June
21, 2016
Longitudinal
study finds 16% have baseline anxiety, 37% develop it over time
BERLIN -- About half of patients with Parkinson's disease may
develop anxiety over time, researchers reported here.
In a 400-patient cohort, 16% had
anxiety at baseline, and 37% developed anxiety during 5 years of
follow-up, Kangdi Zhu, MD,
PhD, of Leiden University Medical Center in the Netherlands, and
colleagues reported at the Movement Disorders Society
meeting here.
Female gender, more cognitive impairment, more insomnia, and
more autonomic dysfunction were associated with higher anxiety scores over
time, they found.
"Anxiety is a common feature in Parkinson's, that in all
likelihood partly shares a common pathophysiological mechanism with
depression," they wrote.
Anxiety and depression are common neuropsychiatric features in
Parkinson's disease and they may affect a patient's sense of well-being. Both
may also have an adverse impact over the course of the disease, Zhu and
colleagues explained.
Anxiety may be episodic or stable, it may vary with severity of
motor fluctuations, and situational anxiety may be related to motor deficits --
like a fear of falling due to freezing, the researchers noted.
While many earlier studies have focused on depression, less is
known about risk factors for developing anxiety. Studies of anxiety in
Parkinson's patients have had cross-sectional designs, and longitudinal studies
with longer follow-up have been scarce, they said.
The PROPARK cohort study, which enrolled 409 patients with
Parkinson's disease who were followed for 5 years, assessed a broad range of
motor and nonmotor features every year.
Of those 409 patients, 67 had anxiety at baseline (16%), and of
the 316 who completed long-term follow-up, 64 developed anxiety (37%), they
reported.
Patients with anxiety at baseline were more often female, but
they didn't differ on disease duration, age, or age at onset of Parkinson's
disease. These patients were also more severely affected on several motor and
nonmotor domains, the researchers said.
Depression was the strongest factor associated with higher
anxiety scores, they added.
In further analyses without depression as a covariate, female
gender, more cognitive impairment, more insomnia at baseline, and autonomic
dysfunction (on the gastrointestinal and cardiovascular domains) were
associated with higher anxiety scores over time, they reported.
Cox proportional hazards models showed that depressive symptoms,
more cognitive impairment, insomnia, and autonomic dysfunction were independent
predictors of future development of anxiety, they added.
Zhu and colleagues said insomnia and autonomic dysfunction could
contribute to anxiety in Parkinson's disease, and that their study is the
"first to confirm a relationship between cognitive dysfunction and anxiety
in Parkinson's disease."
This could be explained by abnormality of noradrenergic cells in
the locus coeruleus in Parkinson's patients with cognitive dysfunction, which
would "further indicate that patients with cognitive dysfunction should be
monitored more closely for developing anxiety symptoms," they said.
Peter Schmidt,
PhD, of the National Parkinson Foundation, who wasn't involved in
the study, agreed that anxiety is a prevalent symptom in Parkinson's patients.
"You often hear about depression, and, later, disease
psychosis in Parkinson's -- but anxiety is often left off the list of important
factors, even though it can be very disabling," Schmidt told MedPage Today.
"There are lots of people who say they don't go out of the house because
of their anxiety."
He noted that pimavanserin was recently approved for Parkinson's
psychosis although only "about a third of patients with Parkinson's who
will develop psychosis at some point in the course of their disease. But here
you can see about half of people during follow-up developed anxiety. We hear
from a lot of people who say anxiety is very disabling for them."
http://www.medpagetoday.com/MeetingCoverage/MDS/58668xid=NL_breakingnews_2016-06-21&eun=g972365d0r
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