Objectives: Fatigue is common in Parkinson's disease (PD), causing serious negative effects on quality of life. Despite its clinical importance, the nature of fatigue in PD is poorly understood because its underlying neurobiology is unknown. Fatigue can be more complicated in advanced PD because of its chronicity. In order to find features that are innate to fatigue in PD, it would be useful to conduct a study looking at de novo PD. Assessing fatigue in de novo patients allows excluding at least one confounding factor. Methods: We prospectively investigated 87 drug-naïve PD patients. Thirty-nine patients (44.8%) were found to have fatigue around the time of diagnosis of PD. Results: We found that depression and difficulties with activities of daily living were independent risk factors for fatigue; however, motor dysfunction was not related. Clinically meaningful responses to dopaminergic medication were observed. Discussion: Our study determined that fatigue occurs in the early stages of PD. It can inform clinical decision-making to significantly benefit PD patients with fatigue.

1.
Antonini A, Barone P, Marconi R, et al: The progression of non-motor symptoms in Parkinson's disease and their contribution to motor disability and quality of life. J Neurol 2012;26:2621-2631.
2.
Havlikova E, Rosenberger J, Nagyova I, et al: Impact of fatigue on quality of life in patients with Parkinson's disease. Eur J Neurol 2008;15:475-480.
3.
Herlofson K, Larsen JP: Measuring fatigue in patients with Parkinson's disease - the Fatigue Severity Scale. Eur J Neurol 2002;9:595-600.
4.
Shen J, Barbera J, Shapiro CM: Distinguishing sleepiness and fatigue: focus on definition and measurement. Sleep Med Rev 2006;10:63-76.
5.
Hughes AJ, Ben-Shlomo Y, Daniel SE, Lees AJ: What features improve the accuracy of clinical diagnosis in Parkinson's disease: a clinicopathologic study. Neurology 1992;42:1142-1146.
6.
Edwards BC, Lambert MJ, Moran PW, McCully T, Smith KC, Ellingson AG: A meta-analytic comparison of the Beck Depression Inventory and the Hamilton Rating Scale for Depression as measures of treatment outcome. Br J Clin Psychol 1984;23:93-99.
7.
Friedman JH, Chou KL: Sleep and fatigue in Parkinson's disease. Parkinsonism Relat Disord 2004;10(suppl 1):S27-S35.
8.
Krupp LB, LaRocca NG, Muir-Nash J, Steinberg AD: The fatigue severity scale. Application to patients with multiple sclerosis and systemic lupus erythematosus. Arch Neurol 1989;46:1121-1123.
9.
Tomlinson CL, Stowe R, Patel S, Rick C, Gray R, Clarke CE: Systematic review of levodopa dose equivalency reporting in Parkinson's disease. Mov Disord 2010;25:2649-2653.
10.
Measurement of fatigue in systemic lupus erythematosus: a systematic review. Arthritis Rheum 2007;57:1348-1357.
11.
Herlofson K, Ongre SO, Enger LK, Tysnes OB, Larsen JP: Fatigue in early Parkinson's disease. Minor inconvenience or major distress? Eur J Neurol 2012;19:963-968.
12.
Schifitto G, Friedman JH, Oakes D, et al: Fatigue in levodopa-naive subjects with Parkinson disease. Neurology 2008;71:481-485.
13.
Alexander NB, Taffet GE, Horne FM, et al: Bedside-to-bench conference: research agenda for idiopathic fatigue and aging. J Am Geriatr Soc 2010;58:967-975.
14.
Pavese N, Metta V, Bose SK, Chaudhuri KR, Brooks DJ: Fatigue in Parkinson's disease is linked to striatal and limbic serotonergic dysfunction. Brain 2010;133:3434-3443.
15.
Politis M, Wu K, Loane C, et al: Depressive symptoms in PD correlate with higher 5-HTT binding in raphe and limbic structures. Neurology 2010;75:1920-1927.
16.
Karlsen K, Larsen JP, Tandberg E, Jorgensen K: Fatigue in patients with Parkinson's disease. Mov Disord 1999;14:237-241.
17.
Alves G, Wentzel-Larsen T, Larsen JP: Is fatigue an independent and persistent symptom in patients with Parkinson disease? Neurology 2004;63:1908-1911.
18.
Okuma Y, Kamei S, Morita A, et al: Fatigue in Japanese patients with Parkinson's disease: a study using Parkinson fatigue scale. Mov Disord 2009;24:1977-1983.
19.
Chou KL: The changing relationship between obesity and disability in middle and older adults: 1997 and 2006 China health and nutrition surveys. J Am Geriatr Soc 2012;60:2364-2365.
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