Selim Selçuk ÇOMOĞLU, Bilge Gönenli KOÇER, Erhan Arif ÖZTÜRK

Fatigue in patients with Parkinson’s disease: Motor and Non- motor Clinical Associations

Amaç: Yorgunluk, Parkinson hastalÖ?ÖnÖn (PH) en sÖk görülen non-motor semptomlarÖndan biridir. Bu çalÖLmada Parkinson hastalarÖnda yorgunluk prevalansÖnÖ araLtÖrmayÖ ve hastalÖ?Ön yorgunluk ile iliLkili olabilecek demografik, motor ve non-motor özelliklerini belirlemeyi amaçladÖk. Gereç ve Yöntem: ÇalÖLmaya 178 idiyopatik Parkinson hastasÖ alÖndÖ (ortalama yaL 64.8±10.8 yÖl). Demografik veriler, hastalÖk ile iliLkili motor ve non-motor klinik özellikler kaydedildi ve günlük kullanÖlan levodopa eLde?er dozlar (LED) hesaplandÖ. HastalarÖ de?erlendirmede modifiye Hoehn Yahr evreleme (mHY), BirleLik Parkinson HastalÖ?Ö De?erleme Ölçe?i (BPHDÖ) bölüm II ve III, Parkinson yorgunluk ölçe?i (PYÖ), mini mental durum muayenesi ve yarÖ yapÖlandÖrÖlmÖL non-motor semptom anketi uygulandÖ. Hastalar PYÖ puanlarÖna göre PYÖ 3.3 yorgunlu?u olmayan, PYÖ 3.3 yorgunlu?u olan olmak üzere iki gruba ayrÖldÖ. Gruplar arasÖ farklÖlÖklar ki-kare ve ba?ÖmsÖz örneklem t-testi ile analiz edildi. Bulgular: Parkinsonlu hastalarda yorgunluk prevalansÖ %48.9'du. Gruplar arasÖnda yaL ve hastalÖk süresi açÖsÖndan anlamlÖ fark yoktu, ancak ortalama LED yorgunlu?u olan Parkinson hastalarÖnda olmayanlara göre anlamlÖ yüksekti (p=0.011). Gruplar arasÖnda PH evresi, günlük yaLam aktiviteleri ve hastalÖk Liddeti açÖsÖndan fark yoktu. Ortostatik hipotansiyon, huzursuz bacak sendromu ve REM uyku davranÖL bozuklu?u gibi uyku bozukluklarÖ yorgunlu?u olan PH grubunda anlamlÖ ölçüde sÖktÖ (sÖrasÖyla p=0.02, p=0.004, p=0.005). Sonuç: Yorgunluk Parkinson hastalarÖnÖn yaklaLÖk yarÖsÖnÖ etkiler. Parkinson hastalÖ?Önda yorgunluk ile bazÖ non-motor semptomlarÖn birlikteli?i altta yatan dopaminerjik ve nondopaminerjik patolojik mekanizmayÖ yansÖtÖyor olabilir

Parkinsonlu Hastalarda Yorgunluk: Motor ve Non-motor Klinik Birliktelikler

Objective: Fatigue is one of the common non-motor symptoms of Parkinson’s disease (PD). In this study, we aimed to investigate the prevalence of fatigue in PD patients and to determine the fatigue-related demographic, motor and non-motor disease characteristics. Materials and Methods: One hundred seventy-eight idiopathic PD patients were enrolled in the study (mean age 64.8±10.8 years). Demographic data and disease-related motor and non-motor clinical characteristics were recorded and total daily levodopa equivalent dose (LED) was calculated. Modified Hoehn and Yahr Staging (mHY), 'Unified Parkinson's Disease Rating Scale' (UPDRS) part II and III, Parkinson Fatigue Scale (PFS), Mini-Mental State Examination and semi-structured non-motor symptom questionnaire were used to assess the patients. Patients were divided into two groups according to the score of PFS 3.3 as PD without fatigue, PFS 3.3 as PD with fatigue. Then we compared the disease characteristics between the two groups. Bivariate associations were analyzed using the chi-square and the independent samples t-test. Results: The fatigue prevalence was 48.9% in all PD patients. There was no significant difference between groups regarding age and the duration of disease, but the mean LED in PD patients with fatigue was significantly higher than without fatigue (p=0.011). Parkinson’s disease stage, activities of daily living and disease severity were not different between two groups. Orthostatic hypotension and sleep disturbances such as restless legs syndrome (RLS) and REM sleep behavior disorder (RBD) were significantly frequent in PD group with fatigue (p=0.02, p=0.004, p=0.005 respectively). Conclusion: Fatigue affects about 50% of PD patients. Association of fatigue and non-motor symptoms may reflect the dopaminergic and non-dopaminergic underlying pathologic mechanisms

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Herlofson K, Kluger BM. Fatigue in Parkinson's disease. J Neurol Sci. 2017;374:38-41.
Fabbrini G, Latorre A, Suppa A, et al. Fatigue in Parkinson's disease: motor or non-motor symptom? Parkinsonism Relat Disord. 2013;19:148-152.
GoâĊb-Janowska M, Kotlęga D, Safranow K, et al. Risk Factors of Fatigue in Idiopathic Parkinson's Disease in a Polish Population. Parkinsons Dis. Neurology. 2014;83:215-220. 2016;2016:2835945.
Friedman J, Friedman H. Fatigue in Parkinson's disease. Neurology. 1993;43:2016-2018.
Pont-Sunyer C, Hotter A, Gaig C, et al. The onset of nonmotor symptoms in Parkinson's disease (the ONSET PD study). Mov Disord. 2015;30:229-237.
Friedman JH, Brown RG, Comella C, et al. Fatigue in Parkinson's disease: a review. Mov Disord. 2007;22:297-308.
Lou JS, Kearns G, Oken B, et al. Exacerbated physical fatigue and mental fatigue in Parkinson's disease. Mov Disord. 2001;16:190-196.
van Hilten JJ, Hoogland G, van der Velde EA, et al. Diurnal effects of motor activity and fatigue in Parkinson's disease. J Neurol Neurosurg Psychiatry. 1993;56:874-877.
Beiske AG, Svensson E. Fatigue in Parkinson's disease: a short update. Acta Neurol Scand Suppl. 2010;190:78-81.
Hagell P, Brundin L. Towards an understanding of fatigue in Parkinson disease. J Neurol Neurosurg Psychiatry. 2009;80:489-492.
Karlsen K, Larsen JP, Tandberg E, et al. Fatigue in patients with Parkinson's disease. Mov Disord. 1999;14:237-241.
Shulman LM, Taback RL, Bean J, et al. Comorbidity of the nonmotor symptoms of Parkinson's disease. Mov Disord. 2001;16:507-510.
Stocchi F, Abbruzzese G, Ceravolo R, et al. Prevalence of fatigue in Parkinson disease and its clinical correlates.
Chaudhuri A, Behan PO. Fatigue in
Goldman JG, Stebbins GT, Leung V, et al. Relationships among cognitive impairment, sleep, and fatigue in Parkinson's disease using the MDS- UPDRS. Parkinsonism Relat Disord. 2014;20:1135-1139.
Hughes AJ, Daniel SE, Kilford L, et al. Accuracy of clinical diagnosis of idiopathic Parkinson's disease: a clinico-pathological study of 100 cases. J Neurol Neurosurg Psychiatry. 1992;55:181-184.
Tomlinson CL, Stowe R, Patel S, et al. Systematic review of levodopa dose equivalency reporting in Parkinson's disease. Mov Disord. 2010;25:2649-2653.
Hoehn MM, Yahr MD. Parkinsonism: onset, progression and mortality. Neurology. 1967;17:427-442.
Fahn S, Elton RL and Members of the UPDRS Development Committee Unified Parkinson's Disease Rating Scale. In: Fahn S, Marsden M, et al. eds. Recent developments in Parkinson's disease II, New York, NY: Macmillan, pp. 153-163, 1987.
Brown RG, Dittner A, Findley L, et al. The Parkinson fatigue scale. Parkinsonism Relat Disord. 2005;11:49-55.
Herlofson K, Larsen JP. Measuring fatigue in patients with Parkinson's disease - the Fatigue Severity Scale. Eur J Neurol. 2002;9:595-600.
Martinez-Martin P, Catalan MJ, Benito- Leon J, et al. Impact of fatigue in Parkinson's disease: the Fatigue Impact Scale for Daily Use (D-FIS). Qual Life Res. 2006;15:597-606. neurological disorders. Lancet. 2004;363(9413):978-988.
Pavese N, Metta V, Bose SK, et al. Fatigue in Parkinson's disease is linked to striatal and limbic serotonergic dysfunction. Brain. 2010;133:3434-3443.
Chou KL, Kotagal V, Bohnen NI. Neuroimaging and clinical predictors of fatigue in Parkinson disease. Parkinsonism Relat Disord. 2016;23:45-49.
Lou JS, Kearns G, Benice T, et al. Levodopa improves physical fatigue in Parkinson's disease: a double-blind, placebo-controlled, crossover study. Mov Disord. 2003;18:1108-1114.
Fu R, Luo XG, Ren Y, et al. Clinical characteristics of fatigued Parkinson's patients and the response to dopaminergic treatment. Transl Neurodegener. 2016;5:9.
Leentjens AF, Dujardin K, Marsh L, et al. Apathy and anhedonia rating scales in Parkinson's disease: critique and recommendations. Apathy and anhedonia rating scales in Parkinson's disease: critique and recommendations. Mov Disord.2008;23:2004-2014.