Objective: To identify changes in brain functional connectivity (FC) after Cognitive Behavioral Therapy (CBT) for anxiety in patients with Parkinson’s disease (PD).

Background: Recently we showed that CBT reduces situational anxiety and avoidance behavior in PD patients with anxiety.

Method: Thirty-five anxious PD patients were randomized between CBT and clinical monitoring only (CMO). T1-weighted and resting-state functional MRI scanning was performed at baseline and after the intervention (at 3 months). The Parkinson Anxiety Scale (PAS) and its subscales for persistent anxiety, episodic anxiety, and avoidance behavior were used to assess anxiety. Between groups changes in FC over time were calculated, and multiple linear regressions were used to relate these to changes in PAS sub-scores.

Results: Compared to the CMO group, the CBT group showed a reduced FC over time between the right thalamus and bilateral orbitofrontal cortices, and between the right superior parietal lobule (SPL) and the right ventral anterior cingulate cortex (ACC); increased FC was seen between the right temporal pole and the left dorsal posterior cingulate cortex (PCC), between the left fusiform gyrus and the right supplementary motor area, and between the right SPL and bilateral secondary visual cortices. After CBT, improvement of episodic anxiety was associated with increased FC between the right nucleus accumbens and the right dorsal ACC, between the right angular cortex and the right ventral PCC, and between the left dorsofrontal cortex and the left cingulate isthmus; decreased FC was seen between the right insular cortex and the right temporal pole. Improvement of avoidance behavior was associated with a decreased FC between the right middle temporal gyrus and the left retrosplenial cingulate, and between the right SPL and the bilateral secondary visual cortices.

Conclusion: CBT for anxiety in PD patients induced changes in FC in the limbic cortico-striato-thalamocortical circuit and in fronto-cingulate, parieto-cingulate and parieto-occipital connectivity. Improvement in episodic anxiety and avoidance behavior are characterized by different and specific changes in FC.

References: Moonen AJH et al. Cognitive Behavioral Therapy for Anxiety in Parkinsonʼs Disease: A Randomized Controlled Trial. Mov Disord 2021 (in press) doi: 10.1002/mds.28533.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/changes-in-brain-functional-connectivity-after-cognitive-behavioral-therapy-for-anxiety-in-parkinsons-disease-a-longitudinal-mri-study/