Management of anxiety and motor symptoms in Parkinson’s disease

Abstract

Parkinson’s disease (PD) is typically known for its cardinal motor symptoms, but a growing body of literature is recognizing a multitude of important nonmotor symptoms as well. Anxiety is one of the most common nonmotor symptoms of PD; unfortunately, neither the management of anxiety nor its influence on motor symptoms is well understood. While recent literature indicates a correlation between motor symptoms and anxiety in PD, it remains uncertain whether one symptom acts as the underlying cause of the other. This review considers the cyclic interaction between anxiety and motor symptoms in PD, each exacerbating the other when they coexist. It may be critically important to disentangle if one symptom serves as an underlying cause of the other, since this might dictate appropriate treatment. Neuroanatomical substrates as well as the treatments for both motor symptoms and anxiety are discussed in detail to consider the evidence-base for the management of PD.

Keywords::

• anxiety
• motor symptoms of PD
• neurological mechanisms of PD motor symptoms
• nonmotor symptoms
• Parkinson’s disease
• treatment of anxiety in PD
• treatment of PD motor symptoms

Financial & competing interests disclosure

Q Almeida was supported by GLG Consulting group, Sun Life Financial, Canada foundation for Innovation. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Key issues

• Anxiety is a prominent nonmotor symptom of Parkinson’s disease (PD) appearing in more than 40% of patients.

• Diagnostic tests and current treatment of anxiety in PD lack validity and appropriate testing to determine their efficacy.

• Anxiety in PD manifests as a result of many neurological pathologies, including deficits in dopamine, norepinephrine and serotonin.

• Loss of dopaminergic neurons is also responsible for the appearance of motor symptoms in PD patients.

• Due to their interrelated etiologies, it is believed that anxiety and motor symptoms are correlated in individuals with PD.

• Motor symptoms can exacerbate anxiety by increasing feelings of embarrassment or fear of falling.

• Treating motor symptoms with dopamine agonists and deep brain stimulation can have subsequent effects on anxiety, either directly through an increase in dopamine or indirectly by treating the motor symptoms associated with anxiety.

• Anxiety symptoms can impair motor function, worsening PD symptoms such as gait disturbance, freezing and postural instability.

• The treatment of anxiety symptoms in PD have been largely overlooked; however, findings have shown that treating anxiety with tricyclic antidepressants, anxiolytics and cognitive behavioral therapy can achieve additional improvements on motor symptoms of PD.