Objective: To identify the association between fatigue, sleep disorders and depression in people with Parkinson’s disease (PD).

Background: Fatigue is one of the most prevalent non-motor symptoms in PD and its impact on quality of life is well described [1]. However, its association with sleep disturbance and depression is controversial in literature [2].

Method: We investigated consecutive PD patients from a movement disorders and PD clinic. Patients with atypical parkinsonism and dementia were excluded. A structured interview for clinical and demographic variables was performed and data concerning the type and dosages of dopamine replacement therapy were recorded, including the levodopa equivalent dosage (LED). Participants were also assessed for sleep disorders (insomnia, REM sleep behavior disorders, excessive daytime sleepiness), with the modified Hoehn and Yahr scale (H&Y), the Mini-mental State Examination (MEEM), the Parkinson’s Fatigue Scale (PFS) and the Beck’s Depression Inventory (BDI). People with BDI ≥ 11 were classified as having depression and those with average PFS ≥ 3.3 as having fatigue.  Kolmogorov-Smirnov normality test was performed to test whether the measures were normally distributed or not and descriptive statistics were calculated for demographic and clinical variables. Categorical variables were compared using the Pearson chi-square or Fisher’s exact test and continuous variables using Student’s t test or Mann-Whitney. Results are shown as median (interquartile range).

Results: Sixty-six patients were included in this study and most of them were male (n=44; 63.6%). The overall sample had a median age of 70 years (IQR 13), disease duration of 9 years (IQR 9), MEEM of 26 (IQR 6), H&Y of 2.5 (IQR 0.5) and LED of 800mg (IQR 608). Fatigue was present in 36 (56.3%) people and 42 (63.6%) had at least one sleep disturbance. Forty-two patients (66.7%) had some level of mood disturbance. Patients with fatigue had lower MEEM [24 (7)] and higher H&Y [3 (0.5)] than those without fatigue [28 (5);2.5 (0.8), respectively] (p<0.001). Depression (85.7% vs 44.4%, p=0.001) and sleep disturbance (77.8% vs 42.9%, p=0.004) were more frequent among patients with fatigue.

Conclusion: People with fatigue had greater disease severity and cognitive impairment than those without fatigue. Depression and sleep disorders were found to be associated with fatigue in individuals with PD.

References: [1] Siciliano M.,et al. Fatigue in Parkinson’s Disease: A Systematic Review and Meta-analysis. Mov Disord, 2018 Nov;33(11):1712-1723. [2] Herlofson K., et al. Fatigue in Parkinson’s disease. J Neurol Sci. 2017 Mar 15;374:38-41.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/association-between-fatigue-depression-and-sleep-disorders-in-people-with-parkinsons-disease/