Fatigue

Do you or a loved one with Parkinson’s disease (PD) feel physically or mentally exhausted? This could be fatigue ― a feeling of deep tiredness that does not improve with rest. About half of people with PD report that fatigue is a major problem and one third say it is their most disabling symptom.

Fatigue is different from sleepiness. A person who is fatigued feels exhausted, however, does not necessarily feel like sleeping.

Fatigue is common early in the course of PD, but can occur at any point and can happen whether movement symptoms are mild or severe. Fatigue can occur on its own or along with other symptoms such as sleep disturbances, pain, or depression. Stress can make fatigue worse.

The cause of fatigue in PD is unknown. It is possible that motor symptoms like tremor and stiffness contribute to making muscles tired, but because fatigue occurs even in those with mild motor symptoms, this is probably not the only explanation. It is important to consider that fatigue can have causes outside of Parkinson’s, too. It is important to identify illnesses or medications unrelated to PD that may contribute to fatigue.

The impact of fatigue can be severe. Extreme exhaustion that comes with fatigue can lead people to avoid social activities, reduce hours at work, or even retire. Understanding fatigue as a symptom of PD and finding ways to cope with it are essential to maintaining a good quality of life.

Therapies

Few therapies have been tested for fatigue in PD and none have been proven effective against fatigue on its own. Optimizing medications for movement symptoms does not typically help fatigue. Despite this, there are strategies and tips that can help:

• When fatigue is mixed with other symptoms, targeting those other symptoms may help a person feel more energetic. For example, treating sleep disturbances can help a person sleep soundly through the night and therefore less fatigued the following day. Treating depression and pain can also be effective in reducing fatigue.
• Some medications for PD motor symptoms may contribute to fatigue or make you sleepy. Adjusting doses of these medications may help solve the problem.
• Work with your primary care doctor to identify and treat any medical causes of fatigue besides PD, such as anemia, thyroid disease, low blood pressure, sleep apnea, nutritional deficiencies in vitamin D, B vitamins, etc.
• Talk with your doctor before taking any vitamins or supplements. These may interact with medications for PD or other disorders.
• Talk to your primary care doctor about medications you take that are not for PD — these also may contribute to fatigue.
• Although little research has been done to evaluate stimulants like amphetamine salts, your physician may recommend trying a low dose if you are otherwise healthy. Not all doctors support this approach.

Fatigue has been identified by the PD community as an unmet need. Research to understand and solve fatigue in PD is ongoing.

Page reviewed by Dr. Addie Patterson, Movement Disorders Neurologist at the Norman Fixel Institute for Neurological Diseases at the University of Florida, a Parkinson’s Foundation Center of Excellence.