Anxiety Disorders in Parkinson’s Disease: A Narrative Review of Epidemiology and Management
Anxiety Disorders in Parkinson’s Disease: A Narrative Review of Epidemiology and Management
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Original abstract
Anxiety disorders are a frequent mood disorder in Parkinson’s disease, often overshadowed by motor and other non-motor symptoms and co-morbid mood disorders. Understanding the epidemiology and management of anxiety in Parkinson’s is crucial to accurately characterise the disorder, improve quality of life, and ensure treatment compliance. The objective of this narrative review was to investigate the epidemiology of anxiety in Parkinson’s disease and review available pharmacological and non-pharmacological treatments. The review involved searching three databases: PubMed, EBSCOhost, and the AI research assistant Elicit. Findings from 37 publications showed anxiety prevalence of approximately 31% (range 6–55%) in Parkinson’s, compared with 4% in the general population. Risk factors included younger age of onset, faster symptom progression, more pronounced motor dysfunction, and motor fluctuations. Earlier-life anxiety was associated with later Parkinsonian symptoms and may double the risk of developing Parkinson’s. Female gender was a risk factor, although gender-specific analyses within Parkinson’s populations were lacking. Of 12 epidemiological studies, most focused on prevalence, with limited data on incidence or mortality. Recommended assessment tools include the GAI and PAS. Pharmacological treatments include tricyclic antidepressants and selective serotonin reuptake inhibitors, with cautious benzodiazepine use; animal studies suggest adenyl cyclase-1 inhibitors may be beneficial. Non-pharmacological approaches, including cognitive behavioural therapy, acupuncture, yoga, resistance training, self-management, and trans-auricular vagus nerve stimulation, showed promise, although comparative efficacy data are limited. In conclusion, anxiety in Parkinson’s is common, under-recognised, and treatable, but further research is needed to address epidemiological gaps and optimise management to improve outcomes and treatment adherence.