Fatigue: The Silent Symptom of Parkinson’s Disease

A 2013 survey by the Parkinson’s disease Foundation (PDF) identified fatigue as the most pressing need for the Parkinson’s research community.

While tremors, muscle stiffness, and irregular gait are the symptoms most associated with Parkinson’s disease, 50% of PD patients experience severe fatigue and a third say it is their single most debilitating symptom. Fatigue is the most significant reason cited for medical disability insurance claims by PD patients in the United States. Despite this overwhelming evidence, neurologists tend not to recognize fatigue as a prominent concern of PD patients.

Two studies in newly diagnosed Parkinson’s patients reported fatigue to be a clinically relevant problem even when motor symptoms were minimal. These studies identified fatigue as a “pre-motor” symptom, appearing well before motor symptoms become obvious. Parkinson’s patients describe their fatigue as different than any tiredness they had experienced before their diagnosis. Unlike fatigue in the general public, PD fatigue often improves with exercise.

Mental fatigue that affects Parkinson’s patients is called “central fatigue” and relates to the experience of feeling weary or exhausted during an intellectually challenging task, along with decreased capacity to initiate or sustain cognitively challenging activities. Parkinson’s patients suffering from cognitive fatigue have reduced attention span, and may have deficits in learning, memory, and information processing. Cognitive fatigue will often emerge as tasks become increasingly more complex or attention demands are greater.

Causes of PD Fatigue

The cause of fatigue in Parkinson’s disease is still elusive, though researchers speculate it may be due to changes that take place in the brain. Recently, researchers have found that Parkinson’s patients with fatigue had significantly lower serotonin transporter binding than patients without fatigue in the basal ganglia and limbic structures of the brain. Other causes of PD fatigue under investigation include peripheral inflammation and immune activation, and mitochondrial dysfunction.

Depression, sleep disturbances, and medications may also contribute to or cause fatigue. However, Dr. Joseph Friedman, Professor and Chief of the Division of Movement Disorders at the Warren Alpert Medical School of Brown University, points out that while fatigue is an early symptom and may be associated with depression, most PD patients with fatigue are not depressed.

Clinicians and researchers use rating scales for diagnosing the existence and severity of PD fatigue. Some scales, such as the Modified Fatigue Impact Scale, evaluate cognitive, as well as physical and social function. While most of these tests evaluate fatigue on a subjective level, objective measures for cognitive function exist that can measure performance changes during mental tasks.

Treatment Approaches

Currently, there are no effective treatments for PD fatigue. Clinicians often encourage patients to exercise, practice good sleep habits, take naps, keep mentally active, increase the intake of fiber and drink plenty of water. 

While few medications have proven to be helpful, methylphenidate, a pharmaceutical stimulant, was shown to be effective in lowering fatigue scores in patients with PD in a 6-week treatment period. This medication is often prescribed off label in clinical practice to help combat the effect of debilitating fatigue in PD patients.

In order to offer better treatment options, clear standards to measure and define fatigue in Parkinson’s disease are necessary. Research is also needed to identify biomarkers that can better diagnose and evaluate fatigue treatments. Using a range of brain imaging techniques to examine the underlying biology of fatigue, including the role of inflammation, could help identify changes in the brain associated with fatigue. Lastly, studying the effectiveness of non-drug therapies such as mindfulness-based stress reduction and energy management strategies (pacing), may be helpful. These non-drug therapies have been shown to also be helpful to patients with fatigue due to Multiple Sclerosis.


  • Pathy
    Pathy Wednesday, 31 May 2017 02:25 Comment Link

    I was diagnosed with Parkinson's disease a year ago at the age of 68. For several months I had noticed tremors in my right hand and the shaking of my right foot when I was sitting. My normally beautiful cursive writing was now small cramped printing. And I tended to lose my balance. Neurologist had me walk down the hall and said I didn't swing my right arm. I had never noticed! I was in denial for a while as there is no history in my family of parents and five older siblings, but now accept I had classic symptoms. I was taking pramipexole (Sifrol), carbidopa/levodopa and Biperiden, 2 mg. and started physical therapy to strengthen muscles. nothing was really working to help my condition.I went off the Siferol (with the doctor’s knowledge) and started on parkinson’s herbal formula i ordered from Health Herbal Clinic, my symptoms totally declined over a 3 weeks use of the Parkinsons disease natural herbal formula. i am now almost 70 and doing very well, the disease is totally reversed!! Visit there website www. healthherbalclinic. net

  • camila logan
    camila logan Monday, 29 May 2017 15:38 Comment Link

    Speaking of doctors,there was one doctor who really helped me and my family
    I was diagnose of Parkinson diseaes over a year which my family doctor told me there is no cure but it can only be controled. Ever since then i have been running heather scepter looking for a solution to my problem because i was going to lose my Job if i dont get better, until i ran into this online testimony of Jennifer Snoody who have been cured of COPD by this herbal centre in Johannesburg (abumereherbalcentre @gmail . com), i immediately contacted them via their email, to God be thy glory i bought this Parkinson herbal remedy and was cured within three weeks of usage, at last this is a break through for all parkinson patients contact this herbal centre via their email or website: abumereherbalcentre @ gmail . com/ www . abumereherbalcentre . simplesite . com

  • Glen
    Glen Tuesday, 23 May 2017 16:22 Comment Link

    I was diagnosed with Parkinson's disease in my mid to late 40's. I had hand tremors for several years. Gradually became worse. I then noticed when I was tired the tremors were worse. I started falling for no apparent reason. I now have stiffness in my legs and need to walk with 2 canes or a walker. I am very slow getting around. I am now 52 years old. I am forgetful at times and have difficulty expressing myself. I have difficulty swallowing at times. I become tired easily, I also become quite dizzy when performing any athletic function (jogging). I was on Levodopa/Carbidopa, 100/25. nothing was really working to help my condition. Finally i started on parkinson's natural herbal formula i ordered from Health HERBAL CLINIC, i read alot of great reviews from other patients who used the parkinson's herbal treatment. My symptoms totally declined over a 4-5 weeks use of the Health herbal clinic Parkinsons disease natural herbal formula. , its effects on parkinson's is amazing, all My symptoms gradually faded away, I have been active and hope to continue! Visit www. healthherbalclinic. net or email at Info@ healthherbalclinic. net I recommend this Parkinson's herbal formula for all Parkinson's Patients.

  • maggie
    maggie Monday, 15 May 2017 06:09 Comment Link

    My husband was diagnosed of Parkinsons disease nearly 7 years ago, when he was 49. He had a stooped posture, tremors, right arm does not move and also a pulsating feeling in his body. He was placed on Senemet for 8 months and then Siferol was introduced and replaced the Senemet, during this time span he was also diagnosed with dementia. He started having hallucinations, lost touch with reality. Suspecting it was the medication I took him off the Siferol (with the doctor's knowledge) and started him on PD natural herbal formula we ordered from NEWLIFE HERBAL CLINIC, his symptoms totally declined over a 3-4 weeks use of the Newlife Parkinsons disease natural herbal formula. He is now almost 57 and doing very well, the disease is totally reversed! (Visit their website www . newlifeherbalclinic . com)

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