Department of Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, The Netherlands.
Eur Neurol. 2013;70(3-4):201-9. doi: 10.1159/000351779. Epub 2013 Aug 22.
Fatigue is a frequent non-motor complaint of patients with Parkinson's disease (PD). Despite increasing knowledge on fatigue, the factors leading to its development are still not recognised. The aim of this investigation was to test, using structural equation modelling, the hypothesis that the influence of disease severity on fatigue is mediated by symptoms of depression in patients with PD.
The sample consisted of 190 PD patients (93 men, 48.9%, mean age 68.2±9.3 years, mean disease duration 6.4±4.7 years) recruited from hospitals and outpatient clinics in the East Slovakia region. The Multidimensional Fatigue Inventory, the Hospital Anxiety and Depression Scale and the Unified Parkinson's Disease Rating Scale were used. LISREL was used to analyse the data.
Disease severity was directly associated with symptoms of depression (β=0.26) and directly affected fatigue in terms of increased levels of general fatigue (β=0.35), physical fatigue (β=0.22), reduced activity (β=0.31) and mental fatigue (β=0.29), but did not directly influence reduced motivation. Symptoms of depression mediated the impact of disease severity on general fatigue (β=0.25), on reduced activity (β=0.31) and on mental fatigue (β=0.28), but not on physical fatigue. Reduced motivation was not mediated, but directly influenced by more symptoms of depression (β=0.82).
Since increased symptoms of depression mediate the impact of disease severity on three domains of fatigue in PD patients, disease management should focus on the treatment of PD and symptoms of depression.
疲劳是帕金森病（PD）患者常见的非运动性主诉。尽管对疲劳的了解越来越多，但导致其发生的因素仍未得到确认。本研究旨在通过结构方程模型测试以下假设，即疾病严重程度对疲劳的影响是通过 PD 患者的抑郁症状来介导的。
该样本由来自斯洛伐克东部地区医院和门诊的 190 名 PD 患者（93 名男性，48.9%，平均年龄 68.2±9.3 岁，平均病程 6.4±4.7 年）组成。使用多维疲劳量表、医院焦虑抑郁量表和统一帕金森病评定量表进行评估。使用 LISREL 分析数据。
疾病严重程度与抑郁症状直接相关（β=0.26），并直接影响疲劳水平，表现为一般疲劳（β=0.35）、体力疲劳（β=0.22）、活动减少（β=0.31）和精神疲劳（β=0.29）增加，但对动机降低没有直接影响。抑郁症状中介了疾病严重程度对一般疲劳（β=0.25）、活动减少（β=0.31）和精神疲劳（β=0.28）的影响，但对体力疲劳没有影响。动机降低没有被中介，而是直接受到更多抑郁症状的影响（β=0.82）。
由于抑郁症状的增加中介了 PD 患者疲劳的三个领域中疾病严重程度的影响，因此疾病管理应侧重于 PD 和抑郁症状的治疗。
