PhD ceremony: mw. E. Havlikova, 13.15 uur, Academiegebouw, Broerstraat 5, Groningen
Thesis: Fatigue, mood disorders and sleep problems in patients with Parkinson's disease
Promotor(s): prof. J.W. Groothoff
Faculty: Medical Sciences
Parkinson’s disease (PD) is a slowly progressive disease characterized by its motor and nonmotor features. This thesis focuses on fatigue, sleep problems and mood disorders, on the relationships between these nonmotor features and their impact on quality of life (QoL) of PD patients.
Sleep problems are frequent in PD patients and they may occur during the nighttime as well as during the daytime. Our results thus showed an important contribution of nighttime sleep disturbances and anxiety to poor QoL. Fatigue is considered to be a multidimensional construct with mental and physical components which are independent from each other. We found the mental components were associated with more psychological QoL domains and the physical components were related to more physical QoL domains. Sleep disturbances (either daytime or nighttime) do not have significant relationships with fatigue domains, thus indicating that these two problems – fatigue and sleep problems in PD patients – are independent from each other.
Looking at factors associated with fatigue depression was found to have significant relationships with worse scores for all the fatigue components. Anxiety was associated with more serious General fatigue and Reduced motivation. To evaluate the causal relationships between depression, functional status and fatigue LISREL analysis was performed. We found that worse functional status and worse depression both lead to worse General fatigue, Reduced activity and Mental fatigue. Worse disease severity alone caused worse Physical fatigue, and worse depression alone caused more fatigue in the Reduced motivation component.
Nonmotor symptoms add significantly to the overall disability caused by PD and are critical determinants of health-related quality of life. In the era of effective symptomatic therapies for the motor symptoms of PD, non-motor dysfunction has developed into a major prognostic factor for overall disease burden and everyday function in PD. The recognition of possible treatable problems and their proper management is extremely important as they may lead to the improvement of the quality of life of PD patients.
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