Parkinson’s Disease Fatigue

Here’s What You Can Do About Parkinson’s Disease And Fatigue

“I can deal with my shaking hand, but what really concerns me the most is my Parkinson’s Disease fatigue. It’s my most frustrating PD symptom.”

If that sounds like your situation, you’re not alone as it’s expected more than 50% of people living with Parkinson’s Disease (PD) live with this debilitating symptom.  PD Related Fatigue (PDRF) is one of the most disabling Parkinson’s symptoms which can profoundly impact your quality of life and is often a major focus of our PD Therapy Programs.

We’ve heard people describe PD fatigue as:

  • He’s lost interest in life
  • I seem to be losing it .. There is no spark or zeal for life
  • We’ve got about 2hrs before the candle is blown out.. that’s what we call it
  • He’s so tired now that just focusing says it hurts his head
  • I’m soo tired, it hurts

So yes, fatigue is a common problem when living with Parkinson’s disease.

The cause of PD-related fatigue is unknown, but it’s thought to be related to problems with sleep regulation or circadian rhythm, mood, medication, neuroinflammation, neurotransmitter dysregulation and more. 

In short, there appears to be many contributing factors and according to Kluger and Friedman (2009) fatigue is a primary symptom of PD. 

Go and grab a good cuppa as this article is to help you get a better understanding of what you can do about fatigue.  Here’s what you’ll learn;

Understanding Parkinson’s

Parkinson’s disease is a neurodegenerative disorder characterized by tremor at rest, bradykinesia, rigidity, postural instability, and impaired gait and balance. Symptoms usually begin slowly and progress gradually.

But, it’s more than just a change in a person’s movement skills.

You see there’s also the non-movement symptoms of Parkinson’s Disease.

Most people will report these thinking, memory,  blood pressure, loss of smell and perception as the greatest challenge to their living their life.

Chief among them is fatigue.

Does Parkinson’s Cause Severe Fatigue

It appears there is an accumulating impact of fatigue as Parkinson’s progresses.  Meaning that it is reported across all stages, though is more frequently a symptom as the disease progress.

According to Kostic et al (2016) literature review findings suggest that there is a growing consensus that fatigue is a primary manifestation of PD. The main theorised mechanisms includes abnormal basal ganglia (BG)‐cortical mechanisms which has a pervasive effect on other functions of the brain and body.

How Common Is Fatigue In People Living With PD?

People with Parkinson’s Disease tend to report fatigue as one of their most troublesome symptoms.

A synthesis and comparison of a number of published research papers (a meta-analysis) showed the prevalence of fatigue in 50% in people living with PD.

Source: pubmed.ncbi.nlm.nih.gov

Parkinson’s disease related fatigue is often present early in the course of the disease, and appears to worsen over time. It is not correlated to the severity of other symptoms – someone with only mild motor symptoms might still have significant fatigue, while someone with severe motor symptoms might experience little fatigue.

Source: ncbi.nlm.nih.gov

How PD Fatigue Impacts Your Life

Fatigue becomes “pathological” meaning associated with disease when it’s

  • Abnormally severe,
  • Limits or prevents your ability to complete your activities independently
  • Is associated with psychological distress
  • however, it remains difficult to define an exact diagnostic threshold

According to Friedman and associates they suggest PD Fatigue as “a sense of exhaustion unexplained by drug effects, other medical, or psychiatric disorders, present for a defined period, and associated with other fatigue-related symptoms, such as reduced motivation and nonrestorative rest, or constraints on activities”

Fatigue Symptoms: So, What Does Parkinson’s Fatigue Feel Like?

Fatigue is a symptom commonly associated with Parkinson’s disease and can be defined as feeling tired after physical activity or mental exertion.

Symptoms may be mild, severe, or intermittent.  A person may experience fatigue in every aspect of their life, or in individual areas, such as:

  • Physical Fatigue: Motor or Movement Fatigue: this domain has attracted the most research attention. Studies have reported that in community dwelling adults motor fatigue can be both common and severe, with the prevalence ranging between 33 and 70% (Friedman et al, 2007). Unlike a general fatigue, some people report their muscle or movement fatigue improves with exercise.
  • Mental Fatigue, Cognitive Fatigue “Memory and Thinking Fatigue”: often referred to as central fatigue relates to experience of feeling weary or exhausted during an intellectually challenging task, along with a decreased capacity to initiate or sustain cognitively challenging activities. This experience of fatigue appears to white ant a person’s Executive Skills. These are the skills needed for complex activities, like driving, managing complex financial matters for example.
  • Emotional Fatigue: A frequent occurrence of depression and PD fatigue is observed in the literature. This means there’s an association as opposed to “being a cause of”. So, people living with PD and also diagnosed with depression are likely to experience fatigue and is often associated with daytime sleepiness and sleep disorders

In summing up fatigue consists of three dimensions: Emotionally, Physically, and Cognitively.

“The issue for most people, is that fatigue is rarely addressed as a clinical concern by many teams, yet this is one of the most disabling symptoms when living with PD.” – David Norris

The Language Of Fatigue

People living with Parkinson’s disease will use a rich and detailed vocabulary when talking about fatigue and this language cue is what we need to watch for.

PD related fatigue may be described with words such as

  • Tiredness, exhaustion, weakness, lack of energy, and feeling drowsy.
  • As well as making statements about trying to motivate themselves to power through fatigue so that they can avoid social isolation, 
  • depression and apathy may also be present as well according to Sneha et al(2020)

With that out of the way, the next questions is so what can you do about it?

What Are The Treatments Of Fatigue In Parkinson’s?

The starting point of any Parkinson’s disease fatigue treatment is to be based on what may be causing or contributing to a person’s sense of fatigue.

Figuring Out The Causes of Fatigue

There are many possible causes of fatigue in patients with Parkinson’s disease. These include medications used to treat the disease, restless legs which impact a person’s ability to sleep,  depression, sleep disorders, anxiety, pain, and poor nutrition to name but a few.

It’s no doubt important to iron out these factors and according to Kostić and colleagues ( 2016) you need to first answer:

Is fatigue primary or secondary? Identify contributing treatable factors (depression, anxiety, apathy, sleep alterations, orthostatic hypotension, anemia etc

What Are The Common Triggers of Parkinson’s Fatigue

A Parkinson’s research study of over 1000 people living with PD identified several behavioural and environmental fatigue triggers.  The study attempted to highlight common experiences of fatigue.

The most frequently reported fatigue trigger was associated with a poor night’s sleep (62%). If you’re experiencing sleep issues and disrupted sleep patterns,  an assessment of your sleep health may be indicated. A sleep study will assess your sleep quality as well as identify issues like sleep apnoea or restless legs syndrome.

The second most reported trigger was physical exertion from exercise, sport or daily living tasks.

Lastly, emotions and being overheated were other reported triggers.

Some respondents could not identify a specific cause for fatigue. 

Interestingly, male respondents were more likely to cite physical exertion as a trigger for fatigue, while female respondents were more likely to report emotional triggers.

Before Treatment- Consider This

Kluger and Friedman (2009) suggest that

Before the administration of any particular pharmacological or non-pharmacological treatment, it may be useful to explain to patients and caregivers that fatigue is quite common and is “a bona fide” symptom of PD.

And Del Sorno and Albanese (2012) argue that it’s very important to distinguish between primary and secondary fatigue when trying to treat the causes of fatigue.

Effects of Exercise: Does Exercise Help With Parkinson’s Fatigue?

Overall, the literature is consistent with reporting the positive benefits of exercise to help with PD symptoms.

A recent study published in the Journal of Neurology found that people with Parkinson’s Disease who exercised regularly had less severe symptoms than those who did not. 

This was true even when researchers accounted for factors such as age, sex, education level, depression, anxiety, sleep quality and medication dosage.

But when it comes to fatigue there appears to be a diverse effect of exercise. Lin and colleagues (2021) found in their 1000 plus study, that

  • Half of (49.7%) thought that exercise helped them feel less tired.
  • A smaller group 18.6% said that exercise didn’t help at all,
  • While 9.5% said that exercise made them feel worse.

Exercise For People Living with Depression

Those who believed that exercise helped, 86.5% said that exercising was a coping strategy for their tiredness. This group of people tended to have less severe PD symptoms and less daytime sleepiness though higher self reported symptoms of depression.

Fatigue Severity May Impact Exercise Effect

Those who thought that exercise helped them feel better had lower fatigue scores than those who thought that exercise made them feel worse. 

However, there was a positive trend in those who believe that exercise helps them cope with their fatigue also tended to engage in more physical activity than people who don’t think so.

  • For example, those people who felt that exercise helped them were more likely to engage in more physical activity than people who didn’t feel that exercise helps their condition.

Steps You Can Take To Help Reduce Fatigue

If you feel fatigue is undermining your ability to do your daily activities? Does the fatigue make it harder to attend clinic visits or rehabilitative sessions? Does it feed into an emotional life? Does it affect your coping ability? If you answered yes, to the above

Firstly, if you’re feeling emotionally distressed or your sleep is poor, ask your doctor if he/she can refer you to a counselor, therapist or specialist.

Secondly, at all stages of Parkinson’s disease, exercise is likely to have some beneficial effect. Exercise has long been known to help people with Parkinson’s disease. It improves muscle strength, coordination, balance and endurance. In addition, regular physical activity may slow down the progression of symptoms. 

However, most studies have focused on aerobic exercises such as walking, running, swimming, cycling and dancing. There is little evidence about the effects of resistance training (lifting weights) on people with Parkinson’s disease, although research suggests that it might also improve function.

Lastly, lifestyle factors, such as alcohol consumption, smoking, and poor nutrition, can contribute to your Parkinson’s disease fatigue.

How to Cope with Disabling Fatigue in Parkinson’s Disease

Fatigue is a major symptom of PD. It affects everyone differently, but there are ways to manage it. Exercise, possibly an antidepressant and/or stimulant, and specific lifestyle adjustments can help.

It’s no secret that people with Parkinson’s disease experience fatigue as one of their most debilitating symptoms.

This is true even when they take medication to help alleviate some of the symptoms. A recent study published by researchers at Stanford University found that fatigue was the second-most common symptom experienced by patients with Parkinson’s disease.

Whilst fatigue may seem like just a nuisance, it has serious consequences for those with Parkinson’s. Although many individuals experience fatigue, few report seeking help. Fatigue no doubt appears to impact every area of life for someone living with the disease and at Occupational Therapy Brisbane, we’d like to help.

Parkinson’s Disease Program At Occupational Therapy Brisbane

The Functional For Life program offers solutions to help people manage their fatigue, improve sleep quality, and reduce the impact of Parkinson’s disease symptoms on your life. You can access the program online, at home or in the clinic.

A two stage initial consultation is the starting point of the program which helps us better understand

  1. Your experience of PD
  2. What your primary goals are
  3. Assist with developing a personalised therapy plan

Please call 1300 783 200 to schedule an initial phone consultation to see if this would be of help to you.

References and Sources

Kluger BM, Friedman JH. Fatigue in Parkinson’s disease In: Chaudhuri KR, Tolosa E, Schapira A, Poewe W, eds. Non‐motor Symptoms of Parkinson’s Disease. Oxford, UK: Oxford University Press; 2009:135–146.

Kostić VS, Tomić A, Ječmenica-Lukić M. The Pathophysiology of Fatigue in Parkinson’s Disease and its Pragmatic Management. Mov Disord Clin Pract. 2016 Mar 11;3(4):323-330. doi: 10.1002/mdc3.12343. PMID: 30363584; PMCID: PMC6178705.

Lin I, Edison B, Mantri S, Albert S, Daeschler M, et al. (2021) Triggers and alleviating factors for fatigue in Parkinson’s disease. PLOS ONE 16(2): e0245285. https://doi.org/10.1371/journal.pone.0245285

Del Sorbo F, Albanese A. Clinical management of pain and fatigue in Parkinson’s disease. Parkinsonism Relat Disord 2012;18:S233–S236. [PubMed]

Pauletti, C., Mannarelli, D., Locuratolo, N. et al. Attention in Parkinson’s disease with fatigue: evidence from the attention network test. J Neural Transm 124, 335–345 (2017). https://doi.org/10.1007/s00702-016-1637-z

Friedman, J., Beck, J., Chou, K. et al. Fatigue in Parkinson’s disease: report from a multidisciplinary symposium. npj Parkinson’s Disease 2, 15025 (2016). https://doi.org/10.1038/npjparkd.2015.25

Mantri S, Klawson E, Albert S, Nabieva K, Lepore M, Kahl S, Daeschler M, Mamikonyan E, Kopil C, Marras C, Chahine LM. Understanding the Lexicon of Fatigue in Parkinson’s Disease. J Parkinsons Dis. 2020;10(3):1185-1193. doi: 10.3233/JPD-202029. PMID: 32568110; PMCID: PMC7458521.

Nicola Pavese, Vinod Metta, Subrata K. Bose, Kallol Ray Chaudhuri, David J. Brooks, Fatigue in Parkinson’s disease is linked to striatal and limbic serotonergic dysfunction, Brain, Volume 133, Issue 11, November 2010, Pages 3434–3443, https://doi.org/10.1093/brain/awq268

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