Motion and emotion: anxiety–axial connections in Parkinson’s disease

Abstract

Anxiety is a serious and frequent complication in Parkinson's disease (PD) that significantly affects the quality of life of patients. Multiple neuroanatomical, experimental, and clinical studies suggest its close association with axial disturbances. However, whether this relation applies for PD patients (commonly suffering from axial difficulties, such as balance and gait disturbance) has not been properly tested yet. The purpose of this study was to determine whether PD patients suffering from axial symptoms have higher levels of anxiety than others and to identify other factors associated with anxiety-axial connections. In this questionnaire study, 212 patients with PD were assessed by standardized scales, such as Hamilton Anxiety Scale, Montgomery-Asberg Depression Rating Scale, Montreal Cognitive Assessment, examining their mood and cognitive status. These data were correlated to dominant motor symptoms of these patients, such as tremor, rigidity, bradykinesia, and axial symptoms. Unlike other motor symptoms, only axial symptoms showed to be significantly related to higher levels of anxiety. The patients suffering from anxiety and axial problems have also shown significantly higher depression levels. Axial disturbances are related to higher anxiety levels in PD patients. It is crucial to pay high attention to symptoms of anxiety in patients having postural instability or gait disorder. Further clinical studies are desirable to investigate new, practical implications of anxiety-axial connection to provide complex management options of these serious symptoms.

Impact of depression on gait variability in Parkinson’s disease

“…Moreover, observed changes in cholinergic function in patients with PD and depression and demonstrated the influence of cholinergic dysfunction on gait and postural control could point to a similar pathophysiological origin. Depression is coupled with axial motor symptoms in PD and appears more frequently in a form with pronounced postural instability and gait disorders [46,47]. A recent study has demonstrated that patients with PD and comorbid depression exhibit differences in postural control compared to patients without depression, wherein the upright position depressive patients exhibit greater flexion in the pelvic area, causing leaning forward of the torso [48].…”

Decision making in Parkinson's disease: An analysis of the studies using the Iowa Gambling Task

“…A better understanding of the emotional components of the IGT would be of great value also for disentangling the relation between motor and non‐motor symptoms in PD, which can affect information processing (Ehgoetz Martens et al, 2015). On this way, it has been described a link between anxiety, axial disturbances and motor symptoms, depression and cognitive functioning, including decision making (Cubo et al, 2000; Šumec et al, 2017). This can be of considerable importance especially in reference to patients' everyday life and the negative consequences that may occur.…”

“…This can be of considerable importance especially in reference to patients' everyday life and the negative consequences that may occur. Understanding more deeply these relationships can contribute to shed a light not only on decision‐making processing but also on innovative ways to manage symptoms in PD, as Šumec et al (2017) suggested.…”

Autonomic factors do not underlie the elevated self-disgust levels in Parkinson’s disease

“…The disorder affects all domains, motor, cognitive and emotional [ 2 ]. Parkinson’s disease is typically characterised by the motor symptoms of resting tremor, “cog-wheel” rigidity and bradykinesia [ 3 – 6 ]. Affective and cognitive symptoms, such as depression, anxiety and dementia have received far less attention and are often underestimated as peripheral although they are associated with high societal and healthcare costs [ 7 ].…”

“…Amongst the cognitive symptoms, deficits in recognition and expression of basic emotions (e.g., fear, disgust, sadness, happiness etc.) have been relatively well researched and documented [ 5 , 6 , 8 – 11 ]. For instance, there is high comorbidity between Parkinson’s disease and alexithymia [ 12 – 15 ], and studies have reported reduced facial and verbal expressivity [ 16 – 21 ], difficulties in emotional regulation [ 22 – 24 ] and emotion recognition [ 25 ] in patients with Parkinson’s disease.…”