May 2010
Hagell P, Brundin L
Objectives: To gain an improved understanding of fatigue in Parkinson disease (PD) by exploring possible predictors among a wide range
of motor and non-motor aspects of PD.
Methods: 118
consecutive PD patients (54% men; mean age 64 years) were assessed
regarding fatigue, demographics and a range of non-motor
and motor symptoms. Variables
significantly associated with fatigue scores in bivariate analyses were
used in multiple regression
analyses with fatigue as the dependent
variable.
Results:
Fatigue was associated with increasing Hoehn & Yahr stages,
specifically the transition from stages I–II to stages III–V. Regression
analysis identified five significant independent variables explaining
48% of the variance in fatigue scores: anxiety, depression, lack of
motivation, Unified PD Rating Scale (UPDRS) motor score and pain.
Gender, age, body mass index, PD duration, motor fluctuations,
dyskinesias, symptomatic orthostatism, thought disorder, cognition, drug
treatment, sleep quality and daytime sleepiness were not significantly
associated with fatigue scores. When considering individual motor
symptom clusters instead of the UPDRS motor score, only
axial/postural/gait impairment was associated with fatigue.
Conclusions:
This study found fatigue to be primarily associated with symptoms of
depression and anxiety, and with compromised motivation,
parkinsonism (particularly
axial/postural/gait impairment) and pain. These results are in agreement
with findings in other
disorders and imply that fatigue should
be considered a separate PD entity differing from, for example,
excessive daytime
sleepiness. Fatigue may have a
distinguished neurobiological background, possibly related to
neuroinflammatory mechanisms.
This implies that novel treatment
options, including anti-inflammatory therapies, could be effective.
