State anxiety predicts cognitive performance in patients with Parkinson’s disease.

Abstract

Objective: Anxiety is common in Parkinson's disease (PD) and frequently a comorbidity that appears alongside nonmotor symptoms such as cognitive deficits; however, the relationship between anxiety and cognition in PD remains poorly understood. The aim of this study was to investigate the relationship between anxiety and specific cognitive domains (e.g., attention/working memory, executive functions, memory, language, and visuospatial function). Method: A total of 48 individuals with PD and 18 healthy controls were assessed using the State Trait Anxiety Inventory along with a comprehensive neuropsychological battery. Hierarchical multiple regression analysis was used to examine whether trait and/or state anxiety predicted deficits in overall cognitive function (Montreal Cognitive Assessment) and/or specific individual cognitive domains in the PD and healthy control samples while controlling for covariates such as age, depression (Geriatric Depression Scale), and Unified Parkinson's disease Rating Scale motor-subsection-III (PD only). Results: Results showed that state anxiety in PD significantly predicted performance across an array of cognitive domains, such as attention/working memory, executive functioning, memory, and language, whereas trait anxiety was a predictor only for executive functioning. In contrast, there was no significant relationship between state anxiety and visuospatial ability Conclusions: Overall, these findings highlight that performance in particular cognitive domains are associated with anxiety in PD. Thus, it may be critically important to consider and quantify the contribution of anxiety to cognitive performance when diagnosing and treating dementia and/or mild cognitive impairments in PD. General Scientific SummaryAnxiety and cognition are extensively linked in healthy controls but more so in patients with Parkinson's disease (PD). This study shows that anxiety is an important factor to consider when performing detailed neuropsychological assessments because it can interfere with cognitive abilities, especially in PD, and thus has important implications for clinicians managing PD patients with these symptoms.

Anxiety in Parkinson's disease is associated with changes in the brain fear circuit

“…In this study, "A+" patients had lower scores in attention, working memory and language. This is in line with a previous study showing that, in PD, state anxiety predicts performance in these cognitive domains [28]. Anxiety could thus worsen PD-associated cognitive dysfunctions.…”

Depressive symptoms precede cognitive impairment in de novo Parkinson’s disease patients: Analysis of the PPMI cohort.

“…In the current study, we did not find a significant relationship between anxiety, apathy, and cognitive functioning. Regarding anxiety and cognitive functioning, past studies have linked anxiety symptoms (independent of depression and/or apathy) to worse cognitive functioning (Ehgoetz Martens et al, 2018, 2016; Jones et al, 2016; Pirogovsky-Turk et al, 2017; Ryder et al, 2002; Wan Mohamed et al, 2015). Specifically, Pirogovsky-Turk and colleagues (2017) found that more severe anxiety symptoms at baseline were predictive of declines in visual learning (but not verbal learning, attention, language, visuospatial functions, or executive functioning) over a 2-year period.…”

“…Specifically, Pirogovsky-Turk and colleagues (2017) found that more severe anxiety symptoms at baseline were predictive of declines in visual learning (but not verbal learning, attention, language, visuospatial functions, or executive functioning) over a 2-year period. In cross-sectional studies, anxiety has been associated with a greater prevalence of mild cognitive impairment and worse performance on tests of working memory, executive functioning, language, and memory (Ehgoetz Martens et al, 2018, 2016; Jones et al, 2016; Pirogovsky-Turk et al, 2017; Ryder et al, 2002; Wan Mohamed et al, 2015). Discrepancies between the current study and past studies may be due to differences in sample characteristics (the current sample consistent of newly diagnosed PD patients), study durations, and/or study measures.…”

“…The current study was able to assess constructs (e.g., working memory, semantic fluency) that are sometimes subsumed under the executive functioning domain. However, anxiety is frequently associated with tests of set-shifting, behavioral inhibition, and letter fluency, which were not available in this secondary data analysis (Ehgoetz Martens et al, 2018, 2016; Reynolds et al, 2017).…”

“…Some studies exclusively measured anxiety, but not depression or apathy, and found that greater anxiety was associated with poorer set-shifting (Reynolds, Hanna, Neargarder, & Cronin-Golomb, 2017) or memory (Dissanayaka et al, 2017). Other cross-sectional studies have examined the independent effects of anxiety and apathy−depression and have found an independent relationship between anxiety and cognition (Ehgoetz Martens, Silveira, Intzandt, & Almeida, 2018; Ehgoetz Martens et al, 2016; Ryder et al, 2002; Wan Mohamed, Che Din, & Ibrahim, 2015). In general, these studies found that higher anxiety was related to worse performance across various cognitive domains, including general cognitive screeners and measures of attention−working memory, executive functioning, visuospatial abilities, learning, and memory.…”