Solla Paolo, Cannas Antonino, Mulas Cesare Salvatore, Perra Silvia, Corona Andrea, Bassareo Pier Paolo, Marrosu Francesco
Department of Neurology, Movement Disorders Center, University of Cagliari, SS 554 Bivio per Sestu, 09042, Monserrato (Cagliari), Italy,
J Neurol. 2014 Feb;261(2):382-91. doi: 10.1007/s00415-013-7207-5. Epub 2013 Dec 28.
Although fatigue is a common non-motor symptom in patients affected by Parkinson's disease (PD), its association with motor and other non-motor symptoms is still largely unclear. We assessed fatigue in PD patients studying the possible association with motor and non-motor symptoms. Eighty-one PD patients were included in the study. The PD Fatigue Scale (PFS) and the Fatigue Severity Scale (FSS) scale were used to measure fatigue. Non-motor symptoms were assessed with the Non-Motor Symptoms Scale (NMSS). Motor impairment was assessed using the modified Hoehn and Yahr (HY) staging and the Unified PD Rating Scale (UPDRS) part-III and IV. Bivariate tests comparing all independent variables between patients with our without fatigue were used. Significant predictors of presence and severity of fatigue were determined with different models of logistic regression analyses. Fatigue severity was significantly higher in female patients. Bivariate test showed significant higher NMSS score in fatigued patients according to PFS (p < 0.00001) and FFS (p < 0.001), while HY was higher only in fatigued patients according to FSS (p < 0.022). Significant correlations between severity of fatigue and HY stage (p < 0.002) and UPDRS-III score (p < 0.001) were found, while, among specific non-motor symptoms, anhedonia presented with the most significant correlation (p < 0.003). Binary logistic regression confirmed NMSS as the main variable predicting presence of fatigue, while HY was significant as predicting variable only in the FSS model. Strongest non-motor symptoms predictors of severity were those included in Domain 3 (mood/anxiety) and Domain 2 (sleep disorders) of the NMSS. A significant increase in severity of fatigue related to the burden of non-motor symptoms (mainly affective and sleep disorders) was observed. Our findings indicate a moderate discrepancy in the ratings of the two fatigue scales, with PFS principally directed towards the burden of non-motor symptoms. Finally, the accurate individuation of the factors underlying fatigue, assessed with the systematic administration of holistic evaluation scales such as the NMSS, might improve current strategies used in the treatment of this disabling condition.
尽管疲劳是帕金森病（PD）患者常见的非运动症状，但其与运动及其他非运动症状之间的关联仍 largely 不清楚。我们在研究 PD 患者疲劳与运动及非运动症状可能的关联时对疲劳进行了评估。81 例 PD 患者纳入研究。使用帕金森病疲劳量表（PFS）和疲劳严重程度量表（FSS）来测量疲劳。使用非运动症状量表（NMSS）评估非运动症状。使用改良的 Hoehn 和 Yahr（HY）分期以及统一 PD 评定量表（UPDRS）第三部分和第四部分评估运动损害。采用双变量检验比较有或无疲劳患者之间的所有自变量。通过不同的逻辑回归分析模型确定疲劳存在和严重程度的显著预测因素。女性患者的疲劳严重程度显著更高。双变量检验显示，根据 PFS（p < 0.00001）和 FFS（p < 0.001），疲劳患者的 NMSS 评分显著更高，而根据 FSS，仅疲劳患者的 HY 更高（p < 0.022）。发现疲劳严重程度与 HY 分期（p < 0.002）和 UPDRS - III 评分（p < 0.001）之间存在显著相关性，而在特定的非运动症状中，快感缺失的相关性最为显著（p < 0.003）。二元逻辑回归证实 NMSS 是预测疲劳存在的主要变量，而 HY 仅在 FSS 模型中作为预测变量具有显著性。NMSS 第 3 领域（情绪/焦虑）和第 2 领域（睡眠障碍）中包含的那些因素是疲劳严重程度最强的非运动症状预测因素。观察到与非运动症状（主要是情感和睡眠障碍）负担相关的疲劳严重程度显著增加。我们的研究结果表明两种疲劳量表的评分存在适度差异，PFS 主要针对非运动症状的负担。最后，通过系统应用如 NMSS 等整体评估量表准确识别疲劳背后的因素，可能会改善目前用于治疗这种致残状况的策略。
