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.


  • Carolyn
    Carolyn Sunday, 21 January 2018 08:50 Comment Link

    God bless Dr. Anonre for his marvelous work in my life, I was diagnosed of Lupus since 2010 and I was taking my medications, I wasn't satisfied all i needed is to be permanently free from the Virus, I searched about some possible cure for LUPUS i saw a comment about Dr. Anonre, how he cured Lupus with his herbal medicine, I contacted him at his email;' and he guided me. I asked for solutions, he started the remedy for my health, he sent me the medicine. I took the medicine as prescribed by him and 8 days later i was cured from Lupus,thank you Dr Anonre ONCE AGAIN THANK YOU SIR!!!

  • Penny Knott
    Penny Knott Friday, 19 January 2018 11:42 Comment Link

    Hello all viewer online HIV has cure but doctor said Hiv/Aids has no cure until i met Dr Zuku who help me in my life. I was infected with HIV/AIDS in 2006, i went to many hospitals for cure but there was no solution, so I was thinking how can I get a solution, so that my body can be okay. until this faithful day as i was browsing the net I saw a testimony on how Dr.Zuku helped people in curing HIV Disease, quickly I copied his Email which is so i contacted him for solution for my HIV, so Dr.Zuku told me that his going to prepare herbal medicine for my health, then he prepared the medicine and luckily after two week my herpes was be cured. Dr Zuku is well recognize as one of the best herbalist doctor in Africa, you don't have to be sad anymore or share your tears anymore on this disease when the cure have already be found by Dr.Zuku herbal medicine, he so cure HERPES,CANCER, ALS,HEPATITIS B, DIABETIC ,or his Mobile number: +16177296273 or his Blogs his website

  • Adam Lallana
    Adam Lallana Friday, 19 January 2018 08:09 Comment Link

    My sister was diagnosed 14 weeks ago after several years of being told she had "restless leg syndrome.” She has very bad toe cramps, where here foot looks like a claw and is very painful. She was also "freezes" on trying to stand from a sitting position. She speaks so quickly and "gabbles" that we are unable to decipher what she is saying. She is now very steady on her feet after we bought the Total cure herbal foundation natural herbs ,she has fallen several times before using the herbal formula;we have to give a try on natural herbal products which really work perfectly on her.
    The herbal remedies helps her body to return to its normal position after using it for several weeks, we are obviously very concerned about other lives out there so please do not hesitate to contact this email address ( to get your Parkinson disease (PD) bottles or for other diseases.

    DIAGO MARY Monday, 15 January 2018 07:27 Comment Link

    My name is Diago Mary a single mum from the UNITED STATE OF AMERICA (TEXAS ) i never thought i will see today if not the help of Dr.losa i was pregnant for over 2yrs and some months the doctor told me i have HIV aids and that the baby was affected also and also i have cancer the doctor also was about going to performe surgery on my left breast i was so fruastrated i thought of killing my self then i ran into an old college friend of mine then i narated my story to her she burst into tears and confrot me then she told me that there was these great man who would give me herbs and root and myself and the baby will be alright as good, and she told me that it will only cost me some funds to get the herbs from Dr LOSA, money was never the problem i never thought of it but i said to myself i will be heal i cotacted him at once after some process i got the herbs he told me how to use it daily and am going to use the herbs for just 1months and after that 1months i should go for check up in the hospital i followed instructions very carfully and could you believe me it has not gotten to 1months and behold i was back again please another year is coming you should not let ailment follow you to next year contact doctor losa on ( ) he is ever ready and happy to render you service.
    contact him at....( OR YOU CAN CALL OR WHATSAPP HIM +2349050141109)
    stay bless
    Diago Mary.
    special on cureing

    1. HIV/AIDS
    2. HERPES
    3. CANCER
    4. ALS
    9. LUPUS (Lupus Vulgaris or Lupus Erythematosus)

  • Sorina
    Sorina Sunday, 14 January 2018 01:49 Comment Link

    Around age 60 I noticed that my handwriting was getting smaller and I was writing faster. I also noticed a small tremor in my right hand. The doctor went over my different symptoms and he suspected I'd either had a small stroke or the beginnings of Parkinson 's disease. After finding a neurologist and some testing I was diagnosed with the beginning stages of Parkinson’s disease. That was 4 years ago. I take Sinimet four times a day to control my symptoms, which include falling, imbalance, gait problems, swallowing difficulties, and slurring of speech,December 2017 our family doctor started me on Mbeki Herbal Clinic Parkinson’s Disease Herbal mixture, 5 weeks into treatment I improved dramatically. At the end of the full treatment course, the disease is totally under control. No case of dementia, hallucination, weakness, muscle pain or tremors.

    Visit Mbeki Herbal Clinic official website w ww.mbekiherbalclinic .com. I am strong again and able to go about daily activities.‌ This Herbal Formula is Incredible!!

Leave a comment

Make sure you enter all the required information, indicated by an asterisk (*). HTML code is not allowed.