Frontiers in Aging Neuroscience (Mar 2023)

Characteristics of fatigue in Parkinson’s disease: A longitudinal cohort study

  • Xiaoxia Zhou,
  • Yaqin Xiang,
  • Tingwei Song,
  • Yuwen Zhao,
  • Hongxu Pan,
  • Qian Xu,
  • Yase Chen,
  • Qiying Sun,
  • Qiying Sun,
  • Xinyin Wu,
  • Xinxiang Yan,
  • Xinxiang Yan,
  • Jifeng Guo,
  • Jifeng Guo,
  • Jifeng Guo,
  • Beisha Tang,
  • Beisha Tang,
  • Beisha Tang,
  • Lifang Lei,
  • Zhenhua Liu,
  • Zhenhua Liu,
  • Zhenhua Liu,
  • for Parkinson's Disease & Movement Disorders Multicenter Database and Collaborative Network in China (PD-MDCNC)

DOI
https://doi.org/10.3389/fnagi.2023.1133705
Journal volume & issue
Vol. 15

Abstract

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ObjectiveTo assess the prevalence, evolution, clinical characteristics, correlates and predictors of fatigue as well as to investigate the influence of comorbid fatigue on the longitudinal changes in motor and non-motor symptoms over a 2-year longitudinal follow-up period in a large cohort of patients with Parkinson’s disease (PD).Materials and methodsA total of 2,100 PD patients were enrolled from the Parkinson’s Disease & Movement Disorders Multicenter Database and Collaborative Network in China (PD-MDCNC), and their motor and non-motor symptoms were assessed biennially using comprehensive scales, including the 16-item Parkinson Fatigue Scale (PFS-16). Each PD patient was categorized as PD with or without fatigue on the basis of a cut-off mean PFS-16 score of 3.3.ResultsThe prevalence of fatigue in our cohort was 36.8%. Compared to PD patients without fatigue, PD patients with fatigue were more likely to be older, have a longer disease duration, and higher baseline levodopa equivalent daily dose (all p < 0.05). Moreover, PD patients with fatigue showed more severe motor and non-motor phenotypes than those without fatigue. Overall, high total Unified Parkinson’s Disease Rating Scale (UPDRS) score (odds ratio [OR] = 1.016, 95% confidence interval [CI]: 1.009–1.024), Non-Motor Symptoms Scale score (OR = 1.022, 95% CI: 1.015–1.029), postural instability and gait difficulty (PIGD) subtype (OR = 1.586, 95% CI: 1.211–2.079), presence of excessive daytime sleepiness (EDS; OR = 1.343, 95% CI: 1.083–1.666), and wearing-off (OR = 1.282, 95% CI: 1.023–1.607) were significantly associated with fatigue in PD patients (all p < 0.05). High total UPDRS score at baseline (OR = 1.014, 95% CI: 1.002–1.027, p = 0.028) increased the risk of developing fatigue during follow-up. Although significant, the odds ratios were low and confidence intervals were narrow. Analysis of disease progression showed significant group differences in motor and non-motor symptoms. In comparison with the never-fatigue group, the persistent-fatigue group showed significantly greater progression in motor, autonomic dysfunction, sleep, depression and cognitive symptoms (all p < 0.05).ConclusionIncreased disease severity, presence of the PIGD subtype, EDS, and wearing-off were associated with fatigue in PD patients. Significant subgroup-level differences were observed in the progression of motor and non-motor symptoms across different fatigue subgroups of PD patients.

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