Diagnostic Overshadowing of Anxiety in Parkinson Disease: Psychosocial Factors and a Cognitive-Behavioral Model.

Abstract

Anxiety in Parkinson disease (PD) is highly prevalent yet frequently underdiagnosed and undertreated, and historically overshadowed in research by a focus on depression. Recently, interest in anxiety has been building with the recognition of its significant impact on quality of life in PD. Anxiety is typically conceptualized as one of many "nonmotor" manifestations of neurologic change, with minimal consideration of potentially important psychosocial factors. This narrative review used a systematic search strategy to identify and synthesize the available evidence for psychosocial risk factors for anxiety. Thirty relevant articles were located and reviewed, and demographic, disease/pharmacologic, and psychosocial risk factors for anxiety in PD were identified. A prominent finding was that individuals with motor fluctuation appeared to be more vulnerable to anxiety. A cognitive-behavioral model of anxiety in PD is proposed and illustrated with a clinical example.