Anxiety in Parkinson's disease: relation to cognition and potential of non-pharmacological interventions
Reynolds, Gretchen Olson
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In addition to the classic motor symptoms, Parkinson’s disease (PD) causes a variety of non-motor symptoms that compromise quality of life and daily functioning. Anxiety, in particular, is prevalent and debilitating, but under-studied and under-treated. There is urgent need to understand the relation of anxiety to other non-motor symptoms, and to develop evidence-based treatments. Cognitive-behavioral therapy (CBT) and aerobic and resistance exercise are promising non-pharmacological treatment strategies for anxiety in PD, with potential to simultaneously reduce additional PD symptoms. Study 1 assessed a large sample of non-demented individuals with mild to moderate PD (N=77) and examined the relation between self-reported anxiety (Beck Anxiety Inventory [BAI]) and cognition with a focus on executive function and attention (Trail Making, Verbal Fluency, Digit Span). The majority of participants reported subclinical symptoms of anxiety (BAI ≤18). Higher anxiety correlated with poorer set-shifting, as well as with more advanced disease stage and severity. Study 2 implemented a single-case experimental design to evaluate the utility and feasibility of a 12-week cognitive-behavioral intervention for individuals with PD who also met criteria for a DSM-5 anxiety disorder (N=9). Weekly therapy sessions were conducted in-person (N=5) or via secure videoconferencing (N=4). At post-treatment, five participants reported significant reductions in anxiety and two additional participants reported significant reductions in comorbid depression. Most improvements were maintained at 6-week follow-up. Effects of CBT on secondary outcome measures (e.g., cognition, motor symptoms, sleep) varied widely across participants. Adherence and retention were high, as was satisfaction with treatment. Study 3 reviewed the effects of aerobic and resistance exercise on disturbances of mood, cognition, and sleep in PD and healthy adults. The literature supports aerobic and resistance exercise as feasible and promising adjunct treatments for mood, cognition, and sleep in PD, contingent upon additional exercise research that systematically targets non-motor symptom outcomes. Together these studies show that even subclinical anxiety is associated with cognitive disturbance in mild-moderate PD, and provide preliminary evidence for the effectiveness of CBT (in-person and internet-delivered), as well as aerobic and resistance exercise, as encouraging and viable treatments for anxiety in this disorder.