pressing need for the Parkinsons research community.

While tremors, muscle stiffness, and irregular gait are the symptoms most associated with Parkinsons disease, 50% of PD patients experience severe fatigue and a third say it is their single most debilitating symptom. Fatigue is the most significant reason cited for medical disability insurance claims by PD patients in the United States. Despite this overwhelming evidence, neurologists tend not to recognize fatigue as a prominent concern of PD patients.

Two studies in newly diagnosed Parkinsons patients reported fatigue to be a clinically relevant problem even when motor symptoms were minimal. These studies identified fatigue as a pre-motor symptom, appearing well before motor symptoms become obvious. Parkinsons patients describe their fatigue as different than any tiredness they had experienced before their diagnosis. Unlike fatigue in the general public, PD fatigue often improves with exercise.

Causes of PD Fatigue

Depression, sleep disturbances, and medications may also contribute to or cause fatigue. However, Dr. Joseph Friedman, Professor and Chief of the Division of Movement Disorders at the Warren Alpert Medical School of Brown University, points out that while fatigue is an early symptom and may be associated with depression, most PD patients with fatigue are not depressed.

Treatment Approaches

Study Sample And Assessments

Phase 1 and Phase 2 Sample Recruitment: Fox Trial Finder was used to identify individuals for this phase of the study. As previously described , FTF is a database of research volunteers. Individuals enrolled in FTF were sent an email invitation to participate in a study of fatigue in PD. The screening questionnaire included a question on dopamine agonist use, the Parkinson Fatigue Scale , Epworth Sleepiness Scale , and the Geriatric Depression Scale-15 item . In an effort to study primary fatigue participants self-reporting use of a dopamine agonist or with ESS> 10 or GDS> 5 were excluded.

Phase 1 Activities: Online journaling occurred for 1 hour per day over 3 days with a pilot sample of 12 participants . The online journaling phase consisted of interactive activities including responding to pictures and graphics and completing free-text responses to prompts provided by the research moderator . Prompts are included in the Appendix. The data collected from phase 1 were informally analyzed by the study team to define dimensions of fatigue important to patients and to inform data collection in other phases.

Assessments in Phase 3, including those administered as part of Fox Insight study as well as additional questionnaires/surveys collected as part of the PDEC 2018 sub-study, that were considered in this analysis are as follows:

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Other Typical Symptoms Of Parkinson’s

Tremor is an uncontrollable movement that affects a part of the body. A Parkinsons tremor typically starts in the hand before spreading to affect the rest of the arm, or down to the foot on the same side of the body.

There is no cure for a tremor, but there are ways to manage the symptom with support from a specialist or Parkinsons nurse.

Slowness of movement also known as bradykinesia may mean that it takes someone with Parkinson’s longer to do things. For example, they might struggle with coordination, walking may become more like a shuffle or walking speed may slow down.

Everyday tasks, such as paying for items at a check-out or walking to a bus stop, might take longer to do.

Parkinsons causes stiff muscles, inflexibility and cramps. This can make certain tasks such as writing, doing up buttons or tying shoe laces, hard to do. Rigidity can stop muscles from stretching and relaxing. It can be particularly noticeable, for example, if you struggle to turn over or get in and out of bed.

Symptoms and the rate at which they develop will vary from person to person. The most important thing to do if youre worried you have Parkinsons is to speak to your GP.

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