Department of Advanced Medical and Surgical Sciences - MRI Research Center Vanvitelli-FISM, University of Campania "Luigi Vanvitelli", Piazza Miraglia 2, 80138, Naples, Italy; Department of Psychology, University of Campania "Luigi Vanvitelli", Viale Ellittico 31, 81100, Caserta, Italy.
Department of Psychology, University of Campania "Luigi Vanvitelli", Viale Ellittico 31, 81100, Caserta, Italy.
Parkinsonism Relat Disord. 2020 Oct;79:3-8. doi: 10.1016/j.parkreldis.2020.08.019. Epub 2020 Aug 15.
Fatigue is one of the most common and disabling nonmotor symptom in Parkinson's disease (PD). The aim of the present study was to investigate the 1-year course of fatigue in a consecutive sample of de novo drug-naïve patients with PD, and at systematically searching for baseline motor and nonmotor predictors associated with fatigue severity over time.
Fifty-five consecutive de novo PD patients (age: 64.71 ± 7.74 years) underwent a comprehensive examination, including Parkinson Fatigue Scale, Epworth Sleepiness Scale, Parkinson's Disease Sleep Scale, Beck Depression Inventory, Parkinson's Anxiety Scale, Apathy Evaluation Scale, and an extensive neuropsychological evaluation. Bivariate and multiple regression analyses were performed to identify baseline predictors independently related to fatigue severity at 1-year follow-up.
Prevalence rate of fatigue (defined by PFS cut-off) increased from 22% at baseline to 38% at 1-year follow-up. A similar increase in prevalence was observed for excessive daytime sleepiness, and apathy. Among patients with fatigue at baseline, 91% had fatigue at follow-up too (i.e., persistent fatigue). Multivariate regression analysis identified fatigue (p < 0.01), daytime sleepiness (p < 0.01), and emotional apathy (p < 0.01) as the main baseline variables significantly predicting fatigue severity at 1-year follow-up.
In early PD, fatigue increases and persists over time, and its severity is related to higher baseline levels of fatigue, excessive daytime sleepiness, and emotional apathy. These results warrant to monitor fatigue since the early stage of disease, and suggest that treating excessive daytime sleepiness and emotional apathy might prevent its worsening.
疲劳是帕金森病（PD）中最常见和最具致残性的非运动症状之一。本研究旨在调查一组连续的初诊、未用药的 PD 患者 1 年内的疲劳进展情况，并系统地寻找与随时间推移的疲劳严重程度相关的基线运动和非运动预测因素。
55 例连续的初诊 PD 患者（年龄：64.71±7.74 岁）接受了全面检查，包括帕金森疲劳量表、Epworth 嗜睡量表、帕金森病睡眠量表、贝克抑郁量表、帕金森焦虑量表、淡漠评估量表和广泛的神经心理学评估。进行了双变量和多变量回归分析，以确定与 1 年随访时疲劳严重程度相关的基线预测因素。
疲劳（以 PFS 截断值定义）的患病率从基线时的 22%增加到 1 年随访时的 38%。白天过度嗜睡和淡漠的患病率也出现了类似的增加。在基线时存在疲劳的患者中，91%在随访时仍存在疲劳（即持续性疲劳）。多变量回归分析确定疲劳（p<0.01）、白天嗜睡（p<0.01）和情感淡漠（p<0.01）是预测 1 年随访时疲劳严重程度的主要基线变量。
在早期 PD 中，疲劳随时间推移而增加并持续存在，其严重程度与较高的基线疲劳水平、白天过度嗜睡和情感淡漠相关。这些结果提示需要从疾病早期开始监测疲劳，并表明治疗白天过度嗜睡和情感淡漠可能预防其恶化。
