Clinical determinants of primary and secondary fatigue in patients with Parkinson’s disease

Abstract

Clinical and psychosocial factors associated separately with primary and secondary fatigue in Parkinson's disease (PD) patients have not been thoroughly studied before. The aim of our study was to assess factors associated with different fatigue domains in groups with primary and secondary fatigue in PD separately. We divided 165 nondemented PD patients according to the absence/presence of depression, anxiety and excessive somnolence into groups with primary fatigue (N = 63) and with secondary fatigue (N = 102). Fatigue domains examined using the multidimensional fatigue inventory were associated through multiple linear regression analyses for each group separately with sociodemographic data, disease duration, functional status as assessed by the Unified Parkinson's Disease Rating Scale, treatment, depression, anxiety, excessive somnolence and sleep quality. Out of the assessed non-motor symptoms, fatigue was the most frequent (77.6 %). The prevalence of fatigue in the secondary fatigue group was significantly higher than in the primary fatigue group. Both fatigue groups differed significantly in factors associated with different fatigue domains. Functional status or other disease-related factors were not associated with primary fatigue. In the secondary fatigue group, we found associations between some fatigue domains and functional status, older age, male gender and higher anxiety scores. To our knowledge, this is the first study to separately describe clinical determinants and psychosocial factors associated with different fatigue domains in primary and secondary fatigue in PD, underlining the importance of distinguishing primary and secondary fatigue in future PD studies and clinical practice.

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

“…However, fatigue in PD is generally considered to be a non-dopaminergic symptom. In fact, most studies have thus far not found any significant association between dopaminergic treatment or daily L -dopa equivalent dose and fatigue [24,28,53]. Similarly, we did not find an association between fatigue and dopaminergic medication in our study (results not shown).…”

“…Our results show that more symptoms of depression are associated with reduced motivation, and that symptoms of depression mediate the impact of worse functional status on mental fatigue, reduced activity and general fatigue. As was found in the study of Skorvanek et al [28], PD patients with depression had both higher UPDRS-III scores and fatigue scores in all fatigue domains compared with primary fatigue; however, once depressed patients were selected, depression did not play a further role in determining fatigue in this group of patients. Their findings are in accordance with some other studies, which have found worse motor and fatigue symptoms in depressed patients [59].…”

“…In a previous study, we found disease severity associated with worse fatigue in all fatigue domains as measured with the MFI [54]. In a recent study, Skorvanek et al [28] found that none of the fatigue domains in primary fatigue (i.e. fatigue in the absence of a mood disorder or EDS) as measured by the MFI was associated with a worse UPDRS-III score.…”

“…A recent paper by Skorvanek et al [28] addressed the issue of primary fatigue, i.e. fatigue in the absence of depression, anxiety and excessive daily somnolence (EDS), and secondary fatigue, i.e.…”

Comorbid states in Parkinson’s disease: an effect of MAO-B inhibitors

“…Если раньше этот симптом считался особен-ностью развернутых стадий заболевания, то сейчас пока-зано, что утомляемость может появляться уже на ранних стадиях БП примерно у 1 / 3 пациентов [70]. В зависимости от методологии исследования частота утомляемости коле-блется от 28 до 77,6% [68,[71][72][73][74][75].…”