Elderly patients who have Parkinson disease show high rates of anxiety and depression substantially related to the severity of fatigue, wrote authors of research published in World Journal of Psychiatry. These findings emphasize the importance of psychological monitoring and targeting mental health interventions when managing Parkinson disease in older individuals.1
When treating patients with Parkinson disease mental health comorbidities, pharmacists play a critical role in managing medication adverse effects (AEs) and dosing.Specifically, pharmacists should determine whether a patient’s AEs are related to the disease itself or from their treatment regimen, and they must recognize that, in addition to the disease itself, fatigue may result from medications used to treat Parkinson disease.
Even though optimizing motor treatments generally does not improve fatigue, pharmacists must look beyond standard Parkinson disease medications, carefully screen for drug interactions in complex medication lists, advise patients to consult professionals before using supplements that may interfere with therapy, recommend antidepressants that relieve mood symptoms without worsening movement, and-in certain specific cases-participate in cautious trials of low-dose stimulants. Because they often interact with patients more frequently than specialists, pharmacists are also well-positioned to monitor subtle signs of anxiety and depression and to advocate for addressing unmet psychological needs that can affect adherence, mobility, and overall quality of life.
In the elderly population, Parkinson disease is rather common. Nonmotor symptoms-such as anxiety, depression, and fatigue-are often subtle, but these can hinder early detection and intervention, thereby affecting patients’ quality of life and clinical outcomes. Unlike normal tiredness, Parkinson disease-related fati
Parkinson’s Disease and Fatigue
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Fatigue is a common non-motor symptom of Parkinson’s disease, characterized by an overwhelming sense of tiredness, low energy, and exhaustion that is not proportional to activity and is not relieved by rest.
While often described as simply feeling tired, fatigue in Parkinson’s differs from everyday tiredness. It can significantly impact daily functioning and quality of life, often being more debilitating than the motor symptoms themselves. The causes of fatigue in Parkinson’s are complex and multifactorial, possibly stemming from the disease process itself, sleep disturbances, depression, medication side effects, and other co-existing medical conditions.
According to the National Institute of Neurological Disorders and Stroke (NINDS), approximately 30-40% of people with Parkinson’s experience critically important fatigue. This percentage can increase as the disease progresses.
Causes of Fatigue in Parkinson’s Disease
Fatigue in Parkinson’s disease arises from a combination of factors affecting the central nervous system and overall health.
These factors include:
- Neurochemical Changes: Disruptions in dopamine and other neurotransmitter systems, central to Parkinson’s pathology, can directly contribute to fatigue.
- Sleep Disorders: REM sleep behavior disorder (RBD), insomnia, and restless legs syndrome are common in Parkinson’s and severely disrupt sleep, leading to daytime fatigue. The Sleep Foundation notes that over 60% of people with Parkinson’s experience sleep disturbances.
- Depression and Anxiety: These mood disorders are frequently comorbid with parkinson’s and can exacerbate fatigue.
- Medication Side Effects: some medications used to treat Parkinson’s symptoms can contribute to fatigue as a side effect.
- Physical Inactivity: Reduced physical activity due to motor symptoms can led to deconditioning and increased fatigue.
- Other Medical Conditions: Co-existing conditions like cardiovascular disease, anemia, and thyroid problems can also contribute to fatigue.
Managing Fatigue in Parkinson’s Disease
Managing fatigue in Parkinson’s requires a multifaceted approach tailored to the individual’s specific needs and contributing factors.
strategies include:
- Optimizing Medication: Working with a neurologist to adjust Parkinson’s medications to minimize side effects and maximize symptom control.
- Improving Sleep Hygiene: Establishing a regular sleep schedule, creating a relaxing bedtime routine, and addressing any underlying sleep disorders. The parkinson’s Foundation provides detailed guidance on sleep management.
- Regular exercise: Engaging in regular physical activity, such as walking, swimming, or tai chi, can improve energy levels and reduce fatigue.
- Healthy Diet: Maintaining a balanced diet rich in fruits, vegetables, and whole grains can provide sustained energy.
- Stress Management: Practicing stress-reducing techniques like meditation,yoga,or deep breathing exercises.
- Energy Conservation: Pacing activities,breaking tasks into smaller steps,and prioritizing rest.
- Addressing Depression and Anxiety: Seeking treatment for any co-occurring mood disorders.
Diagnosis and Assessment
There is no single test to diagnose fatigue in Parkinson’s disease; diagnosis relies on a comprehensive clinical evaluation.
Healthcare professionals typically assess fatigue through:
- Medical History: Reviewing the patient’s medical history, including Parkinson’s diagnosis, medications, and other health conditions.
- Physical Examination: Evaluating motor and non-motor symptoms.
- Fatigue Scales: Using standardized questionnaires, such as the Fatigue Severity Scale (FSS), to quantify the severity of fatigue.
- Sleep Studies: If sleep disturbances are suspected, a sleep study (polysomnography) may be recommended.
- Blood Tests: To rule out other potential causes of fatigue, such as anemia or thyroid problems.
The Movement Disorder Society provides resources for both patients and clinicians regarding Parkinson’s disease and its associated symptoms, including fatigue.
