The Challenge of Disentangling Parkinson’s-related Fatigue and Neuropsychiatric Symptoms

Fatigue is among the most prevalent and debilitating non-motor symptoms in Parkinson’s disease (PD). In the focal article, “Screening cut-off scores for clinically significant fatigue in early Parkinson’s disease”, we discussed the challenges of evaluating fatigue in PD and proposed cut-off scores for select fatigue assessments. This commentary expands on the challenges of evaluating fatigue, especially when it presents alongside psychiatric symptoms. We examine and compare the similarities of fatigue and depression, anxiety, and apathy. Overlapping symptoms include reduced motivation, difficulty sustaining attention, and diminished energy. The challenge of disentangling the phenomena is further complicated by symptoms of PD, which may present with similarities to psychiatric symptoms (e.g., bradykinesia, masked facies, and sleep disturbances). Accurate evaluation and diagnosis of each condition is necessary for a comprehensive approach to PD patient treatment and symptom monitoring.