Anxiety provokes balance deficits that are selectively dopa-responsive in Parkinson’s disease

Martens, Kaylena A. Ehgoetz; Lefaivre, Shannon C.; Beck, Eric N.; Chow, Rebecca; Pieruccini‐Faria, Frederico; Ellard, Colin G.; Almeida, Quincy J.

doi:10.1016/j.neuroscience.2016.11.011

Cited by 12 publications

(9 citation statements)

References 31 publications

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“…The results showed that only the high anxiety group (HA-PD) demonstrated significantly greater postural sway, indicating postural instability, as compared to the control group. This result is consistent with recent studies which showed impaired standing balance under high threat conditions (for example, standing on an elevated plank placed on the ground) [ 12 ]. This may be explained based on distraction models, which argue that anxiety draws attention towards task-irrelevant stimuli, resulting in less attentional resources available for motor control processing and hence disturbed motor performance [ 31 ].…”

Section: Discussionsupporting

confidence: 93%

“…changes of postural reflexes, muscular weakness, decreased anticipatory postural responses, etc.) [ 12 ]. Thus, a high level of anxiety in PD patients may overload the processing resources resulting in impaired postural control in the HA-PD group [ 23 ].…”

Section: Discussionmentioning

confidence: 99%

“…Both PD and healthy participants were excluded if they experienced falling during the test. Because of recent evidence about the importance of testing balance using a wide spectrum of anxious PD participants [ 12 , 23 ], we divided the PD participants into low-anxiety (LA-PD) and high-anxiety (HA-PD) groups according to their anxiety score on the anxiety subscale of HADS. PD participants who obtained scores of less than 11 were grouped as LA-PD, while those whose scores were equal or greater than 11 were grouped as HA-PD [ 24 ].…”

Section: Methodsmentioning

confidence: 99%

“…In their recent study, Ehgoetz Martens et al (2017) evaluated the influence of anxiety on the balance of PD patients using a virtual environment. They reported high anxiety levels, particularly under high threat (elevated plank) conditions [ 12 ]. On the other hand, since a high correlation was found between depression, anxiety and cognitive scores, the effect of anxiety was not conclusively independent.…”

Section: Introductionmentioning

confidence: 99%

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The effects of anxiety and external attentional focus on postural control in patients with Parkinson's disease

et al. 2018

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BackgroundAlthough anxiety is a common non-motor outcome of Parkinson's disease (PD) affecting 40% of patients, little attention has been paid so far to its effects on balance impairment and postural control. Improvement of postural control through focusing on the environment (i.e. external focus) has been reported, but the role of anxiety, as a confounding variable, remains unclear.ObjectivesThis study aimed to investigate the influence of anxiety and attentional focus instruction on the standing postural control of PD patients.MethodsThirty-four patients with PD (17 with high anxiety (HA-PD) and 17 with low anxiety (LA-PD)), as well as 17 gender- and age-matched healthy control subjects (HC) participated in the study. Postural control was evaluated using a combination of two levels of postural difficulty (standing on a rigid force plate surface with open eyes (RO) and standing on a foam surface with open eyes (FO)), as well as three attentional focus instructions (internal, external and no focus).ResultsOnly the HA-PD group demonstrated significant postural control impairment as compared to the control, as indicated by significantly greater postural sway measures. Moreover, external focus significantly reduced postural sway in all participants especially during the FO condition.ConclusionThe results of the current study provide evidence that anxiety influences balance control and postural stability in patients with PD, particularly those with high levels of anxiety. The results also confirmed that external focus is a potential strategy that significantly improves the postural control of these patients. Further investigation of clinical applicability is warranted towards developing effective therapeutic and rehabilitative treatment plans.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The effects of anxiety and external attentional focus on postural control in patients with Parkinson's disease

et al. 2018

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“…Recent evidence has demonstrated a relationship between anxiety and movement control. For instance, individuals with PD who report high trait anxiety have greater balance and gait impairments [8,24,25], as well as increased susceptibility to dual task interference compared to non-anxious individuals with PD [26]. Another study showed that when sensory feedback was provided in virtual reality, which simulated walking across a plank, anxiety had a reduced effect on walking compared to when sensory feedback was not provided [8].…”

Section: Introductionmentioning

confidence: 99%

Sensory focused exercise improves anxiety in Parkinson’s disease: A randomized controlled trial

et al. 2020

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Anxiety has been implicated as one of the greatest influences on quality of life in Parkinson's disease (PD). The etiology of anxiety is unclear, although previous work suggests that anxiety may be linked to sensory deficits that cause uncertainty in movement. Thus, the current study examined whether focusing attention on sensory feedback during goal-based exercise has the potential to provide benefits to anxiety in PD. Thirty-five participants with PD were randomized to either a Sensory Attention Focused Exercise (SAFEx) (i.e. internal focus of attention, n = 18) or Sham Exercise control (i.e. external focus of attention, n = 17) and completed 33 one-hour attention-based exercise sessions over 11-weeks. Before and after the program (pre and post), participants completed the Parkinson Anxiety Scale (PAS) questionnaire. The PAS includes three anxiety sections: persistent, episodic, and avoidance. Changes in the total PAS score and within each section of the PAS were subjected to two-factor mixed repeated measures ANCOVA. Significant group by time interactions demonstrated that from pre to post, total PAS scores (p = 0.007) and episodic anxiety scores (p = 0.010) significantly decreased in the SAFEx group only (ΔTotal PAS =-5.2, F (1,27) = 5.41, p = 0.028, η p 2 = 0.17; ΔEpisodic Score =-1.8, F (1,27) = 6.89, p = 0.014, η p 2 = 0.20). In conclusion, focusing attention on sensory feedback while completing goal-based exercises may provide significant benefits to improving anxiety in PD. As such, sensory attention focused exercise may be a critical adjunct therapy for improving anxiety, and ultimately quality of life in people with PD.

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Differentiation in theta and gamma activation in weight-shifting learning between people with parkinson’s disease of different anxiety severities

Hung,

Wu,

Huang

2024

GeroScience

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Anxiety provokes balance deficits that are selectively dopa-responsive in Parkinson’s disease

Cited by 12 publications

References 31 publications

The effects of anxiety and external attentional focus on postural control in patients with Parkinson's disease

The effects of anxiety and external attentional focus on postural control in patients with Parkinson's disease

Sensory focused exercise improves anxiety in Parkinson’s disease: A randomized controlled trial

Differentiation in theta and gamma activation in weight-shifting learning between people with parkinson’s disease of different anxiety severities

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