Abstract
Although anxiety is one of the most frequent symptoms of Parkinson's disease (PD), only a few clinical tools can efficiently and reliably detect its presence. The aim of the present study was to validate the Hungarian patient-rated version of Parkinson Anxiety Scale (PAS). A total of 190 PD patients were enrolled into the clinimetric validation phase of the study and another 590 participated in the cross-sectional screening phase. The presence of anxiety disorder was diagnosed based on the Diagnostic and Statistical Manual of Mental Disorders criteria. The cutoff value for PAS which best discriminated the presence of anxiety from the absence was 12.5 points (sensitivity of 88.6%, specificity of 79.9). The area under the curve was 0.847 whereas the ROC analysis yielded the statistical significance level (p < 0.001). The optimal threshold values for mild (Hoehn and Yahr Stage, HYS 1 and 2), moderate (HYS 3), and severe (HYS 4 and 5) disease stages were 10.5, 12.5, and 13.5 points, respectively. Based on the general threshold anxiety occurred in 35.8% of the patients (persistent anxiety: 29.2%, episodic anxiety: 20.7%, and avoidant anxiety disorder: 16.8%). We demonstrate that the PAS is a valid, highly reliable, and sensitive tool for assessing anxiety.
Highlights
Among the nonmotor symptoms of Parkinson’s disease (PD), the affective problems have utmost importance
Anxiety has a serious impact on the daily living and health-related quality of life (HRQoL) [5]
While in the validation part of the study, 190 consecutive patients fulfilling the clinical criteria for PD were enrolled, another 590 PD subjects participated in the subsequent part assessing the prevalence of anxiety
Summary
Among the nonmotor symptoms of Parkinson’s disease (PD), the affective problems have utmost importance. The spectrum of anxiety is extremely wide including panic attacks, agoraphobia without panic disorder, social phobia, and generalized anxiety disorder. Besides the general problems of anxiety, PD patients frequently experience disease-specific symptomatology including distress, worry, fear, agitation, embarrassment, and social withdrawal due to motor symptoms and complications of antiparkinsonian medication [3, 4]. Reliable and highly sensitive tools are required to identify anxiety problems and monitor the therapeutic response. Applied instruments, such as Hamilton Anxiety Rating Scale (HAM-A), the Beck Anxiety Inventory, and the Hospital Anxiety and Depression Scale, have unsatisfactory discriminating abilities [6]. Fox Foundation, the Parkinson Anxiety Scale (PAS) was recently developed and validated to overcome the limitation of the abovementioned anxiety scales and to provide a license-free clinical and research tool for the PD population [7]
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