Managing fatigue in patients with Parkinson's disease: a patient-focused perspective

Figures & data

Table 1 Criteria for diagnosis of Parkinson’s disease–related fatigue

Symptoms Symptoms may be induced by routine activities of daily living. Symptoms may occur with little or no exertion. Symptoms limit the type, intensity, or duration of activities performed by the patient. Symptoms are not reliably relieved by rest or may require prolonged periods of rest. Symptoms may be brought on by cognitive tasks or situations requiring sustained attention including social interactions. Patients avoid rigorous activities due to fear of experiencing worsening of symptoms. Mild to moderate exertion may induce a worsening of symptoms lasting from hours to days. Symptoms have a predictable diurnal pattern regardless of activities performed (eg, worsening in the afternoon). Symptoms are unpredictable and may have a sudden onset. The patient experiences clinically significant distress or impairment in social, occupational, or other important areas of function as a result of fatigue. There is evidence from the history and physical examination suggesting fatigue is a consequence of PD. The symptoms are not primarily a consequence of comorbid psychiatric disorders (eg, depression), sleep disorders (eg, obstructive sleep apnea), or medical conditions (eg, anemia and congestive heart failure).

Notes: Patients must report significantly diminished energy levels or increased perceptions of effort which are disproportionate to attempted activities or general activity level. Symptoms must be present for most of the day, every day, or nearly every day during the previous month. In addition, patients must have four or more of the symptoms from Section A as well as meet criteria in Sections B, C, and D. Reproduced from Kluger BM, Herlofson K, Chou KL, et al. Parkinson’s disease-related fatigue: a case definition and recommendations for clinical research. Mov Disord. 2016;31(5):625–631.³⁹ With permission from John Wiley and Sons, © 2016.

Abbreviation: PD, Parkinson’s disease.

Table 2 Randomized controlled trials investigating treatments for fatigue in PD

Study	Intervention	n	Mean age (SD)	Male (%)	Years since diagnosis (SD)	Hoehn & Yahr (SD)	Fatigue is primary outcome	Fatigue scale	Effect on fatigue
Lou et al^Citation74	Modafinil	19	66.8 (8.5)	76	6.1 (5.1)	2.0 (0.6)	Y	MFI, FSS	None
Ondo et al^Citation75	Modafinil	37	64.8 (11.3)	72	6.8 (5.0)	NR	Y	FSS	None
Tyne et al^Citation76	Modafinil	13	59.1 (NR)	69	7 (5)	2.2 (NR)	Y	FSS	None
Mendonca et al^Citation55	Methylphenidate	36	64.1	67	NR	2.49 (0.42)	Y	FSS, MFI	Small positive
Rios Romenets et al^Citation32	Doxepin	18	64.4 (12.4)	78	5 (3.3)	NR	N	FSS	Moderate positive
Rascol et al^Citation58 and Olanow et al^77,Table Footnotea	Rasagiline	1176	62.2 (9.7)	61	0.375 (0.38)	1.51 (0.5)	N	PFS	Positive
Schifitto et al^Citation59	Levodopa	349	64.5 (10.92)	68	0.52 (0.54)	1.8 (0.55)	N	FSS	None
Ray Chaudhuri et al^Citation60	Rotigotine	267	64.6 (9.72)	66	4.8 (4.43)	NR	N	NMSS	Small positive
Ondo et al^Citation62	Memantine	40	69.1 (7.8)	60	NR	2.4 (0.48)	Y	FSS	None
Postuma et al^Citation54	Caffeine	61	66.5 (9.88)	72	7.9 (4.18)	NR	N	FSS	None
Ondo et al^Citation64	Sodium oxybate	30	61.5 (8.7)	80	8.6 (5.5)	2.35 (0.37)	N	ESS, FSS	Positive
Ghahari et al^72,Table Footnoteb	Behavioral program	95	50.25 (12.3)		11.44 (13.4)	NR	Y	FSS	None
Rios Romenets et al^Citation32	CBT	18	66.4 (12.4)	78	5.0 (3.3)	NR	N	FSS	None
Winward et al^Citation69	Exercise	39	64.1 (8.17)	79	5.79 (4.27)	NR	Y	FSS	None
Canning et al^Citation68	Exercise	22	61.8 (8.0)	55	5.65 (3.97)	NR	N	VAS	None
Cugusi et al^Citation70	Exercise (Nordic walking)	20	67.3 (7.8)	80	7(3)	2.35 (0.65)	Y	PFS	Positive
Kluger et al^Citation71	Acupuncture	94	63.7 (11.7)	59	NR	2.30 (0.65)	Y	MFIS, ESS	Positive in both groups, but no difference between groups

Notes:

a Disease modification trial;

b participants included with multiple sclerosis (74%), post-polio syndrome (13%), and PD (8%).

Abbreviations: PD, Parkinson’s disease; ESS, Epworth Sleepiness Scale; FSS, Fatigue Severity Scale; MFI, Multidimensional Fatigue Inventory; NMSS, Non-Motor Symptom Scale; PFS, Parkinson’s Fatigue Scale; VAS, Visual Analog Scale; MFIS, Modified Fatigue Impact Scale; NR, not reported; Y, yes; N, no; CBT, cognitive behavioral therapy.

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