How to Cope with Disabling Fatigue in Parkinson's Disease

Tired woman laying on bed with eyes closed. Credit: Hero Images / Getty Images

For many people with Parkinson's disease, fatigue is just as disabling and unpleasant a symptom as the motor slowing or the trembling.

Fatigue undermines all kinds of daily activities and rehabilitation programs. It feeds into our emotional reactions to Parkinson's symptoms and makes them all the harder to bear. It undermines our ability to cope with the challenges the condition presents to us each day, and makes it more difficult to connect with others.

Therefore, fatigue sometimes can increase our social isolation as it saps us of the energy we need to step out of the door and to interact with others.

If your doctor has not asked you about your level of fatigue, but you have symptoms (or just have questions about it), please bring it up.

Fatigue in Parkinson's: A Major Symptom

Here are the facts about fatigue in Parkinson's disease:

  • It tends to develop early in the disease and, if untreated, gets worse over time.
  • It is associated with reduced physical activity and poorer quality of life.
  • It can make Parkinson's and depression feel worse.
  • It is not due to lack of sleep, though it can be associated with sleep problems.
  • It often influences mental attention, making it harder to concentrate and to focus one’s attention.
  • It is unknown at this time if fatigue is more prevalent in men or women with Parkinson's.
  • One third of Parkinson's patients consider fatigue their single most disabling symptom, worse than the motor symptoms in the condition.
  • Fifty-eight percent of Parkinson's patients consider fatigue to be one of their three most disabling symptoms

How Does the Fatigue Make You Feel?

Fatigue is typically experienced as a state of being tired, weary, exhausted and without energy. Some people say they feel like they are walking underwater or through molasses — everything is an effort and exhausting.

Although fatigue can make depression worse, it is not the same as depression. You can have fatigue without depression, and most people with fatigue are not sad or self-destructive.

Similarly, fatigue is not the same as excessive daytime sleepiness. Although fatigue makes daytime sleepiness worse and harder to bear, you can have daytime sleepiness but not have fatigue. You also can experience the need for and urge to sleep, but not feel like you are walking underwater or through a field of molasses! Exhaustion and weariness are not the same as sleepiness.

Diagnosing Your Fatigue

If you are feeling weary and exhausted all the time and you mention this problem to your doctor, she may ask you to fill out a questionnaire to assess your symptoms. In addition, she may perform some special tests on you. For example:

  • Subjective mental and physical fatigue are evaluated using self-report questionnaires such as the Multidimensional Fatigue Inventory.
  • "Physical fatigability" can be measured by observing your endurance levels when performing physical exercise.
  • "Mental fatigability" is evaluated by measuring attention over time using an evaluation tool called the Attention Network Test. In this test, you will be asked to press a button whenever you see a certain "stimulus" or icon among a group of other icons on a computer screen. People with fatigue show a particular pattern of slowed button presses.

Steps You Can Take to Reduce Fatigue

If you are feeling fatigued and exhausted all the time, what can you do about it?

First and most importantly, speak to your doctor about how much the fatigue disturbs you. Does it undermine your daily activities? Does it make it more difficult to attend clinic visits or rehabilitation appointments? Does it feed into your emotional life? Does it undermine your coping ability? Once you speak to your doctor about your fatigue, your doctor might also recommend the following steps:

  • Engage in regular physical exercise, including the use of weights to increase muscle strength. Studies show that physical exercise combats both physical and mental fatigue.
  • Consider taking anti-depressant medication. Although fatigue is not caused by depression, depression can worsen fatigue (and vice versa). Treating depression if it is present might allow you to overcome fatigue with exercise or some other treatment.
  • Consider trying stimulants like Ritalin (normally prescribed for attention deficit-hyperactivity disorder) or Provigil (prescribed for sleep apnea and narcolepsy). Some doctors have reported that these drugs may help certain Parkinson's patients.


Friedman JH, Brown RG, Comella C, Garber CE, Krupp LB, Lou JS, Marsh L, Nail L, Shulman L, Taylor CB; Working Group on Fatigue in Parkinson's Disease. Fatigue in Parkinson's disease: a review. Mov Disord. 2007 Feb 15;22(3):297-308. Review

Lou JS. Physical and mental fatigue in Parkinson's disease: epidemiology, pathophysiology and treatment. Drugs Aging. 2009;26(3):195-208. Review

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