Fatigue in de novo Parkinson’s Disease: Expanding the Neuropsychiatric Triad?

Article type: Research Article

Authors: Béreau, Matthieu^{a; b; c; *} | Castrioto, Anna^d | Lhommée, Eugénie^d | Maillet, Audrey^{e; f; g} | Gérazime, Aurélie^h | Bichon, Amélie^d | Pélissier, Pierre^d | Schmitt, Emmanuelle^d | Klinger, Hélène^{e; f; g} | Longato, Nadineⁱ | Fraix, Valérie^d | Benatru, Isabelle^{j; k} | Durif, Franck^l | Azulay, Jean-Philippe^m | Moro, Elena^d | Broussolle, Emmanuel^{e; f; g} | Tranchant, Christineⁱ | Anheim, Mathieu^{i; n; o} | Thobois, Stéphane^{c; e; f; g} | Krack, Paul^p

Affiliations: [a] Department of Neurology, University Hospital of Besançon, Besançon, France | [b] Laboratoire de Recherches Intégratives en Neurosciences et Psychologie Cognitive - UR LINC, Université Bourgogne Franche-Comté, Besançon, France | [c] NS-PARK/FCRIN Network, France | [d] University Grenoble Alpes, Inserm, U1216, CHU Grenoble Alpes, Movement Disorders Unit, Grenoble Institut Neurosciences, Grenoble, France | [e] Movement Disorders Unit, Neurology Department, Hospices Civils de Lyon, University Lyon, Lyon, France | [f] Faculté de Médecine Lyon Sud, Université Claude Bernard Lyon 1, Lyon, France | [g] CNRS, Institut des Sciences Cognitives Marc Jeannerod, UMR 5229, Bron, France | [h] Unité de Méthodologie, CIC INSERM 1431, CHRU de Besançon, Besançon, France | [i] Service de Neurologie, Hôpitaux Universitaires de Strasbourg, Strasbourg, France | [j] Department of Neurology, University Hospital of Poitiers, Poitiers, France | [k] INSERM, CHU de Poitiers, University of Poitiers, Centre d’Investigation Clinique CIC1402, Poitiers, France | [l] Neurology Department, Université Clermont Auvergne, EA7280 NPsy-Sydo, Clermont-Ferrand University Hospital, Clermont-Ferrand, France | [m] Movement Disorders Unit, Neurology Department, University Hospital of Marseille, Marseille, France | [n] Institut de Génétique et de Biologie Moléculaire et Cellulaire (IGBMC), INSERM-U964/CNRS-UMR7104/Université de Strasbourg, Illkirch, France | [o] Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, Strasbourg, France | [p] Movement Disorders Center, Department of Neurology, University Hospital of Bern, Bern, Switzerland

Correspondence: [*] Correspondence to: Matthieu Béreau, MD, Service de Neurologie, CHRU de Besançon, 3 Bd Alexandre Fleming, 25030 Besançon Cedex, France. Tel.: +33381668655; E-mails: mbereau@chu-besancon.fr and matthieu.bereau@univ-fcomte.fr.

Abstract: Background:Fatigue is a frequent and troublesome symptom present from the early stages of Parkinson’s disease (PD). Objective:To examine the relationship between fatigue and the neuropsychiatric triad, which includes apathy, depression, and anxiety, in de novo PD. Methods:We performed a cross-sectional study including 197 patients with de novo PD and assessed fatigue using the Parkinson’s Disease Fatigue Scale (PDFS-16). We evaluated motor status using the Unified Parkinson’s Disease Rating Scale (UPDRS) part III score and evaluated neuropsychiatric status using the Ardouin Scale of Behavior in Parkinson’s Disease (ASBPD). We carried out univariate and multivariate analyses to model association between motor signs, non-motor signs, and fatigue risk. Results:Frequency of fatigue (28.9%) was of the same order of magnitude as that of apathy. PD patients with fatigue reported a lower quality of life than patients without fatigue (p < 0.0001). The ASBPD showed that patients with fatigue had higher scores for depressed mood (p < 0.0001), anxiety (p < 0.0001), and apathy (p < 0.0001). In the univariate analysis, fatigue score was positively correlated with apathy, depression, anxiety, and the neuropsychiatric triad as a whole, and to a lesser extent with female sex, hyperemotivity, and the UPDRS part III score. In the multivariate analysis, after adjusting for sex and motor status, the fatigue score remained significantly correlated with apathy (OR = 11.17 [4.33–28.78], p < 0.0001) and depression (OR = 4.28 [1.39–13.12], p = 0.01), but not with anxiety (OR = 0.94 [0.34–2.58], p = 0.9). Conclusion:We propose that the neuropsychiatric triad could be expanded to include fatigue.

Keywords: Parkinson’s disease, fatigue, apathy, depression, motivation

DOI: 10.3233/JPD-213116

Journal: Journal of Parkinson's Disease, vol. 12, no. 4, pp. 1329-1337, 2022