Central and peripheral fatigue have been identified in PD patients.16,18 Although some believe these are distinct types of fatigue, there is evidence that central mechanisms may underlie the accelerated muscle fatigue thought to be corroboration of peripheral fatigue.17,18 Central fatigue is characterized by difficulty in initiating and sustaining mental and physical tasks in the absence of cognitive or motor impairment.18 Mental fatigue has two subdivisions: mental lassitude induced either by hypo- or hypervigilance. The former occurs with repetitive and boring tasks. In PD patients, reduced stimulation due to physical dependence and social isolation consequent to the disease may result in a hypovigilant state. Sustained hypervigilance can also cause mental fatigue, for example, when keeping close track of breaking news stories and making complex decisions. Sustained emotional stressors, such as a critical illness in a close relative, may result in emotional fatigue.
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