Fatigue in Parkinson’s

“Fatigue is the best pillow.” Benjamin Franklin

“Fatigue roughens up the edges of your nerves; it exposes your fears and your weaknesses.” June Havoc

Introduction: Fatigue is a standard part of everyday life. Fatigue is especially prevalent in the Parkinson’s community. Herein is a brief overview of fatigue in people (person)-with-Parkinson’s (PwP).

“Many fears are born of fatigue and loneliness.” Max Ehrmann

Defining Fatigue: The Oxford Dictionary says fatigue is “extreme tiredness resulting from mental or physical exertion or illness.” The Mayo Clinic says this about fatigue, “Unrelenting exhaustion, on the other hand, lasts longer, is more profound and isn’t relieved by rest. It’s a nearly constant state of weariness that develops over time and reduces your energy, motivation and concentration. Fatigue at this level impacts your emotional and psychological well-being, too.” The National Library of Medicine distinguishes fatigue from drowsiness, “Fatigue is a feeling of weariness, tiredness, or lack of energy. Fatigue is different from drowsiness. Drowsiness is feeling the need to sleep. Fatigue is a lack of energy and motivation. Drowsiness and apathy (a feeling of not caring about what happens) can be symptoms that go along with fatigue.”

I can relate to these depictions of fatigue. My experience with fatigue would describe it as an unrelenting and non-ending tiredness so profound that sleep does not relieve the impact on my body. Fatigue is a total absence of energy. Fatigue is not something that frequently happens to me, but it is distinct from being overly tired.

“Sadness is almost never anything but a form of fatigue.” Andre Gide

Highlights of Fatigue in Parkinson’s:
•Fatigue is a common occurrence by a reported 33-58% PwP.
•And fatigue is considered more deleterious than motor symptoms.
•If fatigue develops, it generally happens early in the progression and usually persists.
•Fatigue does not correlate with motor severity but is more common in depression.
•The physiological cause of fatigue is not well understood.
•PwP have “peripheral fatigue,” in which muscles lose power with repeated contractions.
•PwP describe their fatigue as a “feeling of abnormal and overwhelming tiredness and lack of energy, distinct both qualitatively and quantitatively from normal tiredness.”
•Fatigue can be measured by questionnaires as there are no known biomarkers.

“Fatigue makes cowards of us all.” Vince Lombardi

Treatment of Fatigue: A few clinical trials have focused on fatigue in Parkinson’s. They fall into two broad categories, pharmacological and non-pharmacological. Some studies using caffeine and known stimulants (modafinil and methylphenidate) have not proven effective in treating fatigue in Parkinson’s.

Interestingly, some feel that optimizing the motor symptoms of Parkinson’s with different pharmacological agents (e.g., levodopa and dopamine agonists) and their possible detrimental effect against fatigue has not adequately been studied. One study found that fatigue does not respond to carbidopa/levodopa treatment. Dopamine agonists show conflicting results; some studies show a benefit to fatigue, while others describe an adverse effect on fatigue. Regardless, there are other issues with dopamine agonists regarding personality-linked compulsive disorders.

Concerning non-pharmacological intervention, studies with exercise, nutrition, cognitive behavior therapy, energy conservation means, and mindfulness training may be helpful in the PwP to better manage their fatigue.

In the latest review of fatigue in Parkinson’s, Lin et al. (2021) surveyed >1,000 individuals with Parkinson’s. They found that poor sleep and physical exertion were the most common fatigue triggers. They also found that quietly sitting (with or without a nap) or exercising were good coping strategies. They conclude that there are several behavioral and environmental triggers for fatigue in Parkinson’s. In a significantly conflicting conclusion, many PwP feel that exercise can alleviate fatigue; however, exercise is also an instigator. Identifying more effective coping methods seems crucial to reversing the large amount of fatigue in Parkinson’s.

“The strongest have their moments of fatigue.” Friedrich Nietzsche

Conclusions: In the real world of Parkinson’s and living our lives, we must consider fatigue a significant hindrance. Fatigue is a term not well understood in the general population, let alone in Parkinson’s.

A better appreciation of our daily lives and our medical strategy combined with physical activity would help each individual with Parkinson’s. If you have significant fatigue in your Parkinson’s-life, let your Neurologist know about it. Parkinson’s itself would prefer you to be sedentary and not try to be active or exercise too much.

How we each deal with fatigue will help establish a path to better health and a more active strategy/plan to hinder the negative/detrimental effect of Parkinson’s.

References:
Lin, Iris, Briana Edison, Sneha Mantri, Steven Albert, Margaret Daeschler, Catherine Kopil, Connie Marras, and Lana M. Chahine. “Triggers and alleviating factors for fatigue in Parkinson’s disease.” Plos one 16, no. 2 (2021): e0245285.

Friedman, Joseph H., Richard G. Brown, Cynthia Comella, Carol E. Garber, Lauren B. Krupp, Jau‐Shin Lou, Laura Marsh, Lillian Nail, Lisa Shulman, and C. Barr Taylor. “Fatigue in Parkinson’s disease: a review.” Movement disorders: official journal of the Movement Disorder Society 22, no. 3 (2007): 297-308.

Herlofson, Karen, and Benzi M. Kluger. “Fatigue in Parkinson’s disease.” Journal of the neurological sciences 374 (2017): 38-41.

Friedman, Joseph H., Ana Abrantes, and Lawrence H. Sweet. “Fatigue in Parkinson’s disease.” Expert opinion on pharmacotherapy 12, no. 13 (2011): 1999-2007.

“At times, life is hard, as hard as crucible steel. It has its bleak and painful moments. Like the ever flowing water of a river, life has its moments of drought and its moments of flood. Like the ever-changin cycle of the seasons, life has the soothing warmth of the summers and the piercing chill of its winters. But through it all, God walks with us. Never forget that God is able to lift you from the fatigue of despair to the buoyancy of hope, and transform dark and desolate valleys into sunlit paths of inner peace.” Martin Luther King, Jr.

Cover Photo Image by Cindy Lever from Pixabay