{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T15:44:40Z","timestamp":1786463080972,"version":"build-2736575974"},"reference-count":46,"publisher":"Springer Science and Business Media LLC","issue":"4","license":[{"start":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T00:00:00Z","timestamp":1777593600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T00:00:00Z","timestamp":1777593600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100004702","name":"Universit\u00e0 degli Studi di Genova","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100004702","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Acta Neurol Belg"],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Fatigue is a common and disabling non-motor symptom in Parkinson\u2019s disease (PD), significantly affecting patients\u2019 quality of life. However, it is often underdiagnosed due to its subjective nature and the lack of a clear definition, hindering the development of effective treatments.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>This study aims to investigate the prevalence of fatigue and its associations with sociodemographic factors, disease severity, levodopa equivalent daily dosage (LEDD) and motor, non-motor, and cognitive symptoms in an Italian cohort of patients with PD.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>An observational cross-sectional study was carried out in three Italian centers from January to May 2024. One hundred PD patients (H&amp;Y\u2009\u2264\u20094) were assessed using validated tools: Parkinson Fatigue Scale (PFS), Fatigue Severity Scale, and Modified Fatigue Impact Scale. Motor and non-motor signs and symptoms, cognitive status, and LEDD were analyzed using non-parametric tests and Spearman\u2019s correlations. Fatigue prevalence was determined based on PFS score\u2009\u2265\u20093.09.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Fatigue was present in 36% of patients, more prevalent in women and more severe in those with H&amp;Y\u2009&gt;\u20092. Fatigue correlated strongly with non-motor symptoms (MDS-UPDRS Part I; \u03c1\u2009&gt;\u20090.6,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001) and moderately with motor complications (0.4\u2009&lt;\u2009\u03c1\u2009&lt;\u20090.5,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), but weakly with disease duration, LEDD and age (\u03c1\u2009&lt;\u20090.3, 0.002\u2009&lt;\u2009\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.05). Significant intercorrelations among fatigue scales supported their ability to consistently measure the fatigue construct.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Fatigue in PD is a multidimensional phenomenon influenced mainly by non-motor symptoms. Gender-specific differences and the association with disease progression underscore the need of comprehensive and integrated management strategies to address this challenging symptom.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s13760-026-03039-3","type":"journal-article","created":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T10:58:20Z","timestamp":1777633100000},"page":"1323-1333","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Exploring the fatigue phenomenon in individuals with Parkinson\u2019s disease: an Italian multicenter cross-sectional study"],"prefix":"10.1007","volume":"126","author":[{"given":"Elisabetta","family":"Sarasso","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elisa","family":"Pelosin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ilaria","family":"Ruotolo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manuela","family":"Maieron","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandro","family":"Ferrero","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesca","family":"Quarone","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Grassi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martina","family":"Putzolu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Gardoni","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giovanna","family":"Lagravinese","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesca","family":"Di Biasio","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Federica","family":"Agosta","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giovanni","family":"Galeoto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giovanni","family":"Fabbrini","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Avanzino","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Massimo","family":"Filippi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susanna","family":"Mezzarobba","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,5,1]]},"reference":[{"key":"3039_CR1","doi-asserted-by":"publisher","first-page":"2284","DOI":"10.1016\/S0140-6736(21)00218-X","volume":"397","author":"BR Bloem","year":"2021","unstructured":"Bloem BR, Okun MS, Klein C (2021) Parkinson\u2019s disease. Lancet 397:2284\u20132303. https:\/\/doi.org\/10.1016\/S0140-6736(21)00218-X","journal-title":"Lancet"},{"key":"3039_CR2","doi-asserted-by":"publisher","first-page":"896","DOI":"10.1016\/S0140-6736(14)61393-3","volume":"386","author":"LV Kalia","year":"2015","unstructured":"Kalia LV, Lang AE (2015) Parkinson\u2019s disease. Lancet 386:896\u2013912. https:\/\/doi.org\/10.1016\/S0140-6736(14)61393-3","journal-title":"Lancet"},{"key":"3039_CR3","doi-asserted-by":"publisher","first-page":"743","DOI":"10.1016\/bs.irn.2017.05.007","volume":"133","author":"BM Kluger","year":"2017","unstructured":"Kluger BM (2017) Fatigue in Parkinson\u2019s disease. Int Rev Neurobiol 133:743\u2013768. https:\/\/doi.org\/10.1016\/bs.irn.2017.05.007","journal-title":"Int Rev Neurobiol"},{"key":"3039_CR4","doi-asserted-by":"publisher","first-page":"297","DOI":"10.1002\/mds.21240","volume":"22","author":"JH Friedman","year":"2007","unstructured":"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\u2019s D (2007) Fatigue in Parkinson\u2019s disease: a review. Mov Disord 22:297\u2013308. https:\/\/doi.org\/10.1002\/mds.21240","journal-title":"Mov Disord"},{"key":"3039_CR5","doi-asserted-by":"publisher","first-page":"124","DOI":"10.1016\/j.clineuro.2018.11.001","volume":"175","author":"T Hu","year":"2018","unstructured":"Hu T, Ou R, Liu H, Hou Y, Wei Q, Song W, Cao B, Chen Y, Yuan X, Shang H (2018) Gender and onset age related-differences of non-motor symptoms and quality of life in drug-naive Parkinson\u2019s disease. Clin Neurol Neurosurg 175:124\u2013129. https:\/\/doi.org\/10.1016\/j.clineuro.2018.11.001","journal-title":"Clin Neurol Neurosurg"},{"key":"3039_CR6","doi-asserted-by":"publisher","first-page":"54","DOI":"10.1016\/j.parkreldis.2017.02.024","volume":"38","author":"T Maeda","year":"2017","unstructured":"Maeda T, Shimo Y, Chiu SW, Yamaguchi T, Kashihara K, Tsuboi Y, Nomoto M, Hattori N, Watanabe H, Saiki H, group JF (2017) Clinical manifestations of nonmotor symptoms in 1021 Japanese Parkinson\u2019s disease patients from 35 medical centers. Parkinsonism Relat Disord 38:54\u201360. https:\/\/doi.org\/10.1016\/j.parkreldis.2017.02.024","journal-title":"Parkinsonism Relat Disord"},{"key":"3039_CR7","doi-asserted-by":"publisher","first-page":"1639","DOI":"10.1007\/s00415-011-6392-3","volume":"259","author":"P Martinez-Martin","year":"2012","unstructured":"Martinez-Martin P, Falup Pecurariu C, Odin P, van Hilten JJ, Antonini A, Rojo-Abuin JM, Borges V, Trenkwalder C, Aarsland D, Brooks DJ, Ray Chaudhuri K (2012) Gender-related differences in the burden of non-motor symptoms in Parkinson\u2019s disease. J Neurol 259:1639\u20131647. https:\/\/doi.org\/10.1007\/s00415-011-6392-3","journal-title":"J Neurol"},{"key":"3039_CR8","doi-asserted-by":"publisher","first-page":"215","DOI":"10.1212\/WNL.0000000000000587","volume":"83","author":"F Stocchi","year":"2014","unstructured":"Stocchi F, Abbruzzese G, Ceravolo R, Cortelli P, D\u2019Amelio M, De Pandis MF, Fabbrini G, Pacchetti C, Pezzoli G, Tessitore A, Canesi M, Iannacone C, Zappia M, S Group F (2014) Prevalence of fatigue in Parkinson disease and its clinical correlates. Neurology 83:215\u2013220. https:\/\/doi.org\/10.1212\/WNL.0000000000000587","journal-title":"Neurology"},{"key":"3039_CR9","doi-asserted-by":"publisher","first-page":"416","DOI":"10.1111\/ggi.14156","volume":"21","author":"KY Kwon","year":"2021","unstructured":"Kwon KY, Lee EJ, Lee M, Ju H, Im K (2021) Impact of motor subtype on non-motor symptoms and fall-related features in patients with early Parkinson\u2019s disease. Geriatr Gerontol Int 21:416\u2013420. https:\/\/doi.org\/10.1111\/ggi.14156","journal-title":"Geriatr Gerontol Int"},{"key":"3039_CR10","doi-asserted-by":"publisher","first-page":"1206","DOI":"10.1002\/mdc3.13346","volume":"8","author":"OO Ojo","year":"2021","unstructured":"Ojo OO, Wahab KW, Bello AH, Abubakar SA, Ekeh BC, Otubogun FM, Iwuozo EU, Farombi TH, Adeniji O, Ojini FI, Imarhiagbe FA, Nyandaiti Y, Komolafe MA, Fawale MB, Onwuegbuzie GA, Zubair Y, Williams UE, Taiwo FT, Oyakhire SI, Oshinaike OO, Osemwegie N, Osaigbovo GO, Odiase FE, Odeniyi OA, Obiabo YO, Obehighe EE, Nwazor EO, Nwani PO, Kehinde AJ, Erameh CO, Ekenze OS, Dike FO, Balarabe SA, Arigbodi O, Arabambi B, Ani-Osheku I, Ali MW, Akpekpe JE, Akinyemi RO, Agulanna U, Agu CE, Agabi OP, Ademiluyi BA, Adebowale AA, Achoru CO, Abiodun OV, Rizig M, Okubadejo NU (2021) A Cross-Sectional Comprehensive Assessment of the Profile and Burden of Non-motor Symptoms in Relation to Motor Phenotype in the Nigeria Parkinson Disease Registry Cohort. Mov Disord Clin Pract 8:1206\u20131215. https:\/\/doi.org\/10.1002\/mdc3.13346","journal-title":"Mov Disord Clin Pract"},{"key":"3039_CR11","doi-asserted-by":"publisher","first-page":"87","DOI":"10.1016\/j.parkreldis.2017.02.005","volume":"37","author":"BM Kluger","year":"2017","unstructured":"Kluger BM, Pedersen KF, Tysnes OB, Ongre SO, Oygarden B, Herlofson K (2017) Is fatigue associated with cognitive dysfunction in early Parkinson\u2019s disease? Parkinsonism Relat Disord 37:87\u201391. https:\/\/doi.org\/10.1016\/j.parkreldis.2017.02.005","journal-title":"Parkinsonism Relat Disord"},{"key":"3039_CR12","doi-asserted-by":"publisher","first-page":"63","DOI":"10.1016\/j.parkreldis.2017.10.004","volume":"45","author":"M Siciliano","year":"2017","unstructured":"Siciliano M, Trojano L, De Micco R, De Mase A, Garramone F, Russo A, Tedeschi G, Tessitore A (2017) Motor, behavioural, and cognitive correlates of fatigue in early, de novo Parkinson disease patients. Parkinsonism Relat Disord 45:63\u201368. https:\/\/doi.org\/10.1016\/j.parkreldis.2017.10.004","journal-title":"Parkinsonism Relat Disord"},{"key":"3039_CR13","doi-asserted-by":"publisher","first-page":"394","DOI":"10.1111\/ane.12977","volume":"138","author":"K Herlofson","year":"2018","unstructured":"Herlofson K, Heijnen CJ, Lange J, Alves G, Tysnes OB, Friedman JH, Fagundes CP (2018) Inflammation and fatigue in early, untreated Parkinson\u2019s Disease. Acta Neurol Scand 138:394\u2013399. https:\/\/doi.org\/10.1111\/ane.12977","journal-title":"Acta Neurol Scand"},{"key":"3039_CR14","doi-asserted-by":"publisher","first-page":"107","DOI":"10.1016\/j.jns.2008.02.013","volume":"270","author":"E Havlikova","year":"2008","unstructured":"Havlikova E, van Dijk JP, Rosenberger J, Nagyova I, Middel B, Dubayova T, Gdovinova Z, Groothoff JW (2008) Fatigue in Parkinson\u2019s disease is not related to excessive sleepiness or quality of sleep. J Neurol Sci 270:107\u2013113. https:\/\/doi.org\/10.1016\/j.jns.2008.02.013","journal-title":"J Neurol Sci"},{"key":"3039_CR15","doi-asserted-by":"publisher","first-page":"80","DOI":"10.1111\/ane.12282","volume":"131","author":"M Skorvanek","year":"2015","unstructured":"Skorvanek M, Gdovinova Z, Rosenberger J, Saeedian RG, Nagyova I, Groothoff JW, van Dijk JP (2015) The associations between fatigue, apathy, and depression in Parkinson\u2019s disease. Acta Neurol Scand 131:80\u201387. https:\/\/doi.org\/10.1111\/ane.12282","journal-title":"Acta Neurol Scand"},{"key":"3039_CR16","doi-asserted-by":"publisher","first-page":"673","DOI":"10.1016\/j.clineuro.2012.07.032","volume":"115","author":"EM Khedr","year":"2013","unstructured":"Khedr EM, El Fetoh NA, Khalifa H, Ahmed MA, El Beh KM (2013) Prevalence of non motor features in a cohort of Parkinson\u2019s disease patients. Clin Neurol Neurosurg 115:673\u2013677. https:\/\/doi.org\/10.1016\/j.clineuro.2012.07.032","journal-title":"Clin Neurol Neurosurg"},{"issue":"Suppl 1","key":"3039_CR17","doi-asserted-by":"publisher","first-page":"S222","DOI":"10.1016\/S1353-8020(11)70068-2","volume":"18","author":"HB Wen","year":"2012","unstructured":"Wen HB, Zhang ZX, Wang H, Li L, Chen H, Liu Y, Zhang B, Xu Q (2012) Epidemiology and clinical phenomenology for Parkinson\u2019s disease with pain and fatigue. Parkinsonism Relat Disord 18(Suppl 1):S222\u2013225. https:\/\/doi.org\/10.1016\/S1353-8020(11)70068-2","journal-title":"Parkinsonism Relat Disord"},{"issue":"Suppl 1","key":"3039_CR18","doi-asserted-by":"publisher","first-page":"S226","DOI":"10.1016\/S1353-8020(11)70069-4","volume":"18","author":"A Berardelli","year":"2012","unstructured":"Berardelli A, Conte A, Fabbrini G, Bologna M, Latorre A, Rocchi L, Suppa A (2012) Pathophysiology of pain and fatigue in Parkinson\u2019s disease. Parkinsonism Relat Disord 18(Suppl 1):S226\u2013228. https:\/\/doi.org\/10.1016\/S1353-8020(11)70069-4","journal-title":"Parkinsonism Relat Disord"},{"key":"3039_CR19","doi-asserted-by":"publisher","first-page":"153","DOI":"10.1016\/j.jns.2016.09.030","volume":"370","author":"JR Pereira","year":"2016","unstructured":"Pereira JR, Santos LVD, Santos RMS, Campos ALF, Pimenta AL, de Oliveira MS, Bacheti GG, Rocha NP, Teixeira AL, Christo PP, Scalzo PL (2016) IL-6 serum levels are elevated in Parkinson\u2019s disease patients with fatigue compared to patients without fatigue. J Neurol Sci 370:153\u2013156. https:\/\/doi.org\/10.1016\/j.jns.2016.09.030","journal-title":"J Neurol Sci"},{"key":"3039_CR20","doi-asserted-by":"publisher","DOI":"10.1016\/j.clineuro.2021.106844","volume":"208","author":"H Wang","year":"2021","unstructured":"Wang H, Liu Y, Zhao J, Guo X, Hu M, Chen Y (2021) Possible inflammatory mechanisms and predictors of Parkinson\u2019s disease patients with fatigue (Brief Review). Clin Neurol Neurosurg 208:106844. https:\/\/doi.org\/10.1016\/j.clineuro.2021.106844","journal-title":"Clin Neurol Neurosurg"},{"key":"3039_CR21","doi-asserted-by":"publisher","first-page":"477","DOI":"10.1080\/14737175.2020.1752669","volume":"20","author":"C Lazcano-Ocampo","year":"2020","unstructured":"Lazcano-Ocampo C, Wan YM, van Wamelen DJ, Batzu L, Boura I, Titova N, Leta V, Qamar M, Martinez-Martin P, Ray Chaudhuri K (2020) Identifying and responding to fatigue and apathy in Parkinson\u2019s disease: a review of current practice. Expert Rev Neurother 20:477\u2013495. https:\/\/doi.org\/10.1080\/14737175.2020.1752669","journal-title":"Expert Rev Neurother"},{"key":"3039_CR22","doi-asserted-by":"publisher","first-page":"172","DOI":"10.1016\/j.jocn.2020.07.004","volume":"79","author":"ZH Lu","year":"2020","unstructured":"Lu ZH, Chen YK, Fu XL, Liu YL, Qu JF, Xiao WM (2020) Global cortical atrophy may be associated with fatigue in patients with Parkinson\u2019s disease. J Clin Neurosci 79:172\u2013177. https:\/\/doi.org\/10.1016\/j.jocn.2020.07.004","journal-title":"J Clin Neurosci"},{"key":"3039_CR23","doi-asserted-by":"publisher","first-page":"143","DOI":"10.1111\/psyg.12302","volume":"18","author":"DV Nassif","year":"2018","unstructured":"Nassif DV, Pereira JS (2018) Fatigue in Parkinson\u2019s disease: concepts and clinical approach. Psychogeriatrics 18:143\u2013150. https:\/\/doi.org\/10.1111\/psyg.12302","journal-title":"Psychogeriatrics"},{"key":"3039_CR24","doi-asserted-by":"publisher","first-page":"3434","DOI":"10.1093\/brain\/awq268","volume":"133","author":"N Pavese","year":"2010","unstructured":"Pavese N, Metta V, Bose SK, Chaudhuri KR, Brooks DJ (2010) Fatigue in Parkinson\u2019s disease is linked to striatal and limbic serotonergic dysfunction. Brain 133:3434\u20133443. https:\/\/doi.org\/10.1093\/brain\/awq268","journal-title":"Brain"},{"key":"3039_CR25","doi-asserted-by":"publisher","first-page":"1712","DOI":"10.1002\/mds.27461","volume":"33","author":"M Siciliano","year":"2018","unstructured":"Siciliano M, Trojano L, Santangelo G, Micco RD, Tedeschi G, Tessitore A (2018) Fatigue in Parkinson\u2019s disease: a systematic review and meta-analysis. Mov Disord 33:1712\u20131723. https:\/\/doi.org\/10.1002\/mds.27461","journal-title":"Mov Disord"},{"key":"3039_CR26","doi-asserted-by":"publisher","first-page":"1497","DOI":"10.1002\/mds.26650","volume":"31","author":"A Tessitore","year":"2016","unstructured":"Tessitore A, Giordano A, Micco RD, Caiazzo G, Russo A, Cirillo M, Esposito F, Tedeschi G (2016) Functional connectivity underpinnings of fatigue in drug-naive patients with Parkinson\u2019s disease. Mov Disord 31:1497\u20131505. https:\/\/doi.org\/10.1002\/mds.26650","journal-title":"Mov Disord"},{"key":"3039_CR27","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD010925.pub2","volume":"2015","author":"RG Elbers","year":"2015","unstructured":"Elbers RG, Verhoef J, van Wegen EE, Berendse HW, Kwakkel G (2015) Interventions for fatigue in Parkinson\u2019s disease. Cochrane Database Syst Rev 2015:CD010925. https:\/\/doi.org\/10.1002\/14651858.CD010925.pub2","journal-title":"Cochrane Database Syst Rev"},{"key":"3039_CR28","doi-asserted-by":"publisher","first-page":"659","DOI":"10.3233\/JPD-225116","volume":"13","author":"AK Folkerts","year":"2023","unstructured":"Folkerts AK, Nielsen J, Gollan R, Lansu A, Solfronk D, Monsef I, Ernst M, Skoetz N, Zeuner KE, Kalbe E (2023) Physical exercise as a potential treatment for fatigue in Parkinson\u2019s disease? A systematic review and meta-analysis of pharmacological and non-pharmacological interventions. J Parkinsons Dis 13:659\u2013679. https:\/\/doi.org\/10.3233\/JPD-225116","journal-title":"J Parkinsons Dis"},{"key":"3039_CR29","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyt.2021.793804","volume":"12","author":"F Luo","year":"2021","unstructured":"Luo F, Ye M, Lv T, Hu B, Chen J, Yan J, Wang A, Chen F, He Z, Ding Z, Zhang J, Qian C, Liu Z (2021) Efficacy of cognitive behavioral therapy on mood disorders, sleep, fatigue, and quality of life in Parkinson\u2019s disease: a systematic review and meta-analysis. Front Psychiatry 12:793804. https:\/\/doi.org\/10.3389\/fpsyt.2021.793804","journal-title":"Front Psychiatry"},{"key":"3039_CR30","doi-asserted-by":"publisher","first-page":"181","DOI":"10.1136\/jnnp.55.3.181","volume":"55","author":"AJ Hughes","year":"1992","unstructured":"Hughes AJ, Daniel SE, Kilford L, Lees AJ (1992) Accuracy of clinical diagnosis of idiopathic Parkinson\u2019s disease: a clinico-pathological study of 100 cases. J Neurol Neurosurg Psychiatry 55:181\u2013184. https:\/\/doi.org\/10.1136\/jnnp.55.3.181","journal-title":"J Neurol Neurosurg Psychiatry"},{"key":"3039_CR31","doi-asserted-by":"publisher","first-page":"1236","DOI":"10.1002\/mds.29410","volume":"38","author":"ST Jost","year":"2023","unstructured":"Jost ST, Kaldenbach MA, Antonini A, Martinez-Martin P, Timmermann L, Odin P, Katzenschlager R, Borgohain R, Fasano A, Stocchi F, Hattori N, Kukkle PL, Rodriguez-Violante M, Falup-Pecurariu C, Schade S, Petry-Schmelzer JN, Metta V, Weintraub D, Deuschl G, Espay AJ, Tan EK, Bhidayasiri R, Fung VSC, Cardoso F, Trenkwalder C, Jenner P, Ray Chaudhuri K, Dafsari HS (2023) Levodopa dose equivalency in Parkinson\u2019s disease: updated systematic review and proposals. Mov Disord 38:1236\u20131252. https:\/\/doi.org\/10.1002\/mds.29410","journal-title":"Mov Disord"},{"key":"3039_CR32","doi-asserted-by":"publisher","first-page":"105","DOI":"10.1016\/j.parkreldis.2019.05.028","volume":"65","author":"M Siciliano","year":"2019","unstructured":"Siciliano M, Chiorri C, De Micco R, Russo A, Tedeschi G, Trojano L, Tessitore A (2019) Fatigue in Parkinson\u2019s disease: Italian validation of the Parkinson Fatigue Scale and the Fatigue Severity Scale using a Rasch analysis approach. Parkinsonism Relat Disord 65:105\u2013110. https:\/\/doi.org\/10.1016\/j.parkreldis.2019.05.028","journal-title":"Parkinsonism Relat Disord"},{"key":"3039_CR33","doi-asserted-by":"publisher","first-page":"805","DOI":"10.1002\/mds.22989","volume":"25","author":"JH Friedman","year":"2010","unstructured":"Friedman JH, Alves G, Hagell P, Marinus J, Marsh L, Martinez-Martin P, Goetz CG, Poewe W, Rascol O, Sampaio C, Stebbins G, Schrag A (2010) Fatigue rating scales critique and recommendations by the Movement Disorders Society task force on rating scales for Parkinson\u2019s disease. Mov Disord 25:805\u2013822. https:\/\/doi.org\/10.1002\/mds.22989","journal-title":"Mov Disord"},{"key":"3039_CR34","doi-asserted-by":"publisher","first-page":"101","DOI":"10.1016\/j.parkreldis.2017.07.016","volume":"43","author":"BM Kluger","year":"2017","unstructured":"Kluger BM, Garimella S, Garvan C (2017) Minimal clinically important difference of the modified fatigue impact scale in Parkinson\u2019s disease. Parkinsonism Relat Disord 43:101\u2013104. https:\/\/doi.org\/10.1016\/j.parkreldis.2017.07.016","journal-title":"Parkinsonism Relat Disord"},{"key":"3039_CR35","volume-title":"Statistical power analysis for the behavioral sciences","author":"J Cohen","year":"1988","unstructured":"Cohen J (1988) Statistical power analysis for the behavioral sciences. Lawrence Erlbaum Associated, New York"},{"key":"3039_CR36","doi-asserted-by":"publisher","first-page":"533","DOI":"10.5603\/pjnns.107864","volume":"59","author":"JA Szefler-Derela","year":"2025","unstructured":"Szefler-Derela JA, Helisz M, Gawron J, Siuda J, Knapik A (2025) Fatigue in people with Parkinson\u2019s disease - its scale and consequences for activity and quality of life. Neurol Neurochir Pol 59:533\u2013540. https:\/\/doi.org\/10.5603\/pjnns.107864","journal-title":"Neurol Neurochir Pol"},{"key":"3039_CR37","doi-asserted-by":"publisher","first-page":"915","DOI":"10.1007\/s00702-023-02654-1","volume":"130","author":"C Pauletti","year":"2023","unstructured":"Pauletti C, Locuratolo N, Mannarelli D, Maffucci A, Petritis A, Menini E, Fattapposta F (2023) Fatigue in fluctuating Parkinson\u2019s disease patients: possible impact of safinamide. J Neural Transm (Vienna) 130:915\u2013923. https:\/\/doi.org\/10.1007\/s00702-023-02654-1","journal-title":"J Neural Transm (Vienna)"},{"key":"3039_CR38","doi-asserted-by":"publisher","first-page":"409","DOI":"10.1212\/WNL.0b013e31827f07be","volume":"80","author":"BM Kluger","year":"2013","unstructured":"Kluger BM, Krupp LB, Enoka RM (2013) Fatigue and fatigability in neurologic illnesses: proposal for a unified taxonomy. Neurology 80:409\u2013416. https:\/\/doi.org\/10.1212\/WNL.0b013e31827f07be","journal-title":"Neurology"},{"key":"3039_CR39","doi-asserted-by":"publisher","first-page":"481","DOI":"10.1212\/01.wnl.0000324862.29733.69","volume":"71","author":"G Schifitto","year":"2008","unstructured":"Schifitto G, Friedman JH, Oakes D, Shulman L, Comella CL, Marek K, Fahn S, E I Parkinson Study Group (2008) <article-title update=\"modified\" original=\"Fatigue in levodopa-naive subjects with Parkinson disease\">Fatigue in levodopa-nai\u0308ve subjects with Parkinson disease. Neurology 71:481\u2013485. https:\/\/doi.org\/10.1212\/01.wnl.0000324862.29733.69","journal-title":"Neurology"},{"key":"3039_CR40","doi-asserted-by":"publisher","first-page":"45","DOI":"10.1016\/j.parkreldis.2015.11.029","volume":"23","author":"KL Chou","year":"2016","unstructured":"Chou KL, Kotagal V, Bohnen NI (2016) Neuroimaging and clinical predictors of fatigue in Parkinson disease. Parkinsonism Relat Disord 23:45\u201349. https:\/\/doi.org\/10.1016\/j.parkreldis.2015.11.029","journal-title":"Parkinsonism Relat Disord"},{"key":"3039_CR41","doi-asserted-by":"publisher","first-page":"172","DOI":"10.3988\/jcn.2016.12.2.172","volume":"12","author":"LJ Zuo","year":"2016","unstructured":"Zuo LJ, Yu SY, Wang F, Hu Y, Piao YS, Du Y, Lian TH, Wang RD, Yu QJ, Wang YJ, Wang XM, Chan P, Chen SD, Wang Y, Zhang W (2016) Parkinson\u2019s disease with fatigue: clinical characteristics and potential mechanisms relevant to alpha-Synuclein oligomer. J Clin Neurol 12:172\u2013180. https:\/\/doi.org\/10.3988\/jcn.2016.12.2.172","journal-title":"J Clin Neurol"},{"key":"3039_CR42","doi-asserted-by":"publisher","first-page":"34","DOI":"10.1016\/s0022-510x(00)00411-1","volume":"179","author":"A Chaudhuri","year":"2000","unstructured":"Chaudhuri A, Behan PO (2000) Fatigue and basal ganglia. J Neurol Sci 179:34\u201342. https:\/\/doi.org\/10.1016\/s0022-510x(00)00411-1","journal-title":"J Neurol Sci"},{"key":"3039_CR43","doi-asserted-by":"publisher","first-page":"136","DOI":"10.1016\/j.bbr.2014.07.037","volume":"277","author":"M Politis","year":"2015","unstructured":"Politis M, Niccolini F (2015) Serotonin in Parkinson\u2019s disease. Behav Brain Res 277:136\u2013145. https:\/\/doi.org\/10.1016\/j.bbr.2014.07.037","journal-title":"Behav Brain Res"},{"key":"3039_CR44","doi-asserted-by":"publisher","first-page":"80","DOI":"10.1016\/j.parkreldis.2016.08.021","volume":"32","author":"D Martino","year":"2016","unstructured":"Martino D, Tamburini T, Zis P, Rosoklija G, Abbruzzese G, Ray-Chaudhuri K, Pelosin E, Avanzino L (2016) An objective measure combining physical and cognitive fatigability: correlation with subjective fatigue in Parkinson\u2019s disease. Parkinsonism Relat Disord 32:80\u201386. https:\/\/doi.org\/10.1016\/j.parkreldis.2016.08.021","journal-title":"Parkinsonism Relat Disord"},{"key":"3039_CR45","doi-asserted-by":"publisher","first-page":"2631","DOI":"10.1111\/ene.15411","volume":"29","author":"M Siciliano","year":"2022","unstructured":"Siciliano M, Kluger B, Micco RD, Chiorri C, Sant\u2019Elia V, Silvestro M, Giordano A, Tedeschi G, Passamonti L, Trojano L, Tessitore A (2022) Validation of new diagnostic criteria for fatigue in patients with Parkinson disease. Eur J Neurol 29:2631\u20132638. https:\/\/doi.org\/10.1111\/ene.15411","journal-title":"Eur J Neurol"},{"key":"3039_CR46","doi-asserted-by":"publisher","DOI":"10.3389\/fnagi.2021.770920","volume":"13","author":"K Wang","year":"2021","unstructured":"Wang K, Li K, Zhang P, Ge S, Wen X, Wu Z, Yao X, Jiao B, Sun P, Lv P, Lu L (2021) Mind-body exercises for non-motor symptoms of patients with Parkinson\u2019s disease: a systematic review and meta-analysis. Front Aging Neurosci 13:770920. https:\/\/doi.org\/10.3389\/fnagi.2021.770920","journal-title":"Front Aging Neurosci"}],"container-title":["Acta Neurologica Belgica"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s13760-026-03039-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s13760-026-03039-3","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s13760-026-03039-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T13:37:48Z","timestamp":1786455468000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s13760-026-03039-3"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,1]]},"references-count":46,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2026,8]]}},"alternative-id":["3039"],"URL":"https:\/\/doi.org\/10.1007\/s13760-026-03039-3","relation":{},"ISSN":["0300-9009","2240-2993"],"issn-type":[{"value":"0300-9009","type":"print"},{"value":"2240-2993","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,1]]},"assertion":[{"value":"18 November 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"17 March 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"1 May 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"Ilaria Ruotolo, Manuela Maieron, Andrea Grassi, Andrea Gardoni, Alessandro Ferrero, Francesca Quarone, Giovanna Lagravinese, Francesca Di Biasio, Martina Putzolu, Giovanni Galeoto, Giovanni Fabbrini and Susanna Mezzarobba declare no non-financial competing interests. Elisabetta Sarasso received research support from the Italian Ministry of Health. Elisa Pelosin is part of an Advisory Board for the M.J. Fox Foundation. She has received grants from the Italian Ministry of University and Research (PRIN 2022) and Michael J. Fox Foundation (Fall 2022 biomarkers to support therapeutic trials program), and research supports from the Italian Ministry of Health (Ricerca Finalizzata 2022 and 5\u2009\u00d7\u20091000).L. Avanzino has received speaker honoraria from Zambon and Bial and received research supports (Grants) from the EU Joint Programme for Neurodegenerative Disease Research (JPND) (2022 call) and Michael J. Fox Foundation (Fall 2022 biomarkers to support therapeutic trials program). She received research support from FRESCO foundation and the Italian Ministry of Health (Ricerca Corrente and 5\u2009\u00d7\u20091000).Massimo Filippi is Editor-in-Chief of the Journal of Neurology, Associate Editor of Human Brain Mapping, Neurological Sciences, and Radiology; received compensation for consulting services from Alexion, Almirall, Biogen, Merck, Novartis, Roche, Sanofi; speaking activities from Bayer, Biogen, Celgene, Chiesi Italia SpA, Eli Lilly, Genzyme, Janssen, Merck-Serono, Neopharmed Gentili, Novartis, Novo Nordisk, Roche, Sanofi, Takeda, and TEVA; participation in Advisory Boards for Alexion, Biogen, Bristol-Myers Squibb, Merck, Novartis, Roche, Sanofi, Sanofi-Aventis, Sanofi-Genzyme, Takeda; scientific direction of educational events for Biogen, Merck, Roche, Celgene, Bristol-Myers Squibb, Lilly, Novartis, Sanofi-Genzyme; he receives research support from Biogen Idec, Merck-Serono, Novartis, Roche, the Italian Ministry of Health, the Italian Ministry of University and Research, and Fondazione Italiana Sclerosi Multipla. Federica Agosta is Associate Editor of NeuroImage: Clinical, has received speaker honoraria from Biogen Idec, Italfarmaco, Roche, Zambon and Eli Lilly, and receives or has received research supports from the Italian Ministry of Health, the Italian Ministry of University and Research, AriSLA (Fondazione Italiana di Ricerca per la SLA), the European Research Council, the EU Joint Programme \u2013 Neurodegenerative Disease Research (JPND), and Foundation Research on Alzheimer Disease (France).","order":1,"name":"Ethics","label":"Conflict of interest","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The study was carried out in accordance with local ethical committee (EC) procedures (EC IRCCS San Raffaele Scientific Institute of Milan - protocol No. 68\/int\/2019; EC University of Genoa - protocol No. 2025\/25; EC Sapienza University of Rome \u2013 Rif. 5830 protocol No 0428\/2020) and the principles outlined in the Declaration of Helsinki concerning research involving human participants. Prior to participation, written informed consent was obtained from all participants.","order":2,"name":"Ethics","label":"Compliance with ethical standards","group":{"name":"EthicsHeading","label":"Declarations"}}]}}