Sarmento Filipe, Lamp Griffin, Lavu Venkat Srikar, Madamangalam Achyutha S, Reddy Dwarampudi Jagan Mohan, Yuan Qingqi, Martinez-Nunez Alfonso Enrique, Choi Julia, A Johnson Kara, de Hemptinne Coralie, Wong Joshua K
Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA.
Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL, USA.
Clin Park Relat Disord. 2024 Nov 23;11:100288. doi: 10.1016/j.prdoa.2024.100288. eCollection 2024.
Fatigue is a prevalent yet under-recognized non-motor symptom (NMS) of Parkinson's disease (PD), significantly impacting patients' quality of life. Despite its clinical importance, the relationship between fatigue and other motor and non-motor symptoms remains poorly understood. Its frequent co-occurrence with other NMS further complicates both diagnosis and management, often leading to underdiagnosis and suboptimal treatment. This gap in understanding is largely due to the limited exploration of fatigue in PD.
This study aimed to evaluate the prevalence of fatigue at baseline and up to 10 years after symptom onset in a large, well-characterized PD cohort (PPMI) and to explore its associations with other non-motor symptoms (NMS). By providing insights into the prevalence and correlations of fatigue, our goal is to highlight the need for early identification and management, guiding future research efforts.
We conducted a retrospective study using the PPMI database. Fatigue was assessed using item 1.13 of the Movement Disorders Society Unified Parkinson's Disease Rating Scale. Logistic regression was used to analyze the impact of different variables on fatigue, while point-biserial correlation analysis gauged the relationship between continuous variables and fatigue.
At baseline study visit, 52% (575) of patients reported experiencing fatigue, with 9% reporting moderate to severe fatigue early in the disease course. Higher scores on several scales were significantly associated with an increased risk of fatigue, though most associations were weak. Significant associations included the REM Sleep Behavioral Disorder Questionnaire (OR: 1.09, 95% CI: 1.06-1.11), Geriatric Depression Scale (OR: 1.07, 95% CI: 1.03-1.11), State-Trait Anxiety Inventory (OR: 1.01, 95% CI: 1.00-1.02), SCOPA-Autonomic Dysfunction (OR: 1.05, 95% CI: 1.03-1.06), Epworth Sleepiness Scale (OR: 1.06, 95% CI: 1.04-1.08), and Apathy (OR: 2.90, 95% CI: 2.4-3.5).
Over half of patients reported fatigue at baseline, underscoring its significant prevalence early in PD. The predominantly weak associations with other NMS highlight the necessity for comprehensive patient screening and targeted interventions, as addressing one NMS may not effectively alleviate others.
疲劳是帕金森病（PD）一种普遍存在但未得到充分认识的非运动症状（NMS），严重影响患者的生活质量。尽管其具有临床重要性，但疲劳与其他运动和非运动症状之间的关系仍知之甚少。它经常与其他非运动症状同时出现，这使得诊断和管理都更加复杂，常常导致诊断不足和治疗效果欠佳。这种认知差距很大程度上是由于对帕金森病中疲劳的探索有限。
本研究旨在评估一个大型、特征明确的帕金森病队列（PPMI）在基线时以及症状出现后长达10年的疲劳患病率，并探讨其与其他非运动症状（NMS）的关联。通过深入了解疲劳的患病率和相关性，我们的目标是强调早期识别和管理的必要性，为未来的研究工作提供指导。
我们使用PPMI数据库进行了一项回顾性研究。使用运动障碍协会统一帕金森病评定量表的第1.13项评估疲劳。采用逻辑回归分析不同变量对疲劳的影响，同时使用点二列相关分析来衡量连续变量与疲劳之间的关系。
在基线研究访视时，52%（575例）患者报告有疲劳症状，其中9%在疾病病程早期报告有中度至重度疲劳。几个量表上的较高得分与疲劳风险增加显著相关，不过大多数关联较弱。显著关联包括快速眼动睡眠行为障碍问卷（OR：1.09，95%CI：1.06 - 1.11）、老年抑郁量表（OR：1.07，95%CI：1.03 - 1.11）、状态 - 特质焦虑量表（OR：1.01，95%CI：1.00 - 1.02）、SCOPA - 自主神经功能障碍量表（OR：1.05，95%CI：1.03 - 1.06）、爱泼沃斯思睡量表（OR：1.06，95%CI：1.04 - 1.08）和淡漠量表（OR：2.90，95%CI：2.4 - 3.5）。
超过一半的患者在基线时报告有疲劳症状，凸显了其在帕金森病早期的显著患病率。与其他非运动症状的关联大多较弱，这突出了对患者进行全面筛查和针对性干预的必要性，因为解决一种非运动症状可能无法有效缓解其他症状。
