Abstract
Many Parkinson’s disease (PD) patients notice that motor symptoms worsen during stress, and experience stress-related neuropsychiatric symptoms such as anxiety and depression. Here we investigated which personal and disease characteristics are associated with perceived stress in PD, which PD symptoms are sensitive to stress, and we assessed self-reported benefits of stress-reducing strategies such as mindfulness. We sent an online survey to the Fox Insight cohort (n = 28,385 PD patients, n = 11,413 healthy controls). The survey included specific questions about the influence of stress on PD symptoms, use of stress-reducing strategies, and several validated scales measuring perceived stress, anxiety, dispositional mindfulness, rumination, and self-compassion. We received completed surveys from 5000 PD patients and 1292 controls. Patients perceived more stress than controls. Among patients, stress was correlated with increased rumination (R = 0.65), lower quality of life (R = −0.56), lower self-compassion (R = −0.65), and lower dispositional mindfulness (R = −0.48). Furthermore, patients indicated that stress significantly worsened both motor symptoms – especially tremor – and non-motor symptoms. Physical exercise was most frequently used to reduce stress (83.1%). Mindfulness was practiced by 38.7% of PD respondents, who noticed improvement in both motor and non-motor symptoms. Among non-users, 43.4% were interested in gaining mindfulness skills. We conclude that PD patients experience greater levels of stress than controls, and that stress worsens both motor and non-motor symptoms. Mindfulness may improve PD symptom severity, with the strongest effects on anxiety and depressed mood. These findings justify further controlled studies to establish the merits of mindfulness and other stress-alleviating interventions.
Highlights
Parkinson’s disease (PD) is a neurodegenerative disorder characterized by degeneration of dopaminergic neurons in the nigrostriatal pathway, resulting in striatal dopamine depletion.The cardinal motor symptoms are bradykinesia, tremor, and rigidity, but many patients have non-motor symptoms such as anxiety, depression, apathy, sleeping problems, or cognitive impairment[1,2].Both acute and chronic stress play an important role in PD3.Acute stress involves a physiological reaction in response to a perceived threat, in order to restore homeostatic balance[4]
The covid-19 pandemic served as a major stressor worldwide, and we showed in 358 PD patients that those with higher covid-19-related stressor load experienced more PD motor and non-motor symptom severity which were likely secondary to greater psychological distress as well as lifestyle changes, in particular a lack of physical activity because patients are forced to stay more inside their house to mitigate the risk of becoming infected[13]
Models in rodents showing accelerated dopaminergic neuronal loss[14] and increased cerebral alphasynucleopathy after chronic stress[15]. It remains unclear which factors are associated with experienced stress, which PD symptoms are especially sensitive to stress, what patients do themselves to reduce stress, and what effect these strategies have
Summary
Parkinson’s disease (PD) is a neurodegenerative disorder characterized by degeneration of dopaminergic neurons in the nigrostriatal pathway, resulting in striatal dopamine depletion.The cardinal motor symptoms are bradykinesia, tremor, and rigidity, but many patients have non-motor symptoms such as anxiety, depression, apathy, sleeping problems, or cognitive impairment[1,2].Both acute and chronic stress play an important role in PD3.Acute stress involves a physiological reaction in response to a perceived threat, in order to restore homeostatic balance[4]. The cardinal motor symptoms are bradykinesia, tremor, and rigidity, but many patients have non-motor symptoms such as anxiety, depression, apathy, sleeping problems, or cognitive impairment[1,2] Both acute and chronic stress play an important role in PD3. Chronic stress might even accelerate PD disease progression, supported by PD models in rodents showing accelerated dopaminergic neuronal loss[14] and increased cerebral alphasynucleopathy after chronic stress[15]. It remains unclear which factors are associated with experienced stress, which PD symptoms are especially sensitive to stress, what patients do themselves to reduce stress, and what effect these strategies have
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