Clinical issues in the treatment of anxiety and depression in older adults with Parkinson's disease

Abstract

A significant proportion of persons affected by Parkinson's disease (PD) are over age 65 years. Mental health issues are often less a focus of treatment in this population than physical manifestations of the illness. Anxiety or depression alone, as well as comorbid depression and anxiety, are underrecognized in patients with PD and are associated with deleterious effects on physical and interpersonal functioning, negatively impacting quality of life and well-being. We offer a brief overview of salient clinical points with respect to assessment and treatment approaches to enhance efficacy of the treatment of mental health symptoms in older adults with PD. Cognitive behavior therapy involves the patient learning to overcome behavioral avoidance associated with anxiety and challenge unhelpful negative cognitions. It is suggested that cognitive behavior therapy is an effective approach to treatment of anxiety and depression in PD and should be offered as a treatment to patients.

Systematic review of factors associated with depression and anxiety disorders among older adults with Parkinson's disease

“…In addition, there is also an overlapping content between depression and anxiety scales [5]. For these reasons, specific tools should be used to assess for depression and anxiety disorders in older adults with PD [9]. …”

“…PD patients may also be reluctant to report psychological symptoms, which in turn may contribute to the reduced diagnosis of depression and anxiety disorders in this population [12]. The co-occurrence of depression and anxiety disorders adversely affects the course of the disease, and leads to poor health related quality of life and increased mortality [9]. An awareness of the multiple factors associated with depression and anxiety disorders among older adults with PD could help in determining where and how to intervene, and to promote discussion about depression and anxiety disorders with individuals suffering from PD who may be at risk.…”

“…According to Yamanishi et al [5], and Quelhas & Costa [8], anxiety disorders, more so than depression, have a greater impact on the quality of life in PD. Recognizing that depression and anxiety disorders commonly co-occur in PD is essential since both conditions have been associated with negative PD health outcomes and increased mortality [9]. …”

Are Mental Disorders Brain Diseases, and What Does This Mean? A Clinical-Neuropsychological Perspective

“…Long-term consequences of the disease have to be treated with a variety of other means (cognitive training, psychotherapy, etc.). It is increasingly acknowledged that a biopsychosocial perspective is crucial in the treatment of neurological diseases such as Parkinson's disease [47,48], multiple sclerosis [49,50], post-stroke depression [51], epilepsy [52] or organic psychopathology in general [53,54]. …”

The impact of motor symptoms on self-reported anxiety in Parkinson's disease

“…Disease-specific anxiety can develop, such as apprehension toward physical symptoms (e.g., freezing of gait) or the stigma of being perceived as physically disabled [6]. Such experiences may compound the limitations that the disease imposes on independence and quality of life (e.g., social withdrawal) [7]. Mood disorders in PD are underdiagnosed [8] and there are few treatments [2].…”