Fatigue and excessive daytime sleepiness in idiopathic Parkinson’s disease differently correlate with motor symptoms, depression and dopaminergic treatment

May 25, 2010European journal of neurology

Fatigue and daytime sleepiness in Parkinson's disease relate differently to movement problems, depression, and dopamine treatment

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Abstract

Fatigue was reported in 59% and excessive daytime sleepiness in 48% of patients with idiopathic Parkinson's disease.

Patients with fatigue exhibited higher motor symptom severity as indicated by UPDRS III scores compared to non-fatigued patients.
Fatigued individuals also had higher Hoehn & Yahr staging and Beck Depression Inventory scores than those without fatigue.
No significant differences were observed in motor symptom severity or depression between patients with and without excessive daytime sleepiness.
Dopaminergic treatment type impacted excessive daytime sleepiness scores but not fatigue severity scores.
Disease duration showed a positive correlation with excessive daytime sleepiness scores, while no correlation was found with fatigue severity scores.

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BACKGROUND AND PURPOSE: A comprehensive study of both fatigue and excessive daytime sleepiness (EDS) in association with Parkinson's disease (PD)-related symptoms and treatment has not been performed yet. To assess the frequency and severity of fatigue and EDS in patients with idiopathic PD and to study their relation to motor and non-motor symptoms and dopaminergic treatment.

METHODS: We prospectively assessed Fatigue Severity Scale (FSS) scores, Epworth Sleepiness Scale (ESS) scores, Beck Depression Inventory (BDI) scores, severity (Unified PD Rating Scale, UPDRS, part III; Hoehn & Yahr staging) and duration of the disease, and the current dopaminergic treatment in 88 consecutive patients with idiopathic PD.

RESULTS: Fatigue was found in 52 (59%), EDS in 42 (48%), and both complaints in 31 (35%) patients. Fatigued patients had higher UPDRS III scores (23.5 ± 11.1 vs. 18.6 ± 7.6, P = 0.03), higher Hoehn & Yahr staging (2.4 ± 0.9 vs. 2.1 ± 0.7, P = 0.03), and higher BDI scores (13.4 ± 7.1 vs. 9.1 ± 5.8, P = 0.004) than non-fatigued patients. In contrast, UPDRS III, Hoehn & Yahr, and BDI scores did not differ between patients with or without EDS. However, the type of dopaminergic treatment (levodopa monotherapy versus combination of levodopa/dopamine agonists) was associated with significant differences in ESS (8.5 ± 5.2 vs. 10.8 ± 4.3, P = 0.04), but not FSS scores (4.1 ± 1.5 vs. 4.3 ± 1.5, P = 0.55). Disease duration correlated with ESS scores (r = 0.32, P = 0.003), but not with FSS scores (r = -0.02, P = 0.82).

CONCLUSIONS: In PD, there is a significant overlap of fatigue and EDS, but the two symptoms are differently correlated with the severity of motor symptoms, disease duration, depression, and dopaminergic treatment.

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Fatigue and excessive daytime sleepiness in idiopathic Parkinson’s disease differently correlate with motor symptoms, depression and dopaminergic treatment

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