Abstract
Objective: To explore the frequency, evolution, associated factors, and risk factors of fatigue over 3-year of prospective follow-up in a cohort of patients with early Parkinson’s disease (PD).Methods: A total of 174 PD patients in the early stage were enrolled and quantitively assessed motor and non-motor symptoms using comprehensive scales including the Fatigue Severity Scale (FSS) annually. Each subject was categorized as PD with and without fatigue based on a cut-off mean value of 4 using FSS. The generalized estimating equation (GEE) was utilized to investigate the associated factors, and the stepwise binary logistic regression model was performed to explore the predictors.Results: The frequency of fatigue was slightly changed (ranging from 35.1 to 40.4%) during the 3-year follow-up. The changed pattern of the frequency of fatigue was similar to that of anxiety. Fatigue was significantly associated with nocturnal sleep disorders (B 2.446, P < 0.001), high Hamilton Anxiety Rating Scale (HAMA) score (B 1.072, P = 0.011), and high Unified PD Rating Scale (UPDRS) III score (B 1.029, P = 0.003) over time. High UPDRS III score [odds ratio (OR) 1.051, P = 0.015] at baseline increased the risk of developing fatigue after 1-year; high LEDD (OR 1.002, P = 0.037) increased the risk of developing fatigue after 2-year; and high LEDD (OR 1.003, P = 0.049) and high HAMA score (OR 1.077, P = 0.042) increased the risk of developing fatigue after 3-year.Conclusion: Our present study provided evidence of the longitudinal evolution of fatigue in patients with early PD and help clinical management of fatigue.
Highlights
Fatigue is a common and poorly understood non-motor symptom in patients with Parkinson’s disease (PD), occurring in all stages of the disease even in the pre-motor period, and its prevalence often increases with the disease progression (Kluger et al, 2016)
In the prospective cohort study, we found that fatigue was frequent and nonpersistent in patients with early PD, which was linked to motor severity, sleep disorders, and anxiety symptom
We found that the frequency of fatigue was common in the early stage of PD, which supports that fatigue is one of several common non-motor symptoms that is experienced by PD patients in the early stage
Summary
Fatigue is a common and poorly understood non-motor symptom in patients with Parkinson’s disease (PD), occurring in all stages of the disease even in the pre-motor period, and its prevalence often increases with the disease progression (Kluger et al, 2016). It was reported to be associated with older age (Skorvanek et al, 2015), female sex (Kummer et al, 2011; Stocchi et al, 2014), motor disability (Alves et al, 2004; Schifitto et al, 2008; Stocchi et al, 2014), cognitive impairment (Pereira et al, 2016), neuropsychiatric symptoms (Herlofson et al, 2012; Stocchi et al, 2014; Siciliano et al, 2017), and sleep disorders (Okuma et al, 2009; Stocchi et al, 2014), but with great heterogeneity. The pathophysiology of fatigue in PD is still unclear and the evidence for the management of fatigue using pharmacologic or non-pharmacologic treatments is insufficient (Franssen et al, 2014)
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