Anxiety disorders in Parkinson's disease: Prevalence and risk factors

Abstract

Anxiety disorders are common in Parkinson's disease (PD) patients, yet are poorly studied. We examined the prevalence of anxiety disorders in PD, investigated the association between anxiety, and presentation and progression of PD, and studied for the first time the contribution of putative risk factors for anxiety in PD. A case-series of 79 PD patients recruited from neurology out-patient clinics was examined for anxiety disorders using the DSM-IV criteria. The Unified Parkinson's Disease Rating Scale and the Hoehn and Yahr Staging of PD were employed to understand the relationship between anxiety disorders, and the clinical presentation and severity of PD. A validated survey assessed putative risk factors for anxiety in PD. Twenty-five percent of PD patients were diagnosed with anxiety. Panic disorder, generalised anxiety disorder and social phobia were prevalent anxiety disorders. Comorbid depression with anxiety was observed (14%). The severity but not the duration of PD was positively related to anxiety. PD patients with postural instability and gait dysfunction symptom clustering were more likely to experience anxiety than tremor-dominant patients. While levodopa dosage had no relationship to anxiety, experience of dyskinesias or on/off fluctuations increased the risk. Lateralisation of PD had no association with anxiety. Anxiety disorders decreased with age and young onset PD patients were more likely to experience anxiety than the late onset subjects. Anxiety adds to the complexity of PD, lowering patients' quality of life. Future research can be directed to identify reactive and organic nature of anxiety in PD.

Facial emotion recognition in Parkinson's disease: A review and new hypotheses

“…Since 2010, only Baggio et al64 and Linn et al76 have reported a link between depression and FER in PD. Concomitant with depression, apathy and anxiety are also frequent in PD 3, 99. However, these mood disorders have been taken into account less often, although some studies have highlighted their influence on FER (anxiety: Clark et al13 and Ille et al33; apathy: Robert et al100 and Martínez‐Coral et al25).…”

“…The original description characterizing Parkinson's disease (PD) by motor symptoms1, 2 has been updated because patients also experience cognitive and psychiatric symptoms,3, 4, 5, 6, 7 including emotional impairments. These lead to difficulties in describing bodily sensations, physiological arousal and feelings, expressing emotions, and identifying others' emotions from prosody and facial expression 8, 9, 10.…”

Parkinson's disease motor subtypes and mood

“…[25;26] For anxiety, associations with the akinetic-rigid or PIGD motor phenotype are few and inconsistent [12;15;27] while there is no evidence regarding rate of disease progression and only a single negative report relating to lateralization of motor symptoms. [28] The strongest evidence emerging is an association between anxiety and young age of onset [15;20;28-30] and the presence of motor complications of treatment. [15;28-31] The present study assessed, in a large sample of patients, a range of clinical and motor features suggested by previous research to be associated with depression and/or anxiety.…”

Neuropsychiatric symptoms and associated caregiver stress in geriatric patients with Parkinson’s disease

“…A variety of antiparkinsonian agents, most notably anticholinergic agents, dopaminergic agents, and amantadine, can exacerbate neuropsychiatric symptoms in general, specially psychotic symptoms as visual hallucinations (34). All the antiparkinsonian drugs can give rise to hallucinations and psychosis, but the dopamine agonists are the ones with the greatest capacity to do so.…”