Interventions for fatigue in Parkinson's disease

Factors contributing to subjective fatigue in people with idiopathic Parkinson's disease (PD) are not well known. This makes it difficult to manage fatigue effectively in PD. To evaluate the effects of pharmacological and non-pharmacological interventions, compared to an inactive control interv...

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Bibliographic Details
Published in:Cochrane database of systematic reviews 2015-10, Vol.2015 (10), p.CD010925-CD010925
Main Authors: Elbers, Roy G, Verhoef, John, van Wegen, Erwin Eh, Berendse, Henk W, Kwakkel, Gert
Format: Article
Language:English
Subjects:
Akinetic‐rigid syndrome
Central Nervous System Stimulants - therapeutic use
Dopamine Agents - therapeutic use
Exercise
Fatigue - etiology
Fatigue - therapy
Humans
Neurology
Parkinson Disease - complications
Randomized Controlled Trials as Topic
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Summary:Factors contributing to subjective fatigue in people with idiopathic Parkinson's disease (PD) are not well known. This makes it difficult to manage fatigue effectively in PD. To evaluate the effects of pharmacological and non-pharmacological interventions, compared to an inactive control intervention, on subjective fatigue in people with PD. We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library); MEDLINE (via PubMed); Ovid EMBASE; EBSCO CINAHL; Ovid PsycINFO; PEDro; and the WHO International Clinical Trials Registry Platform Search Portal up to April 2015. References of included studies and identified review articles were screened for additional studies. There were no restrictions based on language, date of publication or study setting. Randomised controlled trials (RCTs) that report on subjective fatigue in people with PD. Two review authors independently performed study selection, data collection and risk of bias assessments. Eleven studies were eligible for this systematic review, with a total of 1817 people. Three studies included only people who experienced clinically relevant fatigue (Fatigue Severity Scale score ≥ 4 out of 7 or Multidimensional Fatigue Inventory total score > 48 out of 100), whereas all other studies did not select participants on the basis of experienced fatigue. Nine studies investigated the effects of medication (i.e. levodopa-carbidopa, memantine, rasagiline, caffeine, methylphenidate, modafinil or doxepin) on subjective fatigue. All studies were placebo controlled. There was insufficient evidence to determine the effect of doxepin on the impact of fatigue on activities in daily life (ADL) or fatigue severity (one study, N = 12, standardised mean difference (SMD) = -1.50, 95% confidence interval (CI) -2.84 to -0.15; low quality evidence). We found high quality evidence that rasagiline reduced or slowed down the progression of physical aspects of fatigue (one study, N = 1176, SMD = -0.27, 95% CI -0.39 to -0.16, I(2) = 0%). None of the other pharmacological interventions affected subjective fatigue in PD. With regard to adverse effects, only levodopa-carbidopa showed an increase for the risk of nausea (one study, N = 361, risk ratio (RR) = 1.85, 95% CI 1.05 to 3.27; high quality evidence). Two studies investigated the effect of exercise on fatigue compared with usual care. We found low quality evidence for the effect of exercise on reducing the impact of fatigue on ADL or fatigue severity (
ISSN:1469-493X
DOI:10.1002/14651858.CD010925.pub2