Objective: To report two patients with Parkinson disease and describe the response of this non motor symptom to dopaminergic therapy.

Background: Anxiety is frequent comorbidity in Parkinson disease (1). Althought the relationship between dopaminergic dysfunction and neuropsychiatrc symtomps is well known, the underlying pathophysiological mechanism of anxiety in PD is still unclear (2,3)

Method: We report 2 patients with PD and anxiety related to dopamininergic hypostimulation.

Results: Patient 1: 57 year-old woman with PD of 8 years of evolution, treated with levodopa+carbidopa+entacapone (100/25/200 mg) 4 times per day, rasagiline and rotigotine 8 mg, presented mild motor fluctuations but severe anxiety fluctuations (wering-off) that improved with subcutaneous apomorphine injection (4 mg). Patient 2: 75 years- old patient with advanced PD developped severe fluctuations and dyskinesias. Treatment with enteral levodopa-carbidopa- DUODOPA- was indicated with good initial response. After a fews months of treatment (MD: 14 ml; CD: 4 ml/h) began with severe episodes of anxiety, without motor impairment or severe chorea. The increase of continuous dose of DUODOPA improved anxiety without intensification of chorea.

Conclusion: Anxiety is one of the non motor manifestations of PD and may have important impact of quality of life. In some patients with motor fluctuations may be the most severe and disabling off-symptom. Moreover, the occurrance of  non-motor fluctuations is possible and there is evidence of a good response of some (not all) non-motor symtoms to dopaminergic therapy that must be individually adapted (4). Advanced therapies could be considered (5).Anxiety is one of the non motor manifestations of PD and may have important impact of quality of life. In some patients with motor fluctuations may be the most severe and disabling off-symptom. Moreover, the occurrance of non-motor fluctuations is possible and there is evidence of a good response of some (not all) non-motor symtoms to dopaminergic therapy that must be individually adapted (4). Advanced therapies could be considered (5).

References: 1. Van der Velden RMJ, Broen MPG, Kuijf ML, Leentiens AFG. Frequency of mood and anxiety fluctuations in Parkinson´s disease patients with motor fluctuations: A systematic review. Mov Disord 2018; 33: 1521- 7. 2. Li Y, Jiao Q, Du X, et al. Investigation of behavioral dysfunctions induced by monoamine deplations in a mouse model of Parkinson´s disease. Front Cell Neurosci 2018; 12:241 3. Valli M, Mihaescu A, Strafella AP. Imaging behavioural complications of Parkinson´s disease.Brain Imaging Behav. 2017; 4. Fabbri M, Coelho M, Guedes LC et al. Acute response of non motor symptoms to subthalamic deep brian stimulation in Parkinson¨s disease. Parkinsonism Relat Disord 2017; 41: 113- 7

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MDS Abstracts - https://www.mdsabstracts.org/abstract/anxiety-and-dopaminergic-stimulation-in-patients-with-parkinsons-disease/