Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London, UK.
School of Pharmacy, UCL, London, UK.
Eur J Neurol. 2023 Sep;30(9):2661-2668. doi: 10.1111/ene.15890. Epub 2023 Jun 6.
Anxiety affects approximately 40% of Parkinson's disease (PD) patients. However, little is known about its predictors and development over time.
To identify the clinical factors and biomarkers associated with development of anxiety in patients with newly diagnosed PD, and to test which risk factors predict increases in anxiety over time.
Data from the Parkinson's Progression Markers Initiative (PPMI) were utilized. The primary outcome was the State-Trait Anxiety Inventory (STAI). Covariates were demographics, motor and non-motor symptoms, cognitive functions, dopamine transporter imaging data, and cerebrospinal fluid (CSF) biomarkers. We examined the association of risk factors at baseline and over 4 years with changes in anxiety scores over time.
A total of 252 patients met the inclusion criteria (mean age: 61.36 years, SD 9.53). At year 4, 42 patients had developed anxiety. Baseline predictors of increase in anxiety scores were greater autonomic dysfunction, dysexecutive function, CSF t-tau levels, excessive daytime sleepiness, and lower olfactory function scores but not motor scores. Over 4 years, change in anxiety scores correlated with deterioration in overall cognitive function, excessive daytime sleepiness, as well as depression and disability, and to a lesser degree worsening of Movement Disorder Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS) motor scores and caudate dopaminergic uptake changes.
These findings suggest that development of anxiety in PD is not primarily based on a dopaminergic deficit in the basal ganglia but related to non-dopaminergic or extrastriatal pathology. Early dysexecutive function predicts development of anxiety but increase in anxiety levels correlates most strongly with more global cognitive decline.
焦虑症影响约 40%的帕金森病（PD）患者。然而，人们对其预测因素及其随时间的发展知之甚少。
确定与新发 PD 患者焦虑症发展相关的临床因素和生物标志物，并检验哪些危险因素可预测焦虑程度随时间的增加。
利用帕金森进展标志物倡议（PPMI）的数据。主要结局指标为状态-特质焦虑量表（STAI）。协变量为人口统计学、运动和非运动症状、认知功能、多巴胺转运蛋白成像数据和脑脊液（CSF）生物标志物。我们检查了基线和 4 年内的危险因素与焦虑评分随时间变化的关系。
共有 252 名患者符合纳入标准（平均年龄：61.36 岁，SD 9.53）。在第 4 年，42 名患者出现了焦虑症状。焦虑评分增加的基线预测因素包括自主神经功能障碍、执行功能障碍、CSF t-tau 水平升高、日间过度嗜睡以及嗅觉功能评分降低，但运动评分无变化。4 年内，焦虑评分的变化与整体认知功能恶化、日间过度嗜睡以及抑郁和残疾有关，与运动障碍协会统一帕金森病评定量表（MDS-UPDRS）运动评分恶化和尾状核多巴胺摄取变化的相关性较小。
这些发现表明，PD 中焦虑症的发展并非主要基于基底节的多巴胺缺乏，而是与非多巴胺或非纹状体的病理有关。早期执行功能障碍预测焦虑症的发生，但焦虑程度的增加与更广泛的认知功能下降相关性最强。
