Objective: To investigate objective cardiovascular measures in relation to anxiety in PD patients, and the structural neural changes underlying this putative interaction.T

Background: Anxiety and autonomic dysfunction are prevalent in Parkinson’s Disease (PD). However, their relationship as well as the neural mechanisms underlying this relationship, remain unexplored.

Method: Fifty PD patients (27 with anxiety, defined PD_Anx; 23 without anxiety, defined PD_noAnx) along with 16 age- and gender-matched healthy subjects (HS) were included. Blood Pressure (BP), heart-rate, and hear-rate variability (HRV) were assessed at rest and in response to an orthostatic challenge both ON and OFF dopaminergic medications. Voxel-based morphometry was used to examine grey matter volume in brain area linked to autonomic regulation and anxiety, including amygdala, insula, cingulate cortex, hypothalamus, and putamen.

Results: PD_Anx patients showed significantly lower HRV compared to both PD_noAnx patients and HC (all p<0.05), indicating increased sympathetic activity. Both PD groups had higher BP in the OFF-medication state compared to HC (p<0.001, p<0.005 respectively); there was no difference between PD_Anx and PD_noAnx (p=0.31).

Structural brain analyses showed that anxiety altered the relationship between HRV and left insula volume, with a positive correlation in PD_noAnx and a reversed relationship in PD_Anx patients

Conclusion: Anxiety in PD is associated with a shift toward sympathetic predominance, which correlates with structural brain change in the insula. The change in HRV may be interpreted as a functional indicator of the anxious state in PD. Insular alteration may have a key role in predisposing PD patients to sympathetic predominance and anxiety.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/unravelling-the-relationship-between-autonomic-nervous-system-and-anxiety-in-people-with-parkinsons-disease/