Parkinson's disease fatigability and its correction with the dopamine receptor agonist pramipexole

Abstract

Fatigability is a common nonmotor symptom in Parkinson's disease (PD), which worsens quality of life in patients. Objective: to analyze the association of fatigability with the duration of PD and the degree of movement and neuropsychic (depression, nocturnal sleep disorders, daytime sleepiness) disorders; to evaluate changes in the manifestations of fatigability during therapy with the dopamine receptor agonist pramipexole (Mirapex). Patients and methods. Sixty patients with PD (disease duration 6.02±3.47 years; stage 2.68±0.62) without dementia were examined using the PD fatigue scale (PFS-16), unified PD rating scale (Part 2), the Beck depression inventory, the PD sleep scale, and the Epworth sleeping scale. Results. 66% of the patients were found to consider fatigability to be one of the three most daily life-limiting manifestations of the disease. The integrated rating of fatigability significantly correlated with total depression scores and sleep scores. During pramipexole therapy, there were statistically significant positive changes in fatigability, which did not correlate with those in motor functions, depression, and sleep problems. It is concluded that fatigability substantially impairs the daily activities of patients with PD and is associated with neuropsychic symptoms to a greater extent than with the degree of movement disorders in PD. This may be due to both the common pathophysiological mechanisms of these abnormalities and their comorbidity in PD. The fact that there is no significant association of the time course of changes in fatigability with alterations in the parameters of other neuropsychic functions during therapy conceivably indicated the independent genesis of this symptom.