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Wang F, Zhu L, Cui H, Guo S, Wu J, Li A, Wang Z. Renshen Yangrong decoction for secondary malaise and fatigue: network pharmacology and Mendelian randomization study. Front Nutr 2024; 11:1404123. [PMID: 38966421 PMCID: PMC11222649 DOI: 10.3389/fnut.2024.1404123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Accepted: 06/13/2024] [Indexed: 07/06/2024] Open
Abstract
Background Renshen Yangrong decoction (RSYRD) has been shown therapeutic effects on secondary malaise and fatigue (SMF). However, to date, its bioactive ingredients and potential targets remain unclear. Purpose The purpose of this study is to assess the potential ingredients and targets of RSYRD on SMF through a comprehensive strategy integrating network pharmacology, Mendelian randomization as well as molecular docking verification. Methods Search for potential active ingredients and corresponding protein targets of RSYRD on TCMSP and BATMAN-TCM for network pharmacology analysis. Mendelian randomization (MR) was performed to find therapeutic targets for SMF. The eQTLGen Consortium (sample sizes: 31,684) provided data on cis-expression quantitative trait loci (cis-eQTL, exposure). The summary data on SMF (outcome) from genome-wide association studies (GWAS) were gathered from the MRC-IEU Consortium (sample sizes: 463,010). We built a target interaction network between the probable active ingredient targets of RSYRD and the therapeutic targets of SMF. We next used drug prediction and molecular docking to confirm the therapeutic value of the therapeutic targets. Results In RSYRD, network pharmacology investigations revealed 193 possible active compounds and 234 associated protein targets. The genetically predicted amounts of 176 proteins were related to SMF risk in the MR analysis. Thirty-seven overlapping targets for RSYRD in treating SMF, among which six (NOS3, GAA, IMPA1, P4HTM, RB1, and SLC16A1) were prioritized with the most convincing evidence. Finally, the 14 active ingredients of RSYRD were identified as potential drug molecules. The strong affinity between active components and putative protein targets was established by molecular docking. Conclusion This study revealed several active components and possible RSYRD protein targets for the therapy of SMF and provided novel insights into the feasibility of using Mendelian randomization for causal inference between Chinese medical formula and disease.
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Affiliation(s)
- Fanghan Wang
- Department of Medical Oncology, The Fourth People’s Hospital of Zibo, Zibo, China
| | - Liping Zhu
- Department of Medical Oncology, Shouguang Hospital of Traditional Chinese Medicine, Shouguang, China
| | - Haiyan Cui
- Department of Pathology, The Fourth People’s Hospital of Zibo, Zibo, China
| | - Shanchun Guo
- RCMI Cancer Research Center, Xavier University of Louisiana, New Orleans, LA, United States
| | - Jingliang Wu
- Medical School, Weifang University of Science and Technology, Shouguang, China
| | - Aixiang Li
- Department of Medical Oncology, Shouguang Hospital of Traditional Chinese Medicine, Shouguang, China
| | - Zhiqiang Wang
- Department of Urology, Shouguang Hospital of Traditional Chinese Medicine, Shouguang, China
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Pauletti C, Locuratolo N, Mannarelli D, Maffucci A, Petritis A, Menini E, Fattapposta F. Fatigue in fluctuating Parkinson's disease patients: possible impact of safinamide. J Neural Transm (Vienna) 2023:10.1007/s00702-023-02654-1. [PMID: 37210459 DOI: 10.1007/s00702-023-02654-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 05/13/2023] [Indexed: 05/22/2023]
Abstract
Fatigue is a common non-motor symptom in Parkinson's disease (PD). Among other pathophysiological mechanisms, neuroinflammation, a pathological PD hallmark associated with changes in glutamatergic transmission in basal ganglia, has been proposed as a crucial factor closely related to fatigue. To test the hypothesis that safinamide could represent an effective treatment of fatigue in PD patients, given its dual mechanism of action (it selectively and reversibly inhibits MAOB and modulates glutamate release), we administered the validated versions of fatigue severity scale (FSS) and Parkinson fatigue scale-16 (PFS-16) to 39 fluctuating PD patients with fatigue before and after a 24-week treatment period with safinamide as add-on therapy. An assessment of secondary variables such as depression, quality of life (QoL), and motor and non-motor symptoms (NMS) was conducted. After 24 weeks of treatment with safinamide, both FSS (p < 0.001) and PF-S16 (p = 0.02) scores were significantly lower than at baseline. Moreover, 46.2% and 41% of patients scored below the cut-off for the presence of fatigue according to FSS and PFS-16, respectively (responders). At follow-up, a significant difference emerged between responders and non-responders in mood, QoL, and NMS. Fatigue improved in fluctuating PD, and more than 40% of patients were "fatigue-free" after a 6 month treatment with safinamide. Patients without fatigue at follow-up displayed significantly better scores in QoL domains, such as mobility or activities of daily living, although disease severity remained stable, supporting the hypothesis that fatigue could considerably affect QoL. Drugs that interact with multiple neurotransmission systems, such as safinamide, could be useful in reducing this symptom.
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Affiliation(s)
- Caterina Pauletti
- Department of Human Neurosciences, Universita degli Studi di Roma La Sapienza, Rome, Italy.
| | - Nicoletta Locuratolo
- Department of Human Neurosciences, Universita degli Studi di Roma La Sapienza, Rome, Italy
- National Centre for Disease Prevention and Health Promotion, National Institute of Health, Rome, Italy
| | - Daniela Mannarelli
- Department of Human Neurosciences, Universita degli Studi di Roma La Sapienza, Rome, Italy
| | - Andrea Maffucci
- Department of Human Neurosciences, Universita degli Studi di Roma La Sapienza, Rome, Italy
| | - Alessia Petritis
- Department of Human Neurosciences, Universita degli Studi di Roma La Sapienza, Rome, Italy
| | - Elisa Menini
- Department of Human Neurosciences, Universita degli Studi di Roma La Sapienza, Rome, Italy
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Francesco Fattapposta
- Department of Human Neurosciences, Universita degli Studi di Roma La Sapienza, Rome, Italy
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Mantri S, Chahine LM, Nabieva K, Feldman R, Althouse A, Torsney B, Albert SM, Kopil C, Marras C. Demographic Influences on the Relationship Between Fatigue and Quality of Life in Parkinson's Disease. Mov Disord Clin Pract 2022; 9:76-81. [PMID: 35005068 DOI: 10.1002/mdc3.13360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 08/17/2021] [Accepted: 09/11/2021] [Indexed: 11/09/2022] Open
Abstract
Background Fatigue has a major impact on health-related quality of life (HR-QOL) in Parkinson's disease (PD). Objectives To determine whether demographic characteristics modify the relationship between fatigue and HR-QOL. Methods Patients with PD in the Fox Insight study completed the Parkinson Fatigue Scale (PFS-16) and Geriatric Depression Scale (GDS-15). Linear regression examined the relationship between the PFS-16 and Parkinson Disease Quality of Life, as modified by age, sex, and GDS-15. Results A total of 1029 participants (44% female, mean age 67.4 years, and mean disease duration 4.6 years) were included in this analysis. Multivariable regression modeling demonstrated a negative effect modification for age (β = -0.07, P < 0.001) and a positive effect modification for the GDS-15 (β = 0.057, P = 0.002), but not for sex (β = -0.021, P = 0.231). Conclusion The association between fatigue and worse HR-QOL is greater at younger ages and in individuals with more depressive symptoms. Targeted therapeutics for these individuals may provide the greatest impact on fatigue in PD.
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Affiliation(s)
- Sneha Mantri
- Department of Neurology Duke University School of Medicine Durham North Carolina USA
| | - Lana M Chahine
- Department of Neurology University of Pittsburgh School of Medicine Pittsburgh Pennsylvania USA
| | - Karina Nabieva
- The Edmond J Safra Program in Parkinson's disease Toronto Western Hospital, University of Toronto Toronto Ontario Canada
| | - Robert Feldman
- Center for Clinical Trials and Data Coordination, Division of General Internal Medicine University of Pittsburgh School of Medicine Pittsburgh Pennsylvania USA
| | - Andrew Althouse
- Center for Clinical Trials and Data Coordination, Division of General Internal Medicine University of Pittsburgh School of Medicine Pittsburgh Pennsylvania USA
| | - Benjamin Torsney
- Temple University College of Education and Human Development Philadelphia Pennsylvania USA
| | - Steven M Albert
- Behavioral and Community Health Sciences, Graduate School of Public Health University of Pittsburgh Pittsburgh Pennsylvania USA
| | | | - Connie Marras
- The Edmond J Safra Program in Parkinson's disease Toronto Western Hospital, University of Toronto Toronto Ontario Canada
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Terra MB, Caramaschi IKF, Araújo HAGDO, Souza RJD, Silva TCOD, Nascimento TS, Probst VS, Smaili SM. Is fatigue associated with balance in Parkinson's disease? MOTRIZ: REVISTA DE EDUCACAO FISICA 2022. [DOI: 10.1590/s1980-657420220013921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Understanding fatigue in progressive supranuclear palsy. Sci Rep 2021; 11:16926. [PMID: 34413435 PMCID: PMC8376988 DOI: 10.1038/s41598-021-96443-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 08/09/2021] [Indexed: 11/09/2022] Open
Abstract
Fatigue is a common and disabling non-motor symptom (NMS) of Parkinson's disease (PD); however, it has been poorly understood in patients with progressive supranuclear palsy (PSP). We investigated the association between fatigue, clinical features, and other NMS in patients with probable PSP. In 72 probable PSP patients, fatigue was investigated using the Parkinson Fatigue Scale (PFS). Further, all patients were evaluated using the PSP rating scale (PSPRS), Beck Depression Inventory (BDI), Mini-Mental State Examination (MMSE), Frontal Assessment Battery (FAB), PD Sleep Scale (PDSS), NMS scale (NMSS), PD Questionnaire-39 summary index (PDQ-39 SI), and Scale for outcomes in PD-Autonomic (SCOPA-AUT). The prevalence of fatigue assessed by PFS was 38.9% (28/72) in patients with PSP. The secondary fatigue was defined as fatigued patients with depression and/or sleep disturbances. We divided the patients into primary (n = 15), secondary (n = 13), and non-fatigue groups. There were no differences in age, sex, disease duration, and PSPRS, PDSS, MMSE, and FAB scores among the three groups. The primary fatigue group had higher scores in PDQ-39 SI compared to the non-fatigue group. The secondary fatigue group showed higher scores in NMSS, PDQ-39 SI, and SCOPA-AUT compared to the non-fatigue group. PFS was positively correlated with NMSS and PDQ-39 SI and SCOPA-AUT. Fatigue is common in patients with PSP and is associated with the NMS and the quality of life in these patients. The present study provides meaningful insight into fatigue in patients with PSP.
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Lin I, Edison B, Mantri S, Albert S, Daeschler M, Kopil C, Marras C, Chahine LM. Triggers and alleviating factors for fatigue in Parkinson's disease. PLoS One 2021; 16:e0245285. [PMID: 33540422 PMCID: PMC7861907 DOI: 10.1371/journal.pone.0245285] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Accepted: 12/24/2020] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Fatigue is common in Parkinson's Disease, but few effective treatments are available for it. Exploring triggers and alleviating factors, including effects of exercise, could inform development of management strategies for Parkinson's Disease fatigue. OBJECTIVES To examine triggers and alleviating factors for fatigue reported by individuals with Parkinson's Disease, including perceived effect of exercise. METHODS A sample of individuals with self-reported Parkinson's Disease participating in the study Fox Insight were administered an online survey. The survey included the Parkinson's Fatigue Scale, the Physical Activity Scale for the Elderly, and multiple-choice questions about triggers and alleviating factors for fatigue. RESULTS Among the sample of 1,029 individuals with Parkinson's disease, mean (standard deviation (SD)) age was 67.4 (9.3) years, 44.0% were female. Parkinson's Fatigue Scale score ranged from 16-80, mean (SD) 48.8 (16.2). Poor sleep (62.1%) and physical exertion (45.1%) were frequently reported triggers for fatigue. Coping strategies including sitting quietly (58.1%), laying down with or without napping, and exercise (20%). Physical Activity Scale for the Elderly scores were higher in those who reported that exercise alleviated their fatigue (49.7%) compared to those who reported it worsened their fatigue (18.9%) (mean (SD) score 158.5 (88.8) vs 119.8 (66.6) respectively; p<0.001). CONCLUSIONS Several behavioral and environmental triggers and alleviating strategies for fatigue are reported by individuals with Parkinson's disease. Many feel that exercise alleviates fatigue, though the relationship between exercise and fatigue in Parkinson's Disease appears complex. This exploratory study may inform future development of treatments or coping strategies for Parkinson's disease fatigue.
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Affiliation(s)
- Iris Lin
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA, United States of America
| | - Briana Edison
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA, United States of America
| | - Sneha Mantri
- Department of Neurology, Duke University, Durham, NC, United States of America
| | - Steven Albert
- Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States of America
| | - Margaret Daeschler
- Columbia University School of Social Work, New York, NY, United States of America
| | - Catherine Kopil
- The Michael J. Fox Foundation for Parkinson’s Research, New York, NY, United States of America
| | - Connie Marras
- Department of Neurology, University of Toronto, Toronto, Ontario, Canada
| | - Lana M. Chahine
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA, United States of America
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Zhi Y, Gao C. Acupuncture in the treatment of fatigue in Parkinson's disease: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2020; 99:e23389. [PMID: 33235114 PMCID: PMC7710230 DOI: 10.1097/md.0000000000023389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 10/14/2020] [Accepted: 10/29/2020] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Fatigue is a commonly occurring nonmotor symptom among individuals of Parkinson's disease (PD). Little is known about how to measure fatigue in PD. This study is aiming to investigate the safety and efficacy of acupuncture for PD-related fatigue. METHODS RCTs of acupuncture for PD-related fatigue will be retrieved from inception to July 2020 in 9 different databases such as Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE and so on. Search words will be used for the BC and acupuncture. The analysis would include randomised, controlled, clinical trials of PD patients with fatigue that were published in either Chinese or English. The primary outcome is the fatigue condition. Two or three reviewers should be in charge of study selection, data extraction and evaluating the risk of bias. RevMan software (V.5.3) will be used to perform the assessment of the risk of bias and data synthesis. RESULTS To provide evidence for the efficacy and safety of acupuncture treating PD-related fatigue. CONCLUSION This study will be helpful for understanding the effect and safety of acupuncture for PD-related fatigue. TRIAL REGISTRATION NUMBER CRD42020160823.
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8
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Supplementary motor area functional connectivity in “drug-naïve” Parkinson’s disease patients with fatigue. J Neural Transm (Vienna) 2020; 127:1133-1142. [DOI: 10.1007/s00702-020-02219-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 06/16/2020] [Indexed: 02/07/2023]
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9
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Ahn JH, Kim M, Mun JK, Cho Y, Kim JS, Youn J, Kim JS, Cho JW. The Dysfunctional Autonomic Function and “Dysfunctional” Fatigue in Drug Naïve Parkinson’s Disease. JOURNAL OF PARKINSONS DISEASE 2020; 10:605-612. [DOI: 10.3233/jpd-201919] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Jong Hyeon Ahn
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Gangnam-gu, Seoul, Republic of Korea
- Neuroscience Center, Samsung Medical Center, Gangnam-gu, Seoul, Republic of Korea
| | - Minkyeong Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Gangnam-gu, Seoul, Republic of Korea
- Neuroscience Center, Samsung Medical Center, Gangnam-gu, Seoul, Republic of Korea
| | - Jun Kyu Mun
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Gangnam-gu, Seoul, Republic of Korea
- Neuroscience Center, Samsung Medical Center, Gangnam-gu, Seoul, Republic of Korea
| | - Yoonsu Cho
- Neuroscience Center, Samsung Medical Center, Gangnam-gu, Seoul, Republic of Korea
| | - Ji Sun Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Gangnam-gu, Seoul, Republic of Korea
- Neuroscience Center, Samsung Medical Center, Gangnam-gu, Seoul, Republic of Korea
| | - Jinyoung Youn
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Gangnam-gu, Seoul, Republic of Korea
- Neuroscience Center, Samsung Medical Center, Gangnam-gu, Seoul, Republic of Korea
| | - Joong-Seok Kim
- Department of Neurology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jin Whan Cho
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Gangnam-gu, Seoul, Republic of Korea
- Neuroscience Center, Samsung Medical Center, Gangnam-gu, Seoul, Republic of Korea
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10
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Fatigue in Parkinson's disease: Italian validation of the Parkinson Fatigue Scale and the Fatigue Severity Scale using a Rasch analysis approach. Parkinsonism Relat Disord 2019; 65:105-110. [DOI: 10.1016/j.parkreldis.2019.05.028] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 04/17/2019] [Accepted: 05/19/2019] [Indexed: 12/14/2022]
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11
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Hicks A, Phillips K, Siwik C, Salmon P, Litvan I, Jablonski ME, Filoteo JV, Kayser K, Sephton SE. The role of dispositional mindfulness in a stress-health pathway among Parkinson's disease patients and caregiving partners. Qual Life Res 2019; 28:2705-2716. [PMID: 31201728 DOI: 10.1007/s11136-019-02217-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2019] [Indexed: 12/30/2022]
Abstract
PURPOSE Parkinson's disease (PD) patients and their caregivers experience significant distress that impacts physical, emotional and social functioning in the patient, and in turn, has a significant impact on the caregiver. Lower levels of stress have been associated with a better prognosis in PD. The quality of dispositional mindfulness-innate present moment, non-judgmental awareness-has consistently been associated with less perceived stress, greater well-being, and better physical health in both clinical and healthy populations. To date, associations of mindfulness with distress, depression, sleep problems, and other variables that define health-related quality of life have not been examined in the context of PD patient/caregiver dyads. METHODS We investigated the impact of dispositional mindfulness in a stress-health model among eighteen dyads consisting of PD patients and their caregivers. RESULTS Multilevel linear modeling (actor-partner interdependence models) revealed significant associations between dispositional mindfulness and stress appraisal, interpersonal support, depressive symptoms, sleep, and health-related quality of life (HRQOL) within both dyadic partners. As expected, results demonstrated significant associations of distress with interpersonal support, depressive symptoms, sleep and HRQOL for both PD patients and caregivers. CONCLUSIONS Dispositional mindfulness was associated with reduced distress and its downstream clinical consequences. These results support an ameliorative role for dispositional mindfulness among PD patients and caregivers, as a protective factor against psychosocial burdens imposed on couples related to disease and caregiving. Findings suggest future studies should explore mindfulness training as a therapeutic option.
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Affiliation(s)
- Allison Hicks
- Department of Psychological & Brain Sciences, University of Louisville, Louisville, KY, USA
| | - Kala Phillips
- Department of Psychological & Brain Sciences, University of Louisville, Louisville, KY, USA
| | - Chelsea Siwik
- Department of Psychological & Brain Sciences, University of Louisville, Louisville, KY, USA
| | - Paul Salmon
- Department of Psychological & Brain Sciences, University of Louisville, Louisville, KY, USA
| | - Irene Litvan
- Department of Neurology, University of California San Diego, San Diego, CA, USA
| | - Megan E Jablonski
- Department of Psychology, Frazier Rehabilitation Hospital, Louisville, KY, USA
| | - J Vincent Filoteo
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Karen Kayser
- Kent School of Social Work, University of Louisville, Louisville, KY, USA
| | - Sandra E Sephton
- Department of Psychological & Brain Sciences, University of Louisville, Louisville, KY, USA.
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Mueller C, Rajkumar AP, Wan YM, Velayudhan L, Ffytche D, Chaudhuri KR, Aarsland D. Assessment and Management of Neuropsychiatric Symptoms in Parkinson's Disease. CNS Drugs 2018; 32:621-635. [PMID: 30027401 DOI: 10.1007/s40263-018-0540-6] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Neuropsychiatric symptoms are highly prevalent in Parkinson's disease and associated with decreased quality of life and adverse health outcomes. In this review, the assessment and management of common neuropsychiatric symptoms are discussed: depression, anxiety, psychosis, cognitive impairment, dementia and apathy. Validated assessment scales are now available for the majority of symptoms. Balancing dopaminergic therapy plays an important role in their management as increasing doses of dopaminergic agents might address depression and anxiety related to 'off' phases, non-motor fluctuations and apathy, while dose reduction might alleviate psychotic symptoms. More targeted treatment is possible through medications utilising different pathways. Although efficacy profiles of individual agents require further exploration, antidepressants as a drug class have shown utility in depression and anxiety in Parkinson's disease. Psychological therapies, especially cognitive behavioural approaches, are effective. Pimavanserin allows the treatment of psychosis in Parkinson's disease without directly affecting the dopaminergic and cholinergic system. The cholinergic system is currently the only target in Parkinson's disease dementia, and antagonists of this system, as are many psychotropic drugs, need to be used with caution. Management of apathy largely relies on non-pharmacological strategies adapted from dementia care, with antidepressants being ineffective and the role of stimulant therapy needing further evaluation.
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Affiliation(s)
- Christoph Mueller
- Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, De Crespigny Park, London, SE5 8AF, UK.
- South London and Maudsley NHS Foundation Trust, London, UK.
| | - Anto P Rajkumar
- Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, De Crespigny Park, London, SE5 8AF, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Yi Min Wan
- Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, De Crespigny Park, London, SE5 8AF, UK
- Ng Teng Fong General Hospital, Singapore, Singapore
| | - Latha Velayudhan
- Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, De Crespigny Park, London, SE5 8AF, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Dominic Ffytche
- Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, De Crespigny Park, London, SE5 8AF, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Kallol Ray Chaudhuri
- Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, De Crespigny Park, London, SE5 8AF, UK
- National Parkinson Foundation International Centre of Excellence, King's College Hospital, London, UK
| | - Dag Aarsland
- Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, De Crespigny Park, London, SE5 8AF, UK
- Stavanger University Hospital, Stavanger, Norway
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13
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Kong KH, Ng HL, Li W, Ng DW, Tan SI, Tay KY, Au WL, Tan LCS. Acupuncture in the treatment of fatigue in Parkinson's disease: A pilot, randomized, controlled, study. Brain Behav 2018; 8:e00897. [PMID: 29568693 PMCID: PMC5853635 DOI: 10.1002/brb3.897] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2017] [Revised: 11/11/2017] [Accepted: 11/19/2017] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION Fatigue is a common and disabling problem in patients with Parkinson's disease (PD), and there is currently no satisfactory treatment. As acupuncture has been reported to be effective in fatigue related to other conditions, we sought to evaluate its efficacy in PD. METHODS This was a single center, randomized, sham-controlled study. Forty PD patients with moderately severe fatigue were randomized to receive 5 weeks of biweekly real or sham acupuncture. The primary outcome was change on the General Fatigue score of the Multidimensional Fatigue Inventory (MFI-GF) at 5 weeks. Secondary outcomes included MFI-Total score, Unified Parkinson's Disease Rating Scale Motor score (UPDRS Motor), Parkinson's Disease Questionnaire-39 (PDQ 39), Geriatrics Depression Scale (GDS), and Epworth Sleepiness Scale ESS). All outcome measures were evaluated at baseline, 5 and 9 weeks. RESULTS Both groups showed significant improvements in MFI-GF and MFI-Total scores at 5 and 9 weeks, but there were no significant between-group differences. There were no improvements from baseline for PDQ 39, GDS, and ESS. Although improvements were noted for the UPDRS Motor score in the real acupuncture group, no between-group difference could be demonstrated. CONCLUSIONS Both real and sham acupuncture are equally effective in improving PD-related fatigue, and it is likely that this is due to nonspecific or placebo effects.
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Affiliation(s)
- Keng H Kong
- Complementary Integrative Medicine Tan Tock Seng Hospital Singapore City Singapore
| | - Hwee L Ng
- Neurology, National Neuroscience Institute Singapore City Singapore
| | - Wei Li
- Neurology, National Neuroscience Institute Singapore City Singapore
| | - Dora W Ng
- Complementary Integrative Medicine Tan Tock Seng Hospital Singapore City Singapore
| | - Siang I Tan
- Complementary Integrative Medicine Tan Tock Seng Hospital Singapore City Singapore
| | - Kay Y Tay
- Neurology, National Neuroscience Institute Singapore City Singapore
| | - Wing L Au
- Neurology, National Neuroscience Institute Singapore City Singapore
| | - Louis C S Tan
- Neurology, National Neuroscience Institute Singapore City Singapore
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14
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IL-6 serum levels are elevated in Parkinson's disease patients with fatigue compared to patients without fatigue. J Neurol Sci 2016; 370:153-156. [PMID: 27772747 DOI: 10.1016/j.jns.2016.09.030] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Revised: 07/15/2016] [Accepted: 09/19/2016] [Indexed: 11/20/2022]
Abstract
To investigate the influence of interleukin-6 (IL-6) and soluble tumor necrosis factor receptors (sTNFR) in fatigued Parkinson's disease (PD) patients. Forty-four PD patients were evaluated, and fatigue was assessed with the Parkinson Fatigue Scale. Logistic regression analysis was used to evaluate the contribution of disease severity scores and cytokine levels on fatigue scores. A receiver operating characteristic (ROC) curve was used to evaluate the diagnostic values of IL-6 in fatigue. Fatigued PD patients had worse cognitive function and depressive symptoms. These patients had worse PD signs and symptoms, displayed more advanced stages of PD, and had greater functional dependence. There was a significant difference in IL-6 serum levels (p=0.026), but there was no difference in sTNFR levels. Total scores on the Unified Parkinson Disease Rating Scale (β=1.108; p=0.004) and IL-6 levels (β=12.843; p=0.020) were found to be significant predictors of fatigue scores. A ROC curve revealed that IL-6 concentrations of 1.18pg/ml represented the best cut-off value for detecting fatigue (sensitivity of 0.941 and specificity of 0.704). Fatigued PD patients have poor clinical outcomes and elevated IL-6 serum levels when compared with non-fatigued patients. These results suggest that IL-6 may play a role in the pathophysiology of fatigue in PD.
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Kostić VS, Tomić A, Ječmenica‐Lukić M. The Pathophysiology of Fatigue in Parkinson's Disease and its Pragmatic Management. Mov Disord Clin Pract 2016; 3:323-330. [PMID: 30363584 PMCID: PMC6178705 DOI: 10.1002/mdc3.12343] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2015] [Revised: 01/27/2016] [Accepted: 01/31/2016] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Fatigue is 1 of the most common and most disabling symptoms among patients with Parkinson's disease (PD) and has a significant impact on their quality of life. Yet the pathophysiology of fatigue is poorly understood, while its treatment is "limited to an empirical approach based on plausible hypotheses." METHODS PubMed was searched for articles with the key words "Parkinson's disease" or "parkinsonism" and "fatigue" that were published by or before August 2015. The analysis of articles, which were selected on subjective grounds, was used to review the current knowledge of pathophysiology and treatment outcomes in studies focused on fatigue in PD. CONCLUSIONS Clinical and experimental findings support the view that fatigue is a primary manifestation of PD. The main hypothesized pathophysiological mechanisms include abnormal basal ganglia (BG)-cortical mechanisms, particularly frontal loops, and an imbalance between neurotransmitters (e.g., dopamine [DA] and serotonin), along with an altered hypothalamus-pituitary-adrenal axis, neuroinflammation, cardiac sympathetic denervation, etc. Pragmatic treatment of fatigue in patients with PD includes various pharmacological (dopaminergic and psychostimulant drugs, antidepressants) and nonpharmacological strategies, although current knowledge suffers from insufficient evidence to support the use of any drug or nondrug therapy.
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Affiliation(s)
- Vladimir S. Kostić
- Institute of Neurology CCSSchool of MedicineUniversity of BelgradeBelgradeSerbia
| | - Aleksandra Tomić
- Institute of Neurology CCSSchool of MedicineUniversity of BelgradeBelgradeSerbia
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Risk Factors of Fatigue in Idiopathic Parkinson's Disease in a Polish Population. PARKINSONS DISEASE 2016; 2016:2835945. [PMID: 26925292 PMCID: PMC4746390 DOI: 10.1155/2016/2835945] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Revised: 12/07/2015] [Accepted: 12/24/2015] [Indexed: 11/18/2022]
Abstract
Introduction. Fatigue syndrome is one of the nonmotor symptoms in Parkinson's disease (PD). The aim of the study was assessment of prevalence of fatigue syndrome in PD and answering the question what are the independent risk factors connected with intensity of fatigue in PD. Methods. 114 patients with idiopathic PD (mean age 62.2 + 10.8 years) were enrolled. The fatigue was assessed according to the Fatigue Severity Scale (FSS). We analyzed associations between fatigue and sex, age, education, duration and severity of the disease, everyday activity, intensity of the main symptoms, treatment, presence of dyskinesias and fluctuations, depression and excessive sleep during the day, and presence of pain and nycturia. Results. The fatigue syndrome was detected in 57.9% of patients. The score in the FSS was 1 to 7 points, 4.3 average. Greater fatigue intensity correlated with higher total daily levodopa equivalent dose. Patients with moderate depression had significantly greater fatigue. Conclusions. Fatigue syndrome affects 57.9% of patients with PD. Use of higher LED and presence of moderate depression are independent risk factors of greater intensity of fatigue.
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Skorvanek M, Rosenberger J, Minar M, Grofik M, Han V, Groothoff JW, Valkovic P, Gdovinova Z, van Dijk JP. Relationship between the non-motor items of the MDS-UPDRS and Quality of Life in patients with Parkinson's disease. J Neurol Sci 2015; 353:87-91. [PMID: 25918077 DOI: 10.1016/j.jns.2015.04.013] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2014] [Revised: 03/11/2015] [Accepted: 04/10/2015] [Indexed: 11/17/2022]
Abstract
The Movement Disorder Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS) is a newly developed comprehensive tool to assess Parkinson's disease (PD), which covers a wider range of non-motor PD manifestations than the original UPDRS scale. The aim of this study was to assess the relationship between the MDS-UPDRS and Quality of Life (QoL) and to analyze the relationship between individual MDS-UPDRS non-motor items and QoL. A total of 291 PD patients were examined in a multicenter Slovak study. Patients were assessed by the MDS-UPDRS, HY scale and PDQ39. Data were analyzed using the multiple regression analyses. The mean participant age was 68.0 ± 9.0 years, 53.5% were men, mean disease duration was 8.3 ± 5.3 years and mean HY was 2.7 ± 1.0. In a multiple regression analysis model the PDQ39 summary index was related to MDS-UPDRS parts II, I and IV respectively, but not to part III. Individual MDS-UPDRS non-motor items related to the PDQ39 summary index in the summary group and in the non-fluctuating patients subgroup were pain, fatigue and features of dopamine dysregulation syndrome (DDS). In the fluctuating PD patient subgroup, PDQ39 was related to pain and Depressed mood items. Other MDS-UPDRS non-motor items e.g. Anxious mood, Apathy, Cognitive impairment, Hallucinations and psychosis, Sleep problems, Daytime sleepiness and Urinary problems were related to some PDQ39 domains. The overall burden of NMS in PD is more important in terms of QoL than motor symptoms. Individual MDS-UPDRS non-motor items related to worse QoL are especially pain and other sensations, fatigue and features of DDS.
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Affiliation(s)
- Matej Skorvanek
- Dept. of Neurology, Faculty of Medicine, Safarik University, Kosice, Slovak Republic; Dept. of Neurology, University Hospital of L. Pasteur, Kosice, Slovak Republic; Graduate School Kosice Institute for Society and Health, Safarik University, Kosice, Slovak Republic.
| | - Jaroslav Rosenberger
- Graduate School Kosice Institute for Society and Health, Safarik University, Kosice, Slovak Republic
| | - Michal Minar
- 2nd Dept. of Neurology, Faculty of Medicine, Comenius University, Bratislava, Slovak Republic
| | - Milan Grofik
- Dept. of Neurology, Jessenius Faculty of Medicine, Comenius University, Martin, Slovak Republic
| | - Vladimir Han
- Dept. of Neurology, Faculty of Medicine, Safarik University, Kosice, Slovak Republic; Dept. of Neurology, University Hospital of L. Pasteur, Kosice, Slovak Republic
| | - Johan W Groothoff
- Dept. of Community and Occupational Health, University Medical Center Groningen, Groningen, The Netherlands
| | - Peter Valkovic
- 2nd Dept. of Neurology, Faculty of Medicine, Comenius University, Bratislava, Slovak Republic; Institute of Normal and Pathological Physiology, Slovak Academy of Sciences, Bratislava, Slovak Republic
| | - Zuzana Gdovinova
- Dept. of Neurology, Faculty of Medicine, Safarik University, Kosice, Slovak Republic; Dept. of Neurology, University Hospital of L. Pasteur, Kosice, Slovak Republic
| | - Jitse P van Dijk
- Graduate School Kosice Institute for Society and Health, Safarik University, Kosice, Slovak Republic; Dept. of Community and Occupational Health, University Medical Center Groningen, Groningen, The Netherlands
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Skorvanek M, Gdovinova Z, Rosenberger J, Ghorbani Saeedian R, Nagyova I, Groothoff JW, van Dijk JP. The associations between fatigue, apathy, and depression in Parkinson's disease. Acta Neurol Scand 2015; 131:80-7. [PMID: 25288130 DOI: 10.1111/ane.12282] [Citation(s) in RCA: 84] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2014] [Indexed: 02/03/2023]
Abstract
OBJECTIVES Fatigue and apathy are two of the most common and most disabling non-motor symptoms of Parkinson's disease (PD). They have a high coincidence and can often be confused; moreover, their relationship is not fully understood. The aim of our study was to describe the coincidence of apathy with different fatigue domains in the presence/absence of depression and to separately describe the associations of different aspects of primary and secondary fatigue with apathy and other clinical and disease-related factors. MATERIALS AND METHODS A total of 151 non-demented patients with PD were examined using the Movement Disorder Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS), Starkstein Apathy Scale, Multidimensional Fatigue Inventory (MFI), Beck Depression Inventory-II, and Epworth Sleepiness Scale. RESULTS The prevalence and severity of fatigue and apathy were significantly higher in depressed PD patients. However, our results show that depression, fatigue, and apathy can be clearly distinguished in PD. Apathy was associated with the MFI's-reduced motivation domain in both depressed and non-depressed patients. However, apathy was associated with mental fatigue aspects only in non-depressed patients, and it was not related to the physical aspects of fatigue in any of the studied groups. CONCLUSIONS Although the pathophysiology of fatigue and apathy in PD is clearly multifactorial, in a proportion of PD patients, these symptoms are associated with depression, dopaminergic depletion in the mesocorticolimbic structures, and disruption of the prefrontal cortex-basal ganglia axis. Therefore, in some PD patients, adequate management of depression and optimal dopaminergic medication may improve both fatigue and apathy.
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Affiliation(s)
- M. Skorvanek
- Department of Neurology; Safarik University; Kosice Slovak Republic
- Department of Neurology; L. Pasteur University Hospital; Kosice Slovak Republic
- Graduate School Kosice Institute for Society and Health; Safarik University; Kosice Slovak Republic
| | - Z. Gdovinova
- Department of Neurology; Safarik University; Kosice Slovak Republic
- Department of Neurology; L. Pasteur University Hospital; Kosice Slovak Republic
| | - J. Rosenberger
- Graduate School Kosice Institute for Society and Health; Safarik University; Kosice Slovak Republic
| | - R. Ghorbani Saeedian
- Graduate School Kosice Institute for Society and Health; Safarik University; Kosice Slovak Republic
- Department of Social Medicine; Institute of Public Health; Safarik University; Kosice Slovak Republic
| | - I. Nagyova
- Graduate School Kosice Institute for Society and Health; Safarik University; Kosice Slovak Republic
- Department of Social Medicine; Institute of Public Health; Safarik University; Kosice Slovak Republic
| | - J. W. Groothoff
- Department of Community and Occupational Health; University Medical Center Groningen; Groningen The Netherlands
| | - J. P. van Dijk
- Graduate School Kosice Institute for Society and Health; Safarik University; Kosice Slovak Republic
- Department of Community and Occupational Health; University Medical Center Groningen; Groningen The Netherlands
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van Dijk JP, Havlikova E, Rosenberger J, Nagyova I, Skorvanek M, Gdovinova Z, Lok W, Groothoff JW, Middel B. Influence of disease severity on fatigue in patients with Parkinson's disease is mainly mediated by symptoms of depression. Eur Neurol 2013; 70:201-9. [PMID: 23969578 DOI: 10.1159/000351779] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2012] [Accepted: 04/25/2013] [Indexed: 11/19/2022]
Abstract
PURPOSE Fatigue is a frequent non-motor complaint of patients with Parkinson's disease (PD). Despite increasing knowledge on fatigue, the factors leading to its development are still not recognised. The aim of this investigation was to test, using structural equation modelling, the hypothesis that the influence of disease severity on fatigue is mediated by symptoms of depression in patients with PD. METHOD The sample consisted of 190 PD patients (93 men, 48.9%, mean age 68.2±9.3 years, mean disease duration 6.4±4.7 years) recruited from hospitals and outpatient clinics in the East Slovakia region. The Multidimensional Fatigue Inventory, the Hospital Anxiety and Depression Scale and the Unified Parkinson's Disease Rating Scale were used. LISREL was used to analyse the data. RESULTS Disease severity was directly associated with symptoms of depression (β=0.26) and directly affected fatigue in terms of increased levels of general fatigue (β=0.35), physical fatigue (β=0.22), reduced activity (β=0.31) and mental fatigue (β=0.29), but did not directly influence reduced motivation. Symptoms of depression mediated the impact of disease severity on general fatigue (β=0.25), on reduced activity (β=0.31) and on mental fatigue (β=0.28), but not on physical fatigue. Reduced motivation was not mediated, but directly influenced by more symptoms of depression (β=0.82). DISCUSSION Since increased symptoms of depression mediate the impact of disease severity on three domains of fatigue in PD patients, disease management should focus on the treatment of PD and symptoms of depression.
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Affiliation(s)
- Jitse P van Dijk
- Department of Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, The Netherlands
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Abstract
OBJECTIVES Although fatigue is experienced by everyone, its definition and classification remains under debate. METHODS A review of the previously published data on fatigue. RESULTS Fatigue is influenced by age, gender, physical condition, type of food, latency to last meal, mental status, psychological conditions, personality type, life experience, and the health status of an individual. Fatigue may not only be a symptom but also a measurable and quantifiable dimension, also known as fatigability. Additionally, it may be classified as a condition occurring at rest or under exercise or stress, as physiologic reaction or pathologic condition, as spontaneous phenomenon or triggerable state, as resistant or irresistant to preconditioning, training, or attitude, as prominent or collateral experience, and as accessible or inaccessible to any type of treatment or intervention. Fatigue may be the sole symptom of a disease or one among others. It may be also classified as acute or chronic. Quantification of fatigability is achievable by fatigue scores, force measurement, electromyography, or other means. Fatigue and fatigability need to be delineated from conditions such as sleepiness, apathy, exhaustion, exercise intolerance, lack of vigor, weakness, inertia, or tiredness. Among neurological disorders, the prevalence of fatigue is particularly increased in multiple sclerosis, amyotrophic lateral sclerosis, Parkinson disease, traumatic brain injury, stroke, and bleeding and also in neuromuscular disorders. Fatigue may be influenced by training, mental preconditioning, or drugs. CONCLUSIONS Fatigue needs to be recognized as an important condition that is not only a symptom but may also be quantified and can be modified by various measures depending on the underlying cause.
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Affiliation(s)
| | - Sinda Zarrouk Mahjoub
- Laboratory of Biochemistry, UR "Human Nutrition and Metabolic Disorders" Faculty of Medicine Monastir, Monastir, Tunisie
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