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Nature 2015;528:1236

PD probably reduces somatostatin release from the hypothalamus by increasing the central cholinergic tone

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Additionally, at least five ancillary symptoms must be present, such as limb heaviness or generalized weakness, diminished concentration, or attention, decreased motivation or interest in usual activities, insomnia or hypersomnia, nonrestorative sleep, perceived need to struggle against inactivity, pronounced emotional response to fatigue, perceived short-term memory issues, or prolonged malaise following exertion (11)