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Whitmarsh A, Protea S, Gibson JS. Anxiety Symptoms and Disease Severity in Parkinson Disease. J Neurosci Nurs 2024:01376517-990000000-00094. [PMID: 38959338 DOI: 10.1097/jnn.0000000000000770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/05/2024]
Abstract
ABSTRACT BACKGROUND: Anxiety is prevalent in Parkinson disease (PD), negatively affecting quality of life for patients and their families. Targeted anxiety interventions are needed that account for variables such as disease severity; however, there is insufficient evidence regarding the trajectory of anxiety along the disease course. OBJECTIVE: The aim of this study was to investigate the association between disease severity and anxiety symptoms in a PD sample. METHODS: This descriptive study used secondary data analyses of data from a web-based survey study of individuals with PD in the United States. Participants were 21 years or older, had access to the Internet, and were given a diagnosis of PD (N = 72). We performed multiple regression analyses to assess the relationship between patient-reported disease severity and anxiety symptoms. RESULTS: There was a statistically significant association between disease severity and anxiety symptoms in people with PD, after controlling for all 5 explanatory variables (sex, age, wearing off, disease severity, and disease duration) (P < .001). Age and wearing off PD medication also had statistically significant, although smaller, effects on anxiety symptoms (P < .05). CONCLUSION: Disease severity was related to increased anxiety symptoms among individuals with PD. Anxiety intervention research is needed, and future studies should account for variations in disease severity and medication effects in both intervention and study design.
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Carli G, Kanel P, Michalakis F, Roytman S, Bohnen JLB, Wigstrom TP, Scott P, Albin RL, Wong KK, Raffel D, Bohnen NI. Cardiac sympathetic denervation and anxiety in Parkinson disease. Parkinsonism Relat Disord 2024; 124:106997. [PMID: 38723520 DOI: 10.1016/j.parkreldis.2024.106997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 04/11/2024] [Accepted: 04/30/2024] [Indexed: 07/05/2024]
Abstract
BACKGROUND Anxiety in Parkinson disease (PD) negatively impacts quality of life. While research predominantly focuses on central nervous system changes, some evidence suggests a connection between peripheral autonomic dysfunctions and PD-related anxiety. The role of the peripheral autonomic nervous system in this context may be overlooked. OBJECTIVES This study explores the link between anxiety symptoms and cardiac sympathetic denervation in PD using 11C-meta-hydroxyephedrine ([11C]HED) PET cardiac imaging. METHODS We studied 34 non-demented PD subjects, assessing anxiety levels through the Spielberg Anxiety State-Trait test trait section (STAI-T). Patients underwent comprehensive assessments along with [11C]HED cardiac and [11C]DTBZ brain PET. To identify subdimensions of STAI-T, we employed principal components analysis (PCA). We examined associations between the anxiety subdimensions and two measures of cardiac sympathetic denervation from [11C]HED PET. We utilized correlation and linear regression models for these analyses. RESULTS PCA revealed two STAI-T results components: anxiety-depressive and pure anxiety subcomponents. Only pure anxiety significantly correlated with measures of cardiac sympathetic denervation (rhos -0.40, p = 0.018; 0.35, p = 0.043). Regression models confirmed a significant association, with cardiac sympathetic denervation explaining ∼20 % of pure anxiety variance, independent of sex, dopaminergic impairment, and anxiolytic treatments. DISCUSSION This study provides preliminary evidence of peripheral autonomic nervous system abnormalities contributing to PD-related anxiety, suggesting dysregulation in peripheral autonomic functions influencing anxiety perception.
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Affiliation(s)
- G Carli
- Department of Neurology, University of Michigan, Ann Arbor, MI, USA; Functional Neuroimaging, Cognitive, and Mobility Laboratory, Department of Radiology, University of Michigan, Ann Arbor, MI, USA; Morris K. Udall Center of Excellence for Parkinson's Disease Research, University of Michigan, Ann Arbor, MI, USA.
| | - P Kanel
- Functional Neuroimaging, Cognitive, and Mobility Laboratory, Department of Radiology, University of Michigan, Ann Arbor, MI, USA; Morris K. Udall Center of Excellence for Parkinson's Disease Research, University of Michigan, Ann Arbor, MI, USA; Department of Radiology, University of Michigan, Ann Arbor, MI, USA; Parkinson's Foundation Research Center of Excellence, University of Michigan, Ann Arbor, MI, USA
| | - F Michalakis
- Functional Neuroimaging, Cognitive, and Mobility Laboratory, Department of Radiology, University of Michigan, Ann Arbor, MI, USA; Department of Radiology, University of Michigan, Ann Arbor, MI, USA
| | - S Roytman
- Functional Neuroimaging, Cognitive, and Mobility Laboratory, Department of Radiology, University of Michigan, Ann Arbor, MI, USA; Department of Radiology, University of Michigan, Ann Arbor, MI, USA
| | - J L B Bohnen
- Functional Neuroimaging, Cognitive, and Mobility Laboratory, Department of Radiology, University of Michigan, Ann Arbor, MI, USA; Department of Radiology, University of Michigan, Ann Arbor, MI, USA; University of Michigan Medical School, Ann Arbor, MI, USA
| | - T P Wigstrom
- Functional Neuroimaging, Cognitive, and Mobility Laboratory, Department of Radiology, University of Michigan, Ann Arbor, MI, USA; Department of Radiology, University of Michigan, Ann Arbor, MI, USA; University of Michigan Medical School, Ann Arbor, MI, USA
| | - P Scott
- Department of Radiology, University of Michigan, Ann Arbor, MI, USA
| | - R L Albin
- Department of Neurology, University of Michigan, Ann Arbor, MI, USA; Morris K. Udall Center of Excellence for Parkinson's Disease Research, University of Michigan, Ann Arbor, MI, USA; Parkinson's Foundation Research Center of Excellence, University of Michigan, Ann Arbor, MI, USA; Neurology Service and GRECC, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - K K Wong
- Department of Radiology, University of Michigan, Ann Arbor, MI, USA
| | - D Raffel
- Department of Radiology, University of Michigan, Ann Arbor, MI, USA
| | - N I Bohnen
- Department of Neurology, University of Michigan, Ann Arbor, MI, USA; Functional Neuroimaging, Cognitive, and Mobility Laboratory, Department of Radiology, University of Michigan, Ann Arbor, MI, USA; Morris K. Udall Center of Excellence for Parkinson's Disease Research, University of Michigan, Ann Arbor, MI, USA; Department of Radiology, University of Michigan, Ann Arbor, MI, USA; Parkinson's Foundation Research Center of Excellence, University of Michigan, Ann Arbor, MI, USA; Neurology Service and GRECC, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
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Ratajska AM, Etheridge CB, Lopez FV, Kenney LE, Rodriguez K, Schade RN, Gertler J, Bowers D. The Relationship Between Autonomic Dysfunction and Mood Symptoms in De Novo Parkinson's Disease Patients Over Time. J Geriatr Psychiatry Neurol 2024; 37:242-252. [PMID: 37831611 PMCID: PMC10990848 DOI: 10.1177/08919887231204542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/15/2023]
Abstract
BACKGROUND Autonomic dysfunction is prevalent in Parkinson's disease (PD) and can worsen quality of life. We examined: (a) whether specific autonomic symptoms were more strongly associated with anxiety or depression in PD and (b) whether overall autonomic dysfunction predicted mood trajectories over a 5-year period. METHODS Newly diagnosed individuals with PD (N = 414) from the Parkinson's Progression Markers Initiative completed self-report measures of depression, anxiety, and autonomic symptoms annually. Cross-sectional linear regressions examined relationships between specific autonomic subdomains (gastrointestinal, cardiovascular, thermoregulatory, etc.) and mood. Multilevel modeling examined longitudinal relationships with total autonomic load. RESULTS Gastrointestinal symptoms were associated with both higher anxiety (b = 1.04, 95% CI [.55, 1.53], P < .001) and depression (b = .24, 95% CI [.11, .37], P = .012), as were thermoregulatory symptoms (anxiety: b = 1.06, 95% CI [.46, 1.65], P = .004; depression: b = .25, 95% CI [.09, .42], P = .013), while cardiovascular (b = .36, 95% CI [.10, .62], P = .012) and urinary symptoms (b = .10, 95% CI [.01, .20], P = .037) were associated only with depression. Longitudinally, higher total autonomic load was associated with increases in both depression (b = .01, 95% CI [.00, .02], P = .015) and anxiety (b = .04, 95% CI [.01, .06], P < .001) over time, as well as occasion-to-occasion fluctuations (depression: b = .08, 95% CI [.05, .10], P < .001; anxiety: b = .24, 95% CI [.15, .32], P < .001). CONCLUSION Findings suggest autonomic dysfunction, particularly gastrointestinal and thermoregulatory symptoms, may be an indicator for elevated anxiety/depression and a potential treatment target early on in PD.
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Affiliation(s)
- Adrianna M. Ratajska
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Connor B. Etheridge
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA
| | - Francesca V. Lopez
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Lauren E. Kenney
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Katie Rodriguez
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Rachel N. Schade
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Joshua Gertler
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Dawn Bowers
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA
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Sang S, Ba Y, Yang N. Longitudinal faster anxiety progression of GBA variant carriers in the early Parkinson's disease cohort. Front Neurosci 2024; 18:1353759. [PMID: 38327847 PMCID: PMC10847242 DOI: 10.3389/fnins.2024.1353759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 01/02/2024] [Indexed: 02/09/2024] Open
Abstract
Objective Anxiety symptoms are prevalent neuropsychiatric manifestations in Parkinson's disease (PD) and impact the development of motor complications. Our aim was to evaluate the association of GBA variants with the anxiety development in early PD cohort. Methods This cohort study used data from the Parkinson Progression Marker Initiative. The primary outcome anxiety was assessed by State-Trait Anxiety Inventory (STAI). The association between GBA and longitudinal change in the STAI total score was examined using linear mixed-effects model, and the association between GBA and anxiety progression was examined using Cox survival analysis. Results A total of 385 patients with PD were included in this study, 39 of them were GBA variant carriers and 346 were idiopathic PD without GBA variants. Patients with GBA variants had faster annual increase in anxiety score (β = 0.44; 95% CI, 0.18 to 0.71; p < 0.001) and were at higher risk of anxiety progression (HR 1.87; 95% CI, 1.03 to 3.41; p = 0.03,). Higher baseline scores for Scales for Outcomes in Parkinson's Disease-Autonomic (SCOPA-AUT), which indicated the autonomic dysfunction, also independently predicted faster increase in anxiety score (β = 0.48; 95%CI, 0.19 to 0.69; p < 0.001) and higher incidence of anxiety development (HR = 1.05; 95% CI, 1.01 to 1.08; p = 0.008). Interpretation These findings suggest that longitudinal anxiety symptoms worsening was faster in PD patients who were GBA variant carriers and have dysautonomia, and this association was enhanced if they have both.
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Affiliation(s)
- Shushan Sang
- Department of Otolaryngology-Head and Neck Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yunpeng Ba
- Department of Otolaryngology-Head and Neck Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Nannan Yang
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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