Prevalence of anxiety disorders and anxiety subtypes in patients with Parkinson's disease

Abstract

Anxiety disorders are common in Parkinson's Disease (PD), but are not well-characterized. This study determined the prevalence and clinical correlates of all DSM-IV-TR anxiety disorder diagnoses in a sample of 127 subjects with idiopathic PD who underwent comprehensive assessments administered by a psychiatrist and neurologist. A panel of six psychiatrists with expertise in geriatric psychiatry and/or movement disorders established by consensus all psychiatric diagnoses. Current and lifetime prevalence of at least one anxiety disorder diagnosis was 43% (n=55) and 49% (n=63), respectively. Anxiety Disorder Not Otherwise Specified, a DSM diagnosis used for anxiety disturbances not meeting criteria for defined subtypes, was the most common diagnosis (30% lifetime prevalence, n=38). Compared to non-anxious subjects, panic disorder (n=13) was associated with earlier age of PD onset [50.3(12.2) vs. 61.0(13.7) years, p<.01], higher rates of motor fluctuations [77% (10/13) vs. 39% (25/64), p=.01] and morning dystonia [38% (5/13) vs. 13% (8/62), p<.03]. This high prevalence of anxiety disorders, including disturbances often not meeting conventional diagnostic criteria, suggests that anxiety in PD is likely under-diagnosed and under-treated and refined characterization of anxiety disorders in PD is needed. In addition, certain anxiety subtypes may be clinically useful markers associated with disease impact in PD.

Parkinson's disease motor subtypes and mood

“…[12;15;27] Pontone and colleagues examined the motor characteristics of anxious versus non-anxious people with PD and, although they did not specifically use a motor subtype classification, they did not find any difference in motor features between groups. [30] The present results do not provide any robust evidence for an association between postural instability and anxiety, although in individual patients fear of falling may be a significant source of concern and contribute to activity limitation and social avoidance. [57;58] Already anxious patients who develop postural instability or who then experience falls may well become more anxious in response to this unpredictable and potentially harmful problem.…”

Anxiety disorders in older adults: a comprehensive review

“…One study found that up to 40% individuals with Parkinson's experienced significant anxiety symptoms, [129] whereas another study found that 43% individuals with idiopathic Parkinson's Disease met criteria for a current anxiety disorder. [130] Research has also focused on the relation between anxiety disorders and the manifestation/severity of Parkinson's symptoms. For example, [130] one study found that PD was associated with an earlier age of onset of Parkinson's, higher rates of motor fluctuations, and morning dystonia.…”

“…[130] Research has also focused on the relation between anxiety disorders and the manifestation/severity of Parkinson's symptoms. For example, [130] one study found that PD was associated with an earlier age of onset of Parkinson's, higher rates of motor fluctuations, and morning dystonia. In contrast, Stein et al [131] found that among Parkinson's disease patients with concurrent anxiety, there was no correlation between the severity of Parkinson's symptoms and anxiety severity, duration of L-dopa exposure or dose of L-dopa.…”

Non-motor Symptoms in Parkinson’s Disease

“…60,61 Similar to depression, the presence of anxiety is associated with a worse quality of life. 60 Panic disorder and generalized anxiety disorder have been reported to be the most common anxiety syndromes in PD, but a recent study demonstrated that anxiety disturbances in PD tend not to fall into discrete subtypes. 60 Very little is known about the pathophysiology of anxiety in PD.…”

“…60 Panic disorder and generalized anxiety disorder have been reported to be the most common anxiety syndromes in PD, but a recent study demonstrated that anxiety disturbances in PD tend not to fall into discrete subtypes. 60 Very little is known about the pathophysiology of anxiety in PD. Anxiety is highly associated with 'on-off motor fluctuations in PD, with worsened anxiety and panic attacks during 'off' periods and improvement during 'on' states.…”