Fatigue in a cohort of geriatric patients with and without Parkinson's disease

Abstract

We evaluated the frequency of fatigue in geriatric patients with and without Parkinson's disease (PD) and correlated it with depression and excessive daytime sleepiness. We evaluated 100 patients from Hospital São Paulo, 50 with PD from the Neurologic Outpatient Clinic and 50 with non-neurologic diseases or oncologic diseases from the Geriatric Outpatient Clinic (controls). All patients who scored 28 or more on the Fatigue Severity Scale (FSS) were considered to have fatigue. Also, all patients were submitted to a structured interview to diagnose depression by the criteria of the American Psychiatric Association (DSM-IV, 4th version) and were evaluated by the Modified Impact of Fatigue Scale and the Epworth Sleepiness Scale (ESE) to detect excessive daytime sleepiness. Demographic and disease details of all PD patients were recorded and the patients were examined and rated by the Unified Parkinson's Disease Rating Sale (UPDRS) and Hoehn-Yahr staging. Frequency of fatigue (FSS ≥28) was 70% for PD and 22% for controls. Twenty of 35 PD patients with fatigue had concomitant depression. Compared to controls, PD patients were found more frequently to have depression by DSM-IV criteria (44 vs 8%, respectively) and excessive daytime sleepiness by the ESE (44 vs 16%), although only depression was associated with fatigue. Fatigue was more frequent among depressed PD and control patients and was not correlated with PD duration or with UPDRS motor scores. ESE scores did not differ between patients with or without fatigue.

A systematic review of the literature on disorders of sleep and wakefulness in Parkinson's disease from 2005 to 2015

“…Excessive daytime somnolence is common among patients with Parkinson’s disease, affecting 20-60% of patients[57,89,102,123,124,137,144,145,151,182,183,243,259,261,270,272,273,280-296]. Multiple factors influence the prevalence of EDS, including duration and severity of disease, age, gender, cognition, presence of nocturnal sleep disorders, and mood disorders.…”

“…Supportive controlled studies show subjective sleepiness in 33.5-54% of PD patients, compared to 16-19% controls[40,151,284,291,296]. Similarly, a large study demonstrated EDS in 43% of PD patients compared to 10% of controls, with sleepiness being more common in PD patients with higher age, higher dopamine agonist dose, more severe disease, autonomic dysfunction, and psychiatric symptoms[123].…”

“…--Greater prevalence of fatigue[147,148] (not confirmed in other studies [149-151]), anxiety[152], and impulsive behavior[153], and hyposmia[154]…”

Sleep and Sleep Disorders in Older Adults

“…In addition to sleep problems, people with PD often experience excessive sleepiness during the daytime. One study found EDS in 76% of Parkinson's patients (Goulart et al 2009). Sleep fragmentation in PD may be due to increased skeletal muscle activity, disturbed breathing, and REM-to-NREM variations of the dopaminergic receptor sensitivity (Stocchi et al 1998).…”

When Parkinson’s disease patients go to sleep: specific sleep disturbances related to Parkinson’s disease

“…Daytime sleepiness has also been reported to manifest in the form of sudden, sometimes unnoticed sleep attacks, presenting a serious safety hazard especially in vehicle or machine operation [64]. Present in 32-70% of patients, fatigue is, moreover, common in PD as in other chronic diseases but does not appear to be associated with EDS [24].…”