Epidemiology Of Fatigue

Fatigue is a common problem that is pathological or normal, depending on circumstances. It is a common problem in primary care.26-30 In a community study in Norway, Loge et al.31 found that "substantial fatigue" lasting six months or more affected 11.4% of the population, aged 19 to 80. Other studies have found fatigue is the presenting complaint in 4 to 9% of primary care office visits.27-29 In one study,32 a sense of chronic fatigue was reported as a "major problem" by 25% of consecutive patients seen in a primary care clinic, with 75% of these patients suffering with it for at least one year. Fatigue is costly in terms of direct health care expenditures and indirect costs such as lost employment.26 For instance, fatigue was estimated to account for 9.3% of formal health care expenditures in the UK.26

Fatigue is associated with worse physical and mental health27,33,34 and often adds morbidity to common medical disorders such as diabetes,35 chronic renal failure,36 and cancer.37 It is a diagnostic symptom of mood disorders such as depression and generalized anxiety disorders38 and occurs in many psychiatric illnesses.39 Fatigue is consistently associated with several neurological disorders6-40-44 and affects 80 to 100% of patients with systemic lupus erythematosis.45-47 In one study, fatigue was deemed the most bothersome symptom in more than one-fourth of MS patients.48 Although fatigue is considered a hallmark symptom in multiple sclerosis patients, it was not recognized until 1984, when an influential paper by Freal et al.49 reported that 78% of patients described fatigue as a symptom, making it both the single most common symptom as well as the one most likely to interfere with activities of daily life.

Fatigue is a prevalent and frequently disabling symptom in patients with Parkinson's disease.6,7,16,50-54 Affecting up to two-thirds of all patients with PD,7 15 to 33% of all PD patients report fatigue to be their most disabling symptom, and more than 50% rank fatigue among their three worst symptoms.6,7,52 In a recent study in southwest Norway,54 every patient diagnosed with PD who might require medication was identified and, after excluding depressed and demented patients, 50% were found to suffer from fatigue. Of note here is the observation by Hoehn and Yahr in their classic 1967 paper55 that fatigue was the presenting symptom in 2% of PD patients.

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