Clinical evaluation of fatigue in Japanese patients with Parkinson's disease

Clinical features of freezing of gait in Parkinson's disease patients

OBJECTIVE

To clarify the clinical features of freezing of gait (FOG) in Parkinson's disease (PD) patients by classification into two groups: Clinically observed FOG (CFOG) and self-reported FOG (SFOG).

METHODS

Two hundred twenty-nine PD patients were medically examined in an examination room as well as subjected to a New Freezing of Gait Questionnaire (NFOG-Q) and analysis of nonmotor symptoms including sleep, cognition, depression, and fatigue.

RESULTS

The prevalence of CFOG was 17.9%, while 53.7% of the patients without CFOG reported the presence of FOG via the NFOG-Q. Univariate analysis revealed that CFOG was associated with longer disease duration, motor dysfunction, sleepiness, fatigue, and cognitive dysfunction. These symptoms, excluding akinesia, apathy, rapid eye movement (REM) sleep Behavior Disorder, and cognitive dysfunction, were also associated with SFOG. Multivariate analysis revealed that long PD duration, postural instability, and gait difficulty (PIGD), along with fatigue, were independent factors for SFOG.

CONCLUSIONS

SFOG and CFOG have many common clinical features. Although the clinical relevance of SFOG remains unclear, careful attention should be paid to related features in clinical practice.

Fatigue evaluated using the 16-item Parkinson Fatigue Scale (PFS-16) predicts Parkinson's disease prognosis

BACKGROUND

Although fatigue is an important nonmotor symptom in Parkinson's Disease (PD) patients, little is known about the pathophysiological details of fatigue in PD, and it is still unknown whether fatigue correlates with PD prognosis. In this study, we investigated whether fatigue in PD correlates with clinical manifestations, treatment, or patient prognosis.

METHODS

We recruited 75 idiopathic PD patients and used the Parkinson Fatigue Scale (PFS-16) to investigate fatigue. We compared PFS-16 scores with clinical details such as age, disease duration, daily levodopa equivalent dosage, and Hoehn & Yahr (H&Y) disease stage in the 56 patients who fully completed the questionnaire.

RESULTS

In total, 62% of subjects suffered from fatigue, as defined by a mean PFS-16 score above 3.3. There was no correlation between PFS-16 scores and disease duration or levodopa equivalent daily dose. However, there was a significant correlation between mean PFS-16 scores and a worsening grade of H&Y staging. The comparison between patients who showed stable H&Y grades (n=26) and patients with severely aggravated H&Y grades (n=7) revealed that the most significant differences were in questions 14 and 16 in the PFS-16 (p<0.001).

CONCLUSION

Fatigue is common in PD patients, as demonstrated in the present study. The PFS-16 questionnaire may be helpful to predict disease prognosis.

Fatigue in Parkinson's disease: A systematic review and meta-analysis

We conducted a systematic review and meta-analysis aimed at establishing robust prevalence estimates and identifying clinical correlates of fatigue in PD. From 2,459 titles and abstracts, we selected 44 relevant studies (n = 7427 patients). Overall, the meta-analysis showed a prevalence of fatigue of 50% in PD. This prevalence estimate, however, was significantly moderated by study heterogeneity in measurement scales and cut-off thresholds. In contrast, demographic features, disease severity, cognitive impairment, and depression did not moderate prevalence estimates. Moreover, fatigue prevalence did not differ between de novo and treated PD patients. Compared to nonfatigued patients, fatigued patients had sligthly higher age (1.44 years), disease duration (0.93 years), l-dopa equivalent daily dose (50.89 units), UPDRS-III (4.99 points), and H & Y (0.33 points), as well as risk of comorbid depression (risk ratio = 1.89) and had a little lower MMSE score (-0.66 points). Fatigue was moderately associated with apathy (Hedges' g = 0.55), anxiety (Hedges' g = 0.67), daytime somnolence (Hedges' g = 0.43), sleep disturbances (Hedges' g = 0.66), and poorer quality of life (Hedges' g = 1.23). Our analyses suggest that fatigue is a frequent, independent nonmotor symptom in PD appearing early and persisting throughout the disease course, and that establishing uniform diagnostic criteria for PD-related fatigue is critical. In addition, several nonmotor symptoms appear to be associated with fatigue and negatively impact quality of life. Pharmacological and nonpharmacological interventions targeting fatigue and associated symptoms may improve quality of life in patients with PD. © 2018 International Parkinson and Movement Disorder Society.

Prolonged Walking with a Wearable System Providing Intelligent Auditory Input in People with Parkinson's Disease

Rhythmic auditory cueing is a well-accepted tool for gait rehabilitation in Parkinson's disease (PD), which can now be applied in a performance-adapted fashion due to technological advance. This study investigated the immediate differences on gait during a prolonged, 30 min, walk with performance-adapted (intelligent) auditory cueing and verbal feedback provided by a wearable sensor-based system as alternatives for traditional cueing. Additionally, potential effects on self-perceived fatigue were assessed. Twenty-eight people with PD and 13 age-matched healthy elderly (HE) performed four 30 min walks with a wearable cue and feedback system. In randomized order, participants received: (1) continuous auditory cueing; (2) intelligent cueing (10 metronome beats triggered by a deviating walking rhythm); (3) intelligent feedback (verbal instructions triggered by a deviating walking rhythm); and (4) no external input. Fatigue was self-scored at rest and after walking during each session. The results showed that while HE were able to maintain cadence for 30 min during all conditions, cadence in PD significantly declined without input. With continuous cueing and intelligent feedback people with PD were able to maintain cadence (p = 0.04), although they were more physically fatigued than HE. Furthermore, cadence deviated significantly more in people with PD than in HE without input and particularly with intelligent feedback (both: p = 0.04). In PD, continuous and intelligent cueing induced significantly less deviations of cadence (p = 0.006). Altogether, this suggests that intelligent cueing is a suitable alternative for the continuous mode during prolonged walking in PD, as it induced similar effects on gait without generating levels of fatigue beyond that of HE.

Fatigue is associated with the onset of hallucinations in patients with Parkinson's disease: A 3-year prospective study

Hallucinations remain problematic in Parkinson's disease (PD). Various factors have been studied, and many previous studies identified risk factors for hallucinations, such as sleep disorders. At the same time, fatigue is a common symptom in Parkinson's disease, and any factors associated with fatigue in PD have been reported. Factors associated with fatigue in PD are likely to be similar to risk factors for hallucinations. However, fatigue has been not been reported to be a risk factor for hallucinations in previous studies. We prospectively studied non-hallucinators with PD during 3 years to identify factors associated with the onset of hallucinations, including fatigue. We initially screened 100 consecutive patients and registered 78 patients with PD. During 3 years of follow-up, 31 patients newly presented with visual hallucinations. A total of 18 variables were evaluated by logistic regression analysis. Brief Fatigue Inventory (BFI) (OR = 1.027, p = 0.045, 95% CI = 1.001-1.053) was related to first-onset hallucinations on multivariate logistic regression analysis. The present study is the first to demonstrate an association of fatigue with the onset of hallucinations. Fatigue, especially mental fatigue, can be a risk factor for future hallucinations.

Bone mass and vitamin D levels in Parkinson's disease: is there any difference between genders?

[Purpose] The aim of this study was to determine the bone mineral density, vitamin D level, and frequencies of osteopenia and osteoporosis in patients with Parkinson's disease and to compare male and female patients with the controls separately. [Subjects and Methods] One hundred fifteen Parkinson's disease patients (47 males, 68 females; age range: 55-85 years) and 117 age- and gender-matched controls (47 males, 70 females) were enrolled in the study. Bone mineral density measured by dual-energy X-ray absorptiometry and serum D vitamin levels of each participant were recorded. [Results] The mean lumbar spine, femur neck, and total femur bone mineral density levels, T-scores, and vitamin D levels were found to be significantly lower in Parkinson's disease patients in both genders. Furthermore, osteoporosis rates were found be significantly higher only in female Parkinson's disease patients compared with female controls. [Conclusion] Data from the present study revealed that while osteoporosis was significantly higher only in female Parkinson's disease patients, all Parkinson's disease patients had lower bone mineral density scores and vitamin D levels compared with the controls regardless of gender, suggesting that clinicians should pay attention to the osteoporosis risk in Parkinson's disease and that adequate preventive measures should be taken in order to limit the future risk due to osteoporotic fractures.

Assessment of fatigue in Parkinson's disease: Indian perspective

Context:

Fatigue is one of the most frequent nonmotor manifestations in Parkinson's disease (PD), having a major effect on quality of life but is not reported in Indian patients.

Aims:

To evaluate the frequency of fatigue in a cohort of PD population and its correlation with disease.

Settings and Design:

Fatigue Severity Scale (FSS) was translated and validated in local vernacular language. All patients of PD visiting neurology outpatient department of a tertiary care hospital.

Subjects and Methods:

A total of 150 patients were screened, and 104 were included in this study. They were divided into – Group I with fatigue (score of >4 in each item) and Group II without fatigue.

Statistical Analysis:

Data were analyzed by SPSS software version 20.0. Spearman correlation was used to evaluate the convergent validity of the FSS-Ind score with PD-related variables. The principal components analysis was applied to detect the domain structure of the FSS.

Results:

Of the total 104 patients, 68 (65.3%) patients experienced fatigue. The duration of disease was significantly more (P = 0.021) in Group I (4.39 ± 3.8 years) than in the Group II (3.13 ± 1.6 years). The severity of disease also showed a positive correlation with fatigue with 50.9% patients in H and Y stage >3 experiencing fatigue. 69.1% patients of tremor phenotype experienced fatigue as compared to 32.3% of rigid phenotype. There was no relation of fatigue with age, gender, H and Y stage, levodopa equivalent dose and mean Unified PD Rating Scale motor III score.

Conclusions:

Translated version of the FSS, FSS-Ind has high internal consistency and validity which supports its application as an effective tool in detecting fatigue in patients with PD. Fatigue in PD was related to duration and phenotype of the disease.