Triggers And Alleviating Factors For Fatigue In Parkinsons Disease
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Roles Conceptualization, Data curation, Formal analysis, Writing original draft, Writing review & editing
Affiliation Department of Neurology, University of Pittsburgh, Pittsburgh, PA, United States of America
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Roles Conceptualization, Data curation, Formal analysis, Writing review & editing
Affiliation Department of Neurology, University of Pittsburgh, Pittsburgh, PA, United States of America
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Roles Conceptualization, Writing review & editing
Affiliation Department of Neurology, Duke University, Durham, NC, United States of America
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Roles Conceptualization, Writing review & editing
Affiliation Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States of America
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Roles Conceptualization, Project administration, Writing review & editing
Affiliation Columbia University School of Social Work, New York, NY, United States of America
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Roles Conceptualization, Funding acquisition, Project administration, Writing review & editing
Affiliation The Michael J. Fox Foundation for Parkinsons Research, New York, NY, United States of America
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Roles Conceptualization, Writing review & editing
Affiliation Department of Neurology, University of Toronto, Toronto, Ontario, Canada
Figuring Out Causes Of Fatigue
The first step in easing the fatigue associated with Parkinsons disease is to rule out other causes of tiredness, says Liana Rosenthal, M.D., assistant professor of neurology at the Johns Hopkins University School of Medicine and director of clinical core at the Morris K. Udall Center Parkinsons Disease Research Center of Excellence. We evaluate patients to see if there are other things contributing to the fatigue besides their disease, she says.
Sometimes patients may be referred to a sleep specialist for an evaluation. That can help identify causes of tiredness, like sleep apnea. Rosenthal says: Our aim is to first treat any sleep issues, like insomnia, sleep apnea or other causes of poor sleep. Once we treat and address those issues, we can see if fatigue still persists.
Parkinsons Disease And Traumatic Brain Injuries
Additionally, a 2018 study published in Neurology, demonstrated an increased risk of Parkinsons disease and parkinson like symptoms from traumatic brain injuries the report used U.S. military and VAs databases to identify vets with TBIs to study.
Below, well get into certain environmental factors, such as occupational exposure to chemicals, that have been linked to Parkinsons.
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Caring For A Veteran With Parkinsons
Along with information and resources available to all Parkinsons caregivers, this page adds links and phone numbers to resources specifically available through the VA for Parkinsons care partners. Also included are the signs of depression, hospital preparedness, and the phone number to the Parkinsons Foundations Helpline.
Parkinsons Disease Education Consortium 2018 Research Program Overview
This work was undertaken as part of the Michael J Fox Foundations Parkinsons Disease Education Consortium 2018 research program. The PDEC objective relevant to the present analysis was to understand how individuals with PD experience fatigue.
The PDEC 2018 research program undertook a mixed-methods approach that involved three phases , each of which built on prior phases. Initial phases were aimed at in-depth analysis in a small sample, before expanding to a larger cohort of people with PD. Phase 1 was an online journaling activity, in which an online moderator interacted with individuals with PD via a series of structured activities. Phase 2 involved semi-structured telephone interviews with a different set of participants. Phase 3 involved deployment of a survey to the Fox Insight study cohort. Each of these phases is detailed further below. Participants provided informed consent to each phase separately.
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Whats The Pact Act And How Will It Affect My Va Benefits And Care
The PACT Act is perhaps the largest health care and benefit expansion in VA history. The full name of the law is The Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxics Act.
The PACT Act will bring these changes:
- Expands and extends eligibility for VA health care for Veterans with toxic exposures and Veterans of the Vietnam, Gulf War, and post-9/11 eras
- Adds more than 20 new presumptive conditions for burn pits and other toxic exposures
- Adds more presumptive-exposure locations for Agent Orange and radiation
- Requires VA to provide a toxic exposure screening to every Veteran enrolled in VA health care
- Helps us improve research, staff education, and treatment related to toxic exposures
If youre a Veteran or survivor, you can file claims now to apply for PACT Act-related benefits.
The Relationship Between Parkinsons Disease And Sleep
Its unclear whether poor sleep causes parkinsonian symptoms to worsen or whether worsening parkinsonian symptoms cause poor sleep. In many cases its likely a case of bidirectionality, with each one exacerbating the other.
Fragmented sleep and sleep deprivation appear to leave the brain more vulnerable to oxidative stress, which has been tied to the development of Parkinsons disease. Parkinsons disease is not usually diagnosed until individuals have developed sufficient motor symptoms, by which time a significant portion of brain cells have already been damaged. If poor sleep quality or having sleep disorders foreshadows the development of parkinsonian symptoms, these could be useful in early diagnosis of the disease.
More research is needed to clarify the multifaceted relationship between Parkinsons disease and sleep. A better understanding of this connection may offer medical experts the unique opportunity to screen at-risk individuals and perhaps delay the onset of the disease.
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When To Seek Hospice Care
When you or your loved one have a life expectancy of six months or less, you become eligible for hospice care a type of comfort care provided at the end of life for someone living with end-stage Parkinsons disease. Hospice provides extra support so your loved one can live as comfortably as possible.
If you have experienced a significant decline in your ability to move, speak, or participate in activities of daily living without caregiver assistance, its time to speak with a hospice professional.
Read more: What is hospice care?
Some of the things that determine whether your loved one with end-stage Parkinsons is eligible for hospice include: difficulty breathing, bed bound, unintelligible speech, inability to eat or drink sufficiently, and/or complications including pneumonia or sepsis.
If you live in South Jersey, our nurse care coordinator can answer your questions and decide if your loved one is ready for hospice care. Call us 24/7 at 229-8183.
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Causes Of Fatigue In Parkinsons Disease
Many of the symptoms of PD, including slow movement, muscle stiffness, depression, and changes to sleep quality can cause or worsen the symptom of fatigue.
- Akinesia Fatigue may be caused by akinesia . People experiencing akinesia find it challenging to accomplish simple tasks, requiring significantly more energy to get through the daily activities.
- Muscle fatigue Many of the symptoms of PD that affect the muscles, like stiffness, cramping, tremor, and difficulty starting movement, put extra stress on the muscles, causing fatigue. In addition, some people with PD experience muscle atrophy, in which the muscles shrink and weaken due to lack of use. Muscle atrophy decreases a persons stamina and endurance, contributing to the sense of fatigue.
- Depression Depression is another common non-motor symptom of PD, occurring in approximately 40% of people with PD. Depression can cause fatigue, adding to a sense of low energy or lack of motivation.
- Sleep disturbance PD often causes changes in sleep cycles, which can add to a sense of fatigue during the day.
- Medications Some of the medications used to treat PD, including dopamine agonists, can cause fatigue as a side effect. Others may cause insomnia as a side effect, leading to daytime fatigue.1,2
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Fatigue In Parkinsons Disease Associates With Lower Ambulatory Diastolic Blood Pressure
Article type: Research Article
Authors: Kotagal, Vikasab* | Szpara, Ashleyab | Albin, Roger L.abc | Bohnen, Nicolaas I.abcd
Affiliations: Department of Neurology, University of Michigan, Ann Arbor, MI, USA | Veterans Affairs Ann Arbor Health System and GRECC, Ann Arbor, MI, USA | University of Michigan Morris K. Udall Center of Excellence for Parkinsons Disease Research, Ann Arbor, MI, USA | Department of Radiology, Division of Nuclear Medicine, University of Michigan, Ann Arbor, MI, USA
Correspondence: Correspondence to: Vikas Kotagal, MD MS, Building 14, North Campus Research Center, 2800 Plymouth Road, Ann Arbor MI, 48109, USA. Tel.: +1 734 936 9010 Fax: +1 734 615 4991 E-mail: .
Keywords: Autonomic symptoms, blood pressure, fatigue, hypotension, Parkinsons disease
DOI: 10.3233/JPD-191579
Journal: Journal of Parkinsons Disease, vol. 9, no. 3, pp. 575-581, 2019
Abstract
Imaging Of Fatigue In Pd
Motor symptoms in PD result from nigrostriatal dopaminergic denervation, but dopaminergic dysfunction does not appear to be related to fatigue in PD. In the ELLDOPA cohort, 49 levodopa-naive PD patients with fatigue had similar CIT striatal dopamine transporter uptake as 82 PD patients without fatigue. Another study showed no difference in 18F-dopa uptake between 10 fatigued PD subjects and 10 nonfatigued PD subjects.,
Serotonin transporter uptake has been reported to be reduced in chronic fatigue syndrome,, suggesting that nondopaminergic pathways may be involved in PD fatigue. Pavese et al. compared serotonergic transporter uptake ligand 11C-DASB) in seven PD subjects with fatigue and eight PD subjects without fatigue. Serotonin transporter binding in the caudate, putamen, ventral striatum, insula, and thalamus was decreased in the fatigued patients. The relationship of the cholinergic system to PD fatigue has not been investigated. The autonomic nervous system may also be involved in PD fatigue. One study found that pressor responses in norepinephrine and dobutamine infusion tests were greater and MIBG cardiac uptake was decreased in PD subjects with fatigue compared with those without fatigue.,
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Description Of Included Reviews
See: Characteristics of included systematic reviews in and Characteristics of excluded systematic reviews in .
The initial handsearch of the Cochrane Database of Systematic Reviews in March 2010 and a subsequent followup search in September 2010 yielded 520 titles of potential interest. We reviewed abstracts of these titles and identified 185 for further consideration with full papers being obtained. We identified 110 papers as having objectives and outcomes of interest to the overview. Two overview authors independently categorised the remaining papers for their relevance to the overview. After considerable debate we included systematic reviews where quality of life was a primary outcome measure, with fatigue or weight outcome measures separately reported. We also included systematic reviews reporting fatigue and/or unintentional weight loss as secondary outcomes if these were primary outcomes for the majority of the considered studies. We included 27 systematic reviews in the review and these are described in the Characteristics of included systematic reviews in . Systematic reviews of interventions which impacted on the management of fatigue and weight loss in advanced illness but for which treatment of these conditions was not a primary intent of the intervention are listed in the Characteristics of excluded systematic reviews in .
The Critical Difference Between Sleepiness And Fatigue
Fatigue is a physical or psychological feeling where people feel weary and exhausted and lacking energy. EDS is about needing and having the urge to sleep.
Fatigue is something that people can experience along with EDS however, people who experience fatigue on its ownthe feeling of being tired and out of energy do not also necessarily fall asleep when sedentary, as people who experience EDS often do.
It is estimated that EDS affects up to 50% to 75% of people living with Parkinsons and fatigue is estimated to affect 40% to 60%. Fatigue, however, is more likely to go undiagnosed.
Because the terms fatigue and sleepiness are so heavily linked, and sometimes used interchangeably, research has concluded that fatigue and EDS should be assessed separately in people with Parkinsons so that we can improve our understanding of their overlapping physiology.
With that knowledge, researchers from the University Hospital of Zurich, Switzerland designed a study to determine the overlap between fatigue and EDS and then associate them with other motor and non-motor symptoms as well as dopaminergic medication.
In their study of 88 outpatients, the researchers found that 72% experienced fatigue or EDS and just under half experienced both. Some of the key findings of the study include:
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Diagnosis And Treatment Of Parkinsons Sleep Problems
Parkinsons disease is chronic and progressive, meaning it tends to get worse over time. However, there are treatment options that can help manage symptoms and allow patients to get more restful sleep.
The simplest way to start sleeping better with Parkinsons disease is by adopting healthy sleep habits. Sleep hygiene tips for Parkinsons disease sufferers include:
- Sticking to regular bedtimes
- Following a consistent bedtime routine with soothing activities such as listening to music or reading a calming book
- Getting regular exercise, preferably early in the day
- Getting adequate exposure to light, whether outdoors or through light therapy
- Avoiding long naps and naps late in the day
- Creating a cool, dark, and comfortable sleeping environment
- Restricting bedtime activities to sex and sleep only
- Turning off screens an hour before bedtime
- Reducing liquid intake before bedtime
- Avoiding caffeine, alcohol, and tobacco
- Eating a healthy diet and avoiding large meals at night
Light therapy, exercise, and deep brain stimulation have been successfully used to improve overall sleep quality and to treat specific conditions, such as REM sleep behavior disorder, in patients with Parkinsons disease. Cognitive behavioral therapy for insomnia has proven effective at reducing insomnia in healthy adults, although further research is needed on the effects of CBT in patients with Parkinsons disease.
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What Is The Va Rating For Parkinsons Disease
One of the questions we often field is, Is Parkinsons disease a 100% compensation disability? The VA Parkinsons disability rating can rise to 100%. However, it is not 100% by default.
Instead, the Parkinsons VA disability rating has a minimum or default rating of 30%, but that is just the starting point. When you apply for VA Parkinsons disability benefits, the VA looks at two numbers.
First, it looks at your individual disability rating using the aforementioned formula. Then, it compares that number to the default or overall disability rating for Parkinsons disease, which is 30%. If your individual disability rating exceeds 30%, that is your disability rating.
In that way, your disability rating can reach 100%. Conversely, if your personal disability rating is, for example, 22%, you will instead receive a combined rating of 30%.
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Predictors Of Fatigue In Parkinsons Disease
The predictors for fatigue in PD are presented in Table 3. In the three multivariate models, all the VIF for each variable was less than 5. High UPDRS III score increased the risk of developing fatigue after 1-year high LEDD increased the risk of developing fatigue after 2-year and high LEDD and high HAMA score increased the risk of developing fatigue after 3-year.
Table 3. Predicted factors for the development of fatigue in patients with PD.
Fatigue In Parkinsons Disease
This 23-minute video lecture recommends being extremely specific in describing what you experience as fatigue to your doctor to best determine how to treat it. Treatment options should address sleep issues, exercise, re-evaluate all medications, treat low blood pressure, treat depression or anxiety, eliminate other illness than Parkinsons disease. Fatigue is common with aging.
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Clinical Measures Of Fatigue In Pd
A systematic critique of rating scales for diagnosis and severity of PD fatigue used pre-determined criteria for Recommended, Suggested, or Listed, depending on the quality of data. The FSS met the necessary criteria to be recommended for both diagnostic screening and severity measurement., The Multidimensional Fatigue Inventory was designated as recommended for rating fatigue severity, and may be more sensitive to change with interventions than the FSS. For diagnostic screening only, two other scales were recommended: Functional Assessment of Chronic Illness TherapyFatigue Scale and Parkinson Fatigue Scale . Since the MDS review article, the Modified Fatigue Impact Scale has been validated in a study involving 100 PD patients. This scale involves evaluation of cognitive as well as physical and social functioning.
Drinking Well Water Is Linked With A Higher Likelihood Of Developing Parkinsons
A growing body of research suggests that there is a correlation between drinking well water and developing Parkinsons Disease later in life. One particular study, conducted by a team at UCLA and published in the journal Environmental Health Perspectives, found that those who consume well water are statistically more likely to develop PD. After reviewing the medical records and personal histories of 700 people living in Californias farm belt between 1974 and 1999, they determined that those who ultimately developed PD had consumed private well water on average 4.3 years longer than those who did not.
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Disabilities Secondary To Parkinsons Disease
While most people tend to think of Parkinsons disorder as a neurological movement disorder, and it most certainly is, many people do not realize that other systems in the body can also be severely affected by Parkinsons. Often, the same chemical exposure can also cause other disorders, such as ischemic heart disease. However, often it is the Parkinsons itself, or the medication used to treat it that is the causal factor in the development of a new disorder. Whether a veterans Parkinsons was caused by exposure to the TCDD in agent orange, pesticides, trichloroethylene, or its origins are unknown, Parkinsons cause many secondary health effects and disabilities.
