In Parkinson's disease (PD), both the patient and the health care provider look for ways to preserve the patient's quality of life. Many studies focus on the impact of depression and motor disability on poor life quality but neglect to examine the role of anxiety. We investigated the impact of anxiety and depression on health-related quality of life in PD, using the Parkinson's Disease Quality of Life measure (PDQ-39). Symptoms of anxiety, more than depression, cognitive status, or motor stage, significantly affected quality of life in 38 nondemented patients with mild-to-moderate motor disability. Stepwise regression analyses revealed that anxiety explained 29% of the variance in the PDQ-39 sum score, and depression explained 10% of the variance beyond that accounted for by anxiety. The findings suggest that primary management of anxiety as well as depression may be important to optimizing the quality of life of PD patients. 1. Introduction Parkinson’s disease (PD) is a chronic and progressive neurological condition in which nonmotor disturbances as well as motor deficits significantly impact quality of life. The disease is characterized by motor signs including tremor, rigidity, bradykinesia, and disorders of gait and balance. In addition to the difficulties in motor control, which occur as a result of progressive loss of the dopamine-producing neurons in the substantia nigra and dysfunction of the basal ganglia, PD patients also frequently experience disturbances in mood and cognition. These prevalent and disabling nonmotor symptoms may have a greater impact on the patients’ quality of life than do the principal motor features of PD [1–6]. Depression is the most commonly explored mood disorder influencing quality of life in PD and has been found to be the best predictor overall for quality of life in several studies [3–7]. In a population-based survey using the Parkinson's Disease Quality of Life Questionniare (PDQ-39) and the Beck Depression Inventory (BDI), Schrag and colleagues [5] found that the factor most strongly related to poorer quality of life was depression, although motor disability was also significantly associated. In a model predicting PDQ-39 scores, the BDI score accounted for 54% of the variance, whereas motor disability scores accounted for only 15%. The Global Parkinson’s Disease Survey Steering Committee [6] also found the BDI score to be the most significant predictor of quality of life, accounting for 58% of the variance in PDQ-39 scores, whereas stage of motor severity and PD medication (levodopa, either alone or in combination
References
[1]
E. A. Chrischilles, L. M. Rubenstein, M. D. Voelker, R. B. Wallace, and R. L. Rodnitzky, “Linking clinical variables to health-related quality of life in Parkinson's disease,” Parkinsonism and Related Disorders, vol. 8, no. 3, pp. 199–209, 2002.
[2]
L. J. Findley and M. G. Baker, “Treating neurodegenerative diseases: what patients want is not what doctors focus on,” BMJ, vol. 7532, no. 324, pp. 1466–1476, 2002.
[3]
K. H. Karlsen, J. P. Larsen, E. Tandberg, and J. G. Maeland, “Influence of clinical and demographic variables on quality of life in patients with Parkinson's disease,” Journal of Neurology Neurosurgery and Psychiatry, vol. 66, no. 4, pp. 431–435, 1999.
[4]
A. M. Kuopio, R. J. Marttila, H. Helenius, M. Toivonen, and U. K. Rinne, “The quality of life in Parkinson's disease,” Movement Disorders, vol. 15, no. 2, pp. 216–223, 2000.
[5]
A. Schrag, M. Jahanshahi, and N. Quinn, “How does Parkinson's disease affect quality of life? A comparison with quality of life in the general population,” Movement Disorders, vol. 15, no. 6, pp. 1112–1118, 2000.
[6]
L. Findley, T. Eichhorn, A. Janca et al., “Factors impacting on quality of life in Parkinson's disease: results from an international survey,” Movement Disorders, vol. 17, no. 1, pp. 60–67, 2002.
[7]
P. Hobson, A. Holden, and J. Meara, “Measuring the impact of Parkinson's disease with the Parkinson's disease quality of life questionnaire,” Age and Ageing, vol. 28, no. 4, pp. 341–346, 1999.
[8]
D. Aarsland, J. P. Larsen, K. Karlsen, N. G. Lim, and E. Tandberg, “Mental symptoms in Parkinson's disease are important contributors to caregiver distress,” International Journal of Geriatric Psychiatry, vol. 14, no. 10, pp. 866–874, 1999.
[9]
L. Marsh, “Anxiety disorders in Parkinson's disease,” International Review of Psychiatry, vol. 12, no. 4, pp. 307–318, 2000.
[10]
A. Nuti, R. Ceravolo, A. Piccinni et al., “Psychiatric comorbidity in a population of Parkinson's disease patients,” European Journal of Neurology, vol. 11, no. 5, pp. 315–320, 2004.
[11]
I. H. Richard, “Anxiety disorders in Parkinson's disease,” Advances in Neurology, vol. 96, pp. 42–55, 2005.
[12]
K. Walsh and G. Bennett, “Parkinson's disease and anxiety,” Postgraduate Medical Journal, vol. 77, no. 904, pp. 89–93, 2001.
[13]
I. H. Richard, R. B. Schiffer, and R. Kurlan, “Anxiety and Parkinson's disease,” Journal of Neuropsychiatry and Clinical Neurosciences, vol. 8, no. 4, pp. 383–392, 1996.
[14]
L. C. Routh, J. L. Black, and J. E. Ahlskog, “Parkinson's disease complicated by anxiety,” Mayo Clinic Proceedings, vol. 62, no. 8, pp. 733–735, 1987.
[15]
L. C. Quilty, M. Van Ameringen, C. Mancini, J. Oakman, and P. Farvolden, “Quality of life and the anxiety disorders,” Journal of Anxiety Disorders, vol. 17, no. 4, pp. 405–426, 2003.
[16]
C. I. Higginson, J. A. Fields, and A. I. Tr？ster, “Which symptoms of anxiety diminish after surgical interventions for Parkinson disease?” Neuropsychiatry, Neuropsychology and Behavioral Neurology, vol. 14, no. 2, pp. 117–121, 2001.
[17]
J. C. Gómez-Esteban, B. Tijero, J. Somme et al., “Impact of psychiatric symptoms and sleep disorders on the quality of life of patients with Parkinson's disease,” Journal of Neurology, vol. 258, no. 3, pp. 494–499, 2011.
[18]
R. Quelhas and M. Costa, “Anxiety, depression, and quality of life in Parkinson's disease,” Journal of Neuropsychiatry and Clinical Neurosciences, vol. 21, no. 4, pp. 413–419, 2009.
[19]
K. Belzer and F. R. Schneier, “Comorbidity of anxiety and depressive disorders: issues in conceptualization, assessment, and treatment,” Journal of Psychiatric Practice, vol. 10, no. 5, pp. 296–306, 2004.
[20]
A. F. G. Leentjens, F. R. J. Verhey, G. J. Luijckx, and J. Troost, “The validity of the beck depression inventory as a screening and diagnostic instrument for depression in patients with Parkinson's disease,” Movement Disorders, vol. 15, no. 6, pp. 1221–1224, 2000.
[21]
J. I. Sheikh and J. A. Yesavage, Geriatric Depression Scale (GDS): Recent Evidence and Development of a Shorter Version, Haworth, New York, NY, USA, 1986.
[22]
M. A. Stanley, J. G. Beck, and B. J. Zebb, “Psychometric properties of four anxiety measures in older adults,” Behaviour Research and Therapy, vol. 34, no. 10, pp. 827–838, 1996.
[23]
M. A. Stanley, D. M. Novy, S. L. Bourland, J. G. Beck, and P. M. Averill, “Assessing older adults with generalized anxiety: a replication and extension,” Behaviour Research and Therapy, vol. 39, no. 2, pp. 221–235, 2001.
[24]
B. E. Levin, M. M. Llabre, and W. J. Weiner, “Parkinson's disease and depression: psychometric properties of the beck depression inventory,” Journal of Neurology Neurosurgery and Psychiatry, vol. 51, no. 11, pp. 1401–1404, 1988.
[25]
M. M. Hoehn and M. D. Yahr, “Parkinsonism: onset, progression and mortality,” Neurology, vol. 17, no. 5, pp. 427–442, 1967.
[26]
M. F. Folstein, S. E. Folstein, and P. R. McHugh, ““Mini mental state”. A practical method for grading the cognitive state of patients for the clinician,” Journal of Psychiatric Research, vol. 12, no. 3, pp. 189–198, 1975.
[27]
S. Mattis, Dementia Rating Scale (DRS), Psychological Assessment Resources, Odessa, Fla, USA, 1988.
[28]
G. G. Brown, A. A. Rahill, J. M. Gorell et al., “Validity of the dementia rating scale in assessing cognitive function in Parkinson's disease,” Journal of Geriatric Psychiatry and Neurology, vol. 12, no. 4, pp. 180–188, 1999.
[29]
A. T. Beck and R. A. Steer, Beck Anxiety Inventory Manual, Psychological Corporation, San Antonio, Tex, USA, 1993.
[30]
C. S. Spielberger, R. L. Gorsuch, and R. E. Lushene, Manual for the State-Trait Anxiety Inventory, Consulting Psychologists Press, Palo Alto, Calif, USA, 1970.
[31]
A. T. Beck, R. A. Steer, and G. K. Brown, Manual for the Beck Depression Inventory—II, Psychological Corporation, San Antonio, Tex, USA, 1996.
[32]
J. A. Yesavage, T. L. Brink, and T. L. Rose, “Development and validation of a geriatric depression screening scale: a preliminary report,” Journal of Psychiatric Research, vol. 17, no. 1, pp. 37–49, 1982.
[33]
V. Peto, C. Jenkinson, R. Fitzpatrick, and R. Greenhall, “The development and validation of a short measure of functioning and well being for individuals with Parkinson's disease,” Quality of Life Research, vol. 4, no. 3, pp. 241–248, 1995.
[34]
M. C. Angermeyer and R. Kilian, Theoretical Models of Quality of Life for Mental Disorders, Wiley, New York, NY, USA, 1997.
[35]
C. Jenkinson, R. Fitzpatrick, and V. Peto, The Parkinson's Disease Questionnaire, Joshua Horgan Print Partnership, Oxford, UK, 1998.
[36]
K. Hanna, S. Patel, A. Shah, et al., “The impact of anxiety on quality of life in Parkinson's disease,” in Abstracts of the Cognitive Aging Conference, 2004.
[37]
J. M. Lyness, T. K. Noel, C. Cox, D. A. King, Y. Conwell, and E. D. Caine, “Screening for depression in elderly primary care patients: a comparison of the center for epidemiologic studies-depression scale and the geriatric depression scale,” Archives of Internal Medicine, vol. 157, no. 4, pp. 449–454, 1997.
[38]
J. Marinus, A. F. G. Leentjens, M. Visser, A. M. Stiggelbout, and J. J. van Hilten, “Evaluation of the hospital anxiety and depression scale in patients with Parkinson's disease,” Clinical Neuropharmacology, vol. 25, no. 6, pp. 318–324, 2002.
[39]
M. A. Menza, D. E. Robertson-Hoffman, and A. S. Bonapace, “Parkinson's disease and anxiety: comorbidity with depression,” Biological Psychiatry, vol. 34, no. 7, pp. 465–470, 1993.
[40]
P. Hobson and J. Meara, “Self-reported functioning and well-being in patients with Parkinson's disease: comparison of the short-form 36 and the Parkinson's disease questionnaire,” Age and Ageing, vol. 25, no. 4, pp. 334–335, 1996.
[41]
E. R. Appleman, K. Stavitsky, and A. Cronin-Golomb, “Relation of subjective quality of life to motor symptom profile in Parkinson's disease,” Parkinson's Disease, vol. 2011, Article ID 472830, 5 pages, 2011.
[42]
R. G. Knight, H. P. D. Godfrey, and E. J. Shelton, “The psychological deficits associated with Parkinson's disease,” Clinical Psychology Review, vol. 8, no. 4, pp. 391–410, 1988.
[43]
D. Weintraub, A. B. Newberg, M. S. Cary et al., “Striatal dopamine transporter imaging correlates with anxiety and depression symptoms in Parkinson's disease,” Journal of Nuclear Medicine, vol. 46, no. 2, pp. 227–232, 2005.
[44]
M. Shiba, J. H. Bower, D. M. Maraganore et al., “Anxiety disorders and depressive disorders preceding Parkinson's disease: a case-control study,” Movement Disorders, vol. 15, no. 4, pp. 669–677, 2000.
[45]
E. L. Jacob, N. M. Gatto, A. Thompson, Y. Bordelon, and B. Ritz, “Occurrence of depression and anxiety prior to Parkinson's disease,” Parkinsonism and Related Disorders, vol. 16, no. 9, pp. 576–581, 2010.
[46]
J. H. Bower, B. R. Grossardt, D. M. Maraganore et al., “Anxious personality predicts an increased risk of parkinson's disease,” Movement Disorders, vol. 25, no. 13, pp. 2105–2113, 2010.
[47]
D. Bakish, “The patient with comorbid depression and anxiety: the unmet need,” Journal of Clinical Psychiatry, vol. 60, supplement 6, pp. 20–24, 1999.
[48]
R. C. Kessler, M. B. Keller, and H. U. Wittchen, “The epidemiology of generalized anxiety disorder,” Psychiatric Clinics of North America, vol. 24, no. 1, pp. 19–39, 2001.
[49]
K. Rickels and E. Schweizer, “The treatment of generalized anxiety disorder in patients with depressive symptomatology,” Journal of Clinical Psychiatry, vol. 54, no. 1, pp. 20–23, 1993.
[50]
A. J. Rush, M. Zimmerman, S. R. Wisniewski et al., “Comorbid psychiatric disorders in depressed outpatients: demographic and clinical features,” Journal of Affective Disorders, vol. 87, no. 1, pp. 43–55, 2005.
[51]
E. Tandberg, J. P. Larsen, D. Aarsland, and J. L. Cummings, “The occurrence of depression in Parkinson's disease: a community-based study,” Archives of Neurology, vol. 53, no. 2, pp. 175–179, 1996.
[52]
B. Bolluk, E. T. ？zel-Kizil, M. C. Akbostanci, and E. C. Atbasoglu, “Social anxiety in patients with Parkinson's disease,” Journal of Neuropsychiatry and Clinical Neurosciences, vol. 22, no. 4, pp. 390–394, 2010.
[53]
N. N. W. Dissanayaka, A. Sellbach, S. Matheson et al., “Anxiety disorders in Parkinson's disease: prevalence and risk factors,” Movement Disorders, vol. 25, no. 7, pp. 838–845, 2010.
[54]
G. M. Pontone, J. R. Williams, K. E. Anderson et al., “Prevalence of anxiety disorders and anxiety subtypes in patients with Parkinson's disease,” Movement Disorders, vol. 24, no. 9, pp. 1333–1338, 2009.
[55]
V. Hunot, R. Churchill, V. Teixeira, and M. S. de Lima, “Psychological therapies for generalised anxiety disorder (Review),” Cochrane Database of Systematic Reviews, no. 1, Article ID CD001848, 2007.
[56]
N. Mor and D. Haran, “Cognitive-behavioral therapy for depression,” Israel Journal of Psychiatry and Related Sciences, vol. 46, no. 4, pp. 269–273, 2009.
[57]
R. D. Dobkin, M. Menza, K. L. Bienfait et al., “Depression in Parkinson's disease: symptom improvement and residual symptoms after acute pharmacologic management,” American Journal of Geriatric Psychiatry, vol. 19, no. 3, pp. 222–229, 2011.
