Fatigue Management And Parkinson's Disease

Insights Into Fatigue From Other Disorders

Fatigue in Parkinson’s Disease: For patients & caregivers

Although perceived fatigue is probably similar among different illnesses, there may be disease-specific differences. Both similarities and differences may provide insights into fatigue pathophysiology. Similarities in fatigue would be compatible with a hypothesis of shared mechanisms, and thus the possibility of similar interventions. The high prevalence of fatigue in medical and psychiatric disorders points either to some very generalized mechanisms or a limitation in the brains ability to distinguish perceptions. We limited our review of other disorders with prominent fatigue, but excluded chronic fatigue syndrome because of its frequent association with psychiatric disorders such as personality disorders and post-traumatic stress disorder that might confound physiological interpretations.

How Can I Help Myself

The general rule is to keep as mentally and physically active as possible. The following suggestions may be helpful:

Daily activities:

Plan your most vigorous activities around when your medication is most effective. You may find keeping a diary to track your symptoms and medication helps with timing when you are likely to be more mobile and energetic.
Learn how to pace yourself, taking regular short rests and periods in which to relax throughout the day.

If tasks are complicated or likely to take time, break them down into smaller stages so that you can rest between each stage. Share tasks if you live with someone and make use of labour saving devices such as a dishwasher or microwave.
Recognise your limitations, identify the priorities of the day and get to know your energy reserves.
Plan your major activities in advance and ensure that you have time for recovery afterwards. For instance, if you have a big social function such as a wedding, rest more in the days leading up to the event and also plan to have a few restful days afterwards.

Work:

if you work, talk with your employer to see if you can take regular short breaks, even if its only to make a drink or talk with colleagues

Diet and exercise:

Sleep and rest:

Content last reviewed: May 2018

General wellbeing:

Managing Fatigue And Parkinsons Disease

If you are living with Parkinsons disease , you might often feel run down, out of energy, or even a bone-deep kind of tired that isnt relieved with rest. Those feelings of intense tiredness are known as fatigue a symptom that affects at least 50 percent of those with Parkinsons.

Many MyParkinsonsTeam members experience fatigue. I didnt know it was caused by PD. I just thought I was getting lazy, said one self-proclaimed chronic napper.

Im getting a better understanding of fatigue reading other PD patients stories and knowing I’m more normal than I thought, wrote another member, relieved.

Read Also: L Shaped Anti Fatigue Mat

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.,

How Does It Show Up In Pd

Managing Fatigue in People Living with Parkinson`s Disease

Fatigue is more than being tired. However, fatigue is a complex symptom that can be difficult to define.2

Fatigue is a physical, emotional, and mental state of being extremely tired or exhausted. While most people have experienced fatigue at some point in their lives, those with PD can have fatigue that greatly impacts their quality of life.2

With physical fatigue, your body is weary and exhausted. Mental fatigue can make it hard to concentrate and finish even the simplest tasks.2

Coping With Fatigue In Pd

Fatigue can make motor symptoms, like tremors, seem like they are worst when they are not. Dr. De León has a list of eight things you can do to prevent or improve fatigue, If you still have severe fatigue discuss it with your physician because there are some medications which can help. The key is well adjusted medications, exercise, good nutrition, and rest at least 5 minutes every day.

Treating Fatigue Associated With Parkinsons

There is still much work to be done in figuring out the specific causes of fatigue in Parkinsons disease in order to arrive at more effective treatment options. However, there are some things that you and your loved ones can try to help manage fatigue caused by Parkinsons.

One member offered this advice for those who feel overwhelmed by fatigue: It is really difficult for others to understand how often someone with Parkinsons gets tired My approach is one day at a time.

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Fatigue In Parkinsons Disease

Fatigue is a common but under-recognized problem for people with Parkinsons disease . Fatigue can be defined as an unpleasant sensation of lacking energy, making the performance of routine activities, physical or mental, a strain. People with PD may experience physical fatigue, mental fatigue, or both. Fatigue in PD is not the same as the feeling you might get at the end of a hard days work. It is not necessarily something that goes away with rest. When people with PD are asked about fatigue, they use phrases such as, I feel run down, I am out of energy, I am unable to do anything, I cant get motivated.

Fatigue in Parkinsons Brochure

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Fatigue is common in PD

Fatigue and Depression

There is a large overlap between fatigue and other problems in PD, especially depression and sleep disorders. People with fatigue are more likely to be depressed and people who are depressed are more likely to be fatigued, but there is nonetheless a large group of PD patients who are fatigued but not depressed. Depression in PD typically responds to antidepressant treatment, and depression-related fatigue may improve with such treatment.

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Fatigue and Sleep disorders

Causes of Fatigue

What Causes Fatigue In People Living With Parkinson’s Disease

Fatigue and Parkinson’s

There exists many causes that interact with one another and are responsible for fatigue. Some of these causes can be treated and others cannot:

The decrease in neurotransmitters associated with Parkinsons disease. The levels of dopamine and serotonin, which usually regulate movement and mood, decrease as neurons disappear.
Medications to treat conditions such as insomnia, anxiety, muscle pain and spasms, as well as allergies.
Medications taken to control the motor symptoms of the disease.

Low blood pressure or orthostatic hypotension which are characteristics of Parkinsons disease and which are aggravated by antiparkinsonian drugs.
Involuntary muscle contractions , slow movements , muscle stiffness and tremors.
Depression

Lack of exercise which can fuel the vicious cycle of low energy.

Mental fatigue can also be exacerbated by difficulty concentrating, memorizing, or performing cognitive tasks.

People living with Parkinsons disease often use these phrases to describe their fatigue:

I have no energy
I am unable to do anything
I am not able to motivate myself

I feel overwhelmed

Out of the many medical conditions, lack of sleep and aging can be the cause of fatigue. In general, the fatigue associated with Parkinsons disease improves with antiparkinsonian treatments, but does not go away completely.

Your neurologist can help you determine the cause of your fatigue and eventually find the best treatment.

Pragmatic Management Of Fatigue In Pd

Treatment approaches focused on fatigue in PD are faced with 2 main limitations: lack of clear insight into its pathophysiology and mechanisms, and probably its multifactorial nature . Therefore, as stated by Kluger and Friedman,22 contemporary treatment of fatigue in PD is limited to an empirical approach based on plausible hypotheses .50

The Impacts Of Fatigue On Those With Parkinsons

Fatigue in Parkinsons disease can be debilitating. This fatigue can take the form of physical exhaustion that makes you feel completely lacking in energy. This is described as the sort of exhaustion that makes moving nearly impossible. Its not just sleepiness its feeling weary, without enough energy to even get out of bed or off the couch. Woke up feeling fatigue, wrote one member, like I have to push myself to get going.

Another shared that their day would be much better if I didnt get so tired by noon. After noon, about all I can do is sit in the recliner or lay in the bed and sleep for a couple of hours.

Fatigue can also show up as crippling mental exhaustion. Mental fatigue makes concentrating nearly impossible and can result in an inability to remember things or follow simple directions. As members have shared, you may feel excessive daytime sleepiness no matter how much rest you get: I, too, suffer from chronic fatigue. I believe I could sleep for 24 hours and still be tired.

For some with Parkinsons disease, fatigue is a constant. Others, however, find that their fatigue comes and goes. One member shared that they are not always tired and lethargic, but sometimes, it hits me for a whole day. I have always had plenty of energy, and I am now perplexed with the ups and downs of PD conditions. I fall asleep often when sitting after eating, while watching TV, during quiet times, and generally doze when I used to not do it.

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What Causes Fatigue In Parkinsons Disease

Parkinsons symptoms are categorized into motor and nonmotor . Fatigue is considered a nonmotor symptom of Parkinsons.

Fatigue associated with any disease can be a result of the disease itself , or it can be the result of the diseases symptoms . In Parkinsons disease, evidence indicates that fatigue is mostly primary. Fatigue is often experienced before motor symptoms first appear. Because fatigue often clusters with other conditions and those conditions can also lead to fatigue, its difficult for researchers to unravel its true causes.

Currently, studies support that the pathophysiology of primary fatigue in people with Parkinsons is related to inflammation and dysfunction in specific parts of the brain. This inflammation and dysfunction particularly affect the basal ganglia the part of the brain involved in controlling motor function and in maintaining the balance of important neurotransmitters, like dopamine and serotonin. One study also found that fatigue in Parkinsons was correlated with reduced frontal lobe circulation. The bottom line? Parkinsons disease disrupts the function of specific parts of the brain to directly cause fatigue.

Fatigue In Parkinsons Disease: Report From A Multidisciplinary Symposium

[Full text] Managing fatigue in patients with Parkinson

A summary of a symposium in October, 2014, reviewing what is known about the diagnosis and treatment of fatigue, its physiology, and what we might learn from other disorders in which fatigue figures prominently, and concluding with focused recommendations to enhance understanding and treatment of fatigue in Parkinsons disease.

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Fatigue Sleep Difficulties And Restless Legs

Although Parkinsons is classified as a movement disorder, it can affect people in various different ways. Sometimes the non-movement symptoms can be more troublesome and can have a bigger impact on the daily life of someone living with Parkinsons.

Some of the more common non-movement symptoms of Parkinsons are:

Fatigue

Restless legs

How Is Fatigue Treated

Although fatigue is common in Parkinsons, it has often been rather neglected by doctors. There are numerous causes of fatigue that are unrelated to Parkinsons but these still need to be recognised for treatment to be successful.

You should first talk with your doctor or specialist to let them know how fatigue affects you and what changes you have noticed over recent months. They will then carry out any tests they feel are appropriate.

Medication: If your doctor suspects that your Parkinsons treatment is a factor they may recommend a change in medication so that symptoms are better managed, which should give you more energy.

Sleep: It is important to understand the reasons for poor sleep and to treat symptoms that disturb your sleep pattern. For example tremor, stiffness or restless legs may interrupt your sleep, or you may need to use the toilet at night. Your doctor will be able to suggest ways to manage these symptoms and so improve your sleep and reduce fatigue.

Triggers And Alleviating Factors For Fatigue In Parkinsons Disease

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

Roles Conceptualization, Data curation, Formal analysis, Writing review & editing

Affiliation Department of Neurology, University of Pittsburgh, Pittsburgh, PA, United States of America
Roles Conceptualization, Writing review & editing

Affiliation Department of Neurology, Duke University, Durham, NC, United States of America
Roles Conceptualization, Writing review & editing

Affiliation Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States of America

Roles Conceptualization, Project administration, Writing review & editing

Affiliation Columbia University School of Social Work, New York, NY, United States of America
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
Roles Conceptualization, Writing review & editing

Affiliation Department of Neurology, University of Toronto, Toronto, Ontario, Canada

Treatment For Fatigue In Parkinson’s Disease

Fatigue in Parkinson’s

At least one-third of people with Parkinson’s disease complain about fatigue. It is unclear what treatment is best to reduce fatigue in people with Parkinson’s disease.

We reviewed the medical literature up to April 2015, and found 11 studies that included a total of 1817 people. Nine studies investigated the effects of medication on fatigue. Two studies investigated the effects of exercise on fatigue. We found no studies that investigated the effect of cognitive-behavioural therapy.

We found that doxepin , a drug to treat depression, may reduce fatigue. We found that rasagiline , an anti-Parkinson drug, reduced or slowed down the progression of physical fatigue. Most drugs were safe however, levodopa-carbidopa may cause nausea.

We found no evidence that exercise reduces fatigue in Parkinson’s disease.

Based on the current evidence, it is not clear what treatment is most effective to treat fatigue in people with Parkinson’s disease. Future studies should investigate the effect of cognitive-behavioural therapy on fatigue in people with Parkinson’s disease.

Factors contributing to subjective fatigue in people with idiopathic Parkinsons disease are not well known. This makes it difficult to manage fatigue effectively in PD.

To evaluate the effects of pharmacological and non-pharmacological interventions, compared to an inactive control intervention, on subjective fatigue in people with PD.

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I am a very active person, but deep fatigue must be addressed with rest. Taking a day to rest is not in my nature. It makes me feel like a sloth. Yet, when deep fatigue hits me, the best remedy is to do just that take the day off! I limit myself to one day of physical rest, very rarely two days . I also find that the mind must rest with the body. Getting the mind to a quiet place is the practice of meditation, in whatever form suits the moment. At the height of deep fatigue, meditation can be very difficult, but not impossible. At times, it has taken me four hours to quiet my mind and body to get rejuvenating rest.

But there is a caution here: Be wary of using rest as an excuse to procrastinate. In another column, Ill address the link of scenario looping to set-shifting issues and difficulty initiating new tasks. Basically, getting off the sofa can be problematic if I stay there too long. Perhaps this seems contradictory to my history as a highly active person, but that is the nature of PDs nonmotor effects. Once off the sofa, I make myself shift into a physical task, followed by a short rest and then some type of mental task. There is always some resistance to overcome to do this to get off the sofa but the rest is absolutely necessary to stop the deep fatigue.

S You Can Take To Reduce Fatigue

If you are feeling fatigued and exhausted all the time, what can you do about it?

First and most importantly, speak to your healthcare provider about how much the fatigue disturbs you. Does it undermine your daily activities? Does it make it more difficult to attend clinic visits or rehabilitation appointments? Does it feed into your emotional life? Does it undermine your coping ability? Once you speak to your practitioner about your fatigue, your medical professional might also recommend the following steps:

Engage in regular physical exercise, including the use of weights to increase muscle strength. Studies show that physical exercise combats both physical and mental fatigue.
Consider taking anti-depressant medication. Although fatigue is not caused by depression, depression can worsen fatigue . Treating depression if it is present might allow you to overcome fatigue with exercise or some other treatment.
Consider trying stimulants like Ritalin , normally prescribed for attention deficit-hyperactivity disorder or Provigil , prescribed for sleep apnea, as an adjunct for depression and as a palliative treatment in end of life care. Some healthcare providers have reported that these drugs may help certain Parkinson’s patients.

Fatigue Management And Parkinson’s Disease

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