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Purpose: Fatigue is a frequent non-motor complaint of patients with Parkinson's disease (PD). Despite increasing knowledge on fatigue, the factors leading to its development are still not recognised. The aim of this investigation was to test, using structural equation modelling, the hypothesis that the influence of disease severity on fatigue is mediated by symptoms of depression in patients with PD., Method: The sample consisted of 190 PD patients (93 men, 48.9%, mean age 68.2±9.3 years, mean disease duration 6.4±4.7 years) recruited from hospitals and outpatient clinics in the East Slovakia region. The Multidimensional Fatigue Inventory, the Hospital Anxiety and Depression Scale and the Unified Parkinson's Disease Rating Scale were used. LISREL was used to analyse the data., Results: Disease severity was directly associated with symptoms of depression (β=0.26) and directly affected fatigue in terms of increased levels of general fatigue (β=0.35), physical fatigue (β=0.22), reduced activity (β=0.31) and mental fatigue (β=0.29), but did not directly influence reduced motivation. Symptoms of depression mediated the impact of disease severity on general fatigue (β=0.25), on reduced activity (β=0.31) and on mental fatigue (β=0.28), but not on physical fatigue. Reduced motivation was not mediated, but directly influenced by more symptoms of depression (β=0.82)., Discussion: Since increased symptoms of depression mediate the impact of disease severity on three domains of fatigue in PD patients, disease management should focus on the treatment of PD and symptoms of depression., (Copyright © 2013 S. Karger AG, Basel.)

Sleep disturbances are common and often severe in patients with Parkinson's disease (PD) and their symptoms can be present at any time of day. The purpose of our study was to examine how excessive daytime sleepiness or poor nocturnal sleep quality and mood disorders influence the quality of life (QoL) in PD patients. Ninety-three PD patients from eastern Slovakia were recruited (49.5% males, mean age 68.0 ± 9.5 years, mean disease duration 6.1 ± 5.9 years). Sleep disturbances were measured using the Epworth Sleepiness Scale (ESS) and the Pittsburgh Sleep Quality Index (PSQI); QoL with the Parkinson's Disease Quality of Life Questionnaire (PDQ-39); depression and anxiety with the Hospital Anxiety and Depression Scale (HADS) and disease severity with the Unified Parkinson's Disease Rating Scale (UPDRS). χ (2) test, bivariate correlations and multiple linear regressions were performed. PSQI and ESS had significant correlations with worse QoL (p < 0.01, p < 0.05, respectively). HADS-D (p < 0.01), HADS-A (p < 0.01), UPDRS (p < 0.01) and disease duration (p < 0.05) were also significantly related to worse QoL. In the linear regression analysis, however, only PSQI (p < 0.01), anxiety (p < 0.001) and UPDRS (p < 0.001) remained significant. The model with PSQI explained 74% of the variance, and the model with ESS explained 63% of the variance in PDQ-39 when analyses were performed separately. In an overall model, however, only PSQI remained significant, accounting for 82% of the variance in PDQ-39. Nighttime poor sleep and anxiety are important contributors leading to a worse QoL. As these are treatable conditions, they should be recognized by clinicians and managed properly.

Objectives: Personality traits appear as determinants of quality of life (QoL) in most chronic diseases. Type D personality is characterized by ineffective coping strategies that reduce QoL in patients with coronary heart disease. The aim of this study was to evaluate whether Type D personality also predicts QoL in patients with Parkinson's disease (PD). In addition, gender differences in Type D personalities are explored., Methods: The sample consisted of 153 PD patients (51.4% males; mean age 67.9 +/- 9.3 years). DS-14 was used to measure Type D personality, negative affectivity (NA) and social inhibition (SI). The Parkinson's Disease Quality of Life Questionnaire (PDQ-39) was used to assess QoL, and the Unified Parkinson's Disease Rating Scale (UPDRS) was used to assess functional status. The regression model consisted of disease severity, disease duration, age and DS-14 and its two scales (NA and SI)., Results: Type D is negatively associated with overall QoL in PD patients and most subscales of the PDQ-39. Type D explained emotional well-being in both genders but was significant in the models for stigma, cognition, and communication only in men. NA and SI played a less important role in women in comparison with men., Conclusion: Type D personality is an important part of the QoL model in PD patients of both genders, especially in the NA scale. The gender differences suggest that male and female PD patients require different coping strategies.

Purpose: Personality traits appear as determinants of quality of life (QoL) in most chronic diseases. The aim of this study is to explore whether neuroticism and extraversion contribute to the variance in QoL in patients with Parkinson's disease (PD) when controlled for age, functional status and disease duration., Methods: The Parkinson's Disease Quality of Life Questionnaire (PDQ-39) was used to assess QoL and the Unified Parkinson's Disease Rating Scale (UPDRS) for disease severity. Neuroticism and extraversion were measured with the Eysenck Personality Questionnaire (EPQR-A). Multiple linear regression analysis was then used to assess the contribution of neuroticism and extraversion to QoL., Results: The sample consisted of 153 PD patients (48.4% women; 67.9 +/- 9.3 years; mean disease duration 7.5 +/- 5.8 years). Neuroticism was, after disease severity, the second most important variable associated with QoL in PD patients, in particular for domains associated with psychological processes: emotional well-being, social support, stigma and communication. A higher score in extraversion was significantly associated with better emotional well-being in males, but surprisingly, with worse emotional well-being in females., Conclusions: After functional status, personality traits were clearly associated with QoL in PD patients. Therefore, they should be taken into account by health-care professionals in their appraisal of patient complaints.

Objectives: Many patients with Parkinson's disease (PD) suffer from non-motor symptoms like sleep disturbances, excessive daytime sleepiness and fatigue. The aim of our research was to explore whether fatigue is related to sleepiness and sleep problems, depression and functional status, controlled for age, gender and disease duration., Methods: The sample consisted of 78 PD patients from Eastern Slovakia (52% males, mean age 68.8+/-8.7, mean disease duration 7.2+/-6.8). The Multidimensional Fatigue Inventory (5 dimensions), the Epworth Sleepiness Scale, the Pittsburgh Sleep Quality Index, Hospital Anxiety and Depression Scale and the Unified Parkinson's Disease Rating Scale were used. Demographic data were obtained in a structured interview. Multiple linear regression was used to analyse the data., Results: Sleepiness did not show significant association with fatigue in any of the fatigue domains; neither did quality of sleep. Depression was significantly associated with all domains of fatigue, the strongest being the relationship with general fatigue (beta .42), reduced motivation (beta .39), mental fatigue (beta .35) (p<.001), and physical fatigue (beta .31) (p<.01), while the relationship with reduced activity was less strong (beta .22) (p<.05). Worse functional status was significantly related to reduced activity (beta .50), general fatigue (beta .35), physical fatigue (beta .35), and mental fatigue (beta .35) (p<.001)., Conclusion: Fatigue is not related to daytime sleepiness or night-time sleep dysfunction. Fatigue is more strongly influenced by the presence of depression and worse functional status.

Background and Purpose: Fatigue is frequent and important in the lives of Parkinson's disease (PD) patients. It is multidimensional, with physical and mental aspects. The aim of our study was to explore the impact of fatigue on quality of life (QoL) for PD patients., Methods: The sample consisted of 175 PD patients from Eastern Slovakia (52% males, mean age 68.2 +/- 9.2, mean disease duration 7.4 +/- 6.7). The Multidimensional Fatigue Inventory (five dimensions), the Parkinson's Disease Quality of Life Questionnaire (eight dimensions) and the Unified Parkinson's Disease Rating Scale were used. Demographic data were obtained in a structured interview. Fisher's exact test, t-test, and multiple linear regression analysis were used., Results: Different aspects of fatigue selectively explained different domains of QoL - physical dimensions of fatigue were connected with Mobility and Activities of daily living; mental fatigue dimensions affected Cognition, Emotional well-being, Communication and Activities of daily living; general fatigue was related to Bodily discomfort. The explained variances varied from 5% (Social support) to 65% (Activities of daily living)., Conclusion: Fatigue combined with worse functional status appears to be a significant contributor to poor quality of life. Its multidimensional construct can be used to develop strategies for improving specific aspects of fatigue to improve QoL for PD patients.

Fatigue is an important contributor to poor quality of life. The aim of our research was to identify factors associated with fatigue among patients with Parkinson's disease (PD). The sample consisted of 150 patients. The Multidimensional Fatigue Inventory (MFI), Unified Parkinson's Disease Rating Scale (UPDRS), Hospital Anxiety and Depression Scale (HADS) and Charlson co-morbidity index were used for analysis. Demographic data were obtained in a structured interview. T-test, chi(2)-test and general linear regression were used. Fatigue was reported in 81% of the patients, with the worst scores in physical fatigue. Mood disorders and worse UPDRS scores were associated with fatigue.