Objective: To determine the functional consequences of baseline anxiety symptoms and the longer-term impact of initiation of anxiety treatment in Parkinson’s disease (PD).

Background: While anxiety is a common, disabling neuropsychiatric symptom in PD, there is limited data on the efficacy of pharmacological treatment of anxiety symptoms.

Method: We used data from the Parkinson’s Progression Markers Initiative (PPMI), a longitudinal, observational study of newly-diagnosed, untreated (at baseline) PD. Participants complete motor, cognitive, and psychiatric assessments, and provide biological samples, on an annual basis up to 7 years. A positive (i.e., potentially clinically significant) anxiety screen was defined as a State Trait Anxiety Inventory (STAI) score ≥ 40 (range 0-63). Anxiety treatment included self-reported antidepressant or anxiolytic/sedative use. We assessed the effect of anxiety and anxiety treatment on motor and non-motor outcomes using marginal mean regression models controlling for age, sex, race/ethnicity, education and depression scores. We also evaluated the effect of anxiety and anxiety treatment on time to initiation of dopaminergic therapy using Cox proportional hazards models.

Results: A total of 493 de novo PD participants were identified of whom 111 (22.5%) screened positive for anxiety at baseline, with 71 (64.0%) untreated. In adjusted analyses, anxiety was associated with worse MDS-UPDRS Part 1, 2, 3 and total scores and greater disability (Schwab & England) both at baseline and longitudinally. It was also associated with a faster time to initiation of PD therapy (HR 1.37, 95% CI 1.08, 1.74), but not with total levodopa equivalent daily dose (LEDD). Initiation of anxiety treatment (n=16, 22.5%) during the study was associated with a significant reduction in total MDS-UPDRS scores (effect size prior to treatment 5.45, p<0.001; change after treatment -3.11, p=0.038) and lower LEDD (effect size prior to treatment 142.69, p<0.001; change after treatment -85.57, p=0.022).

Conclusion: Anxiety contributes to ongoing functional decline in PD and is a promising, treatable symptom that may improve outcomes. In this observational dataset, initiation of anxiety treatment was associated with a reduction in both MDS-UPDRS scores and PD medication use.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/the-impact-of-anxiety-symptoms-and-treatment-on-parkinsons-disease-related-disability-findings-from-the-parkinsons-progression-markers-initiative/