Management of Anxiety in Parkinson's Disease.

IF 2.7 4区医学 Q2 CLINICAL NEUROLOGY

Movement Disorders Clinical Practice Pub Date : 2025-06-26 DOI:10.1002/mdc3.70144

Alex J Berry, Harry Costello, Silvia Jesús, Gary Price, Ashwani Jha

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Abstract

Background: Anxiety is a common, distressing, hard-to-diagnose and hard-to-treat symptom in Parkinson's disease. No formal guidelines exist to assist management.

Objective: We provide a pragmatic guide to detecting and managing anxiety in Parkinson's disease.

Methods: In this educational review, we describe the phenomenology, diagnostic challenges, hypothesized neurobiology, and the rationale for treatments for anxiety in Parkinson's disease. We review the major drug-classes and non-pharmacological treatment approaches in current use. We also present a meta-analysis of pharmacological treatments of anxiety derived from previously published systematic reviews of RCTs for depression in Parkinson's disease in which anxiety was a secondary outcome.

Results: In our meta-analysis, anxiolytic medications showed a moderate overall anxiolytic effect compared to placebo (standardized mean difference: -0.45 [95% CI: -0.78, -0.12], p = 0.02). There were significant limitations with the studies included in this meta-analysis, with studies generally having small cohort sizes, and each specific pharmacotherapy was not studied in more than one randomized control trial. We also describe a pragmatic algorithm for individualized pharmacological management, based on our own experience of selecting treatments to optimize side-effect profile and treatment of comorbid symptoms.

Conclusions: Detecting and treating anxiety likely benefits people with Parkinson's disease, though the current evidence-base for specific treatments or specific pharmacotherapy remains limited. Further work is needed to investigate the different evidence-based approaches for managing anxiety in Parkinson's disease.

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帕金森病焦虑的管理。

背景：焦虑是帕金森病中一种常见的、令人痛苦的、难以诊断和治疗的症状。没有正式的指导方针来帮助管理。目的：为帕金森病焦虑的检测和治疗提供实用指南。方法：在这篇教育综述中，我们描述了帕金森病的现象学、诊断挑战、假设的神经生物学和治疗焦虑的基本原理。我们回顾了目前使用的主要药物类别和非药物治疗方法。我们还提出了一项关于焦虑的药物治疗的荟萃分析，该荟萃分析来源于先前发表的帕金森病抑郁症随机对照试验的系统综述，其中焦虑是次要结局。结果：在我们的荟萃分析中，与安慰剂相比，抗焦虑药物显示出中等的总体抗焦虑效果（标准化平均差：-0.45 [95% CI: -0.78, -0.12], p = 0.02）。本荟萃分析中纳入的研究存在明显的局限性，研究的队列规模通常较小，每种特定药物治疗没有在一个以上的随机对照试验中进行研究。我们还描述了一个实用的算法，个性化的药物管理，基于我们自己的经验，选择治疗方案，以优化副作用概况和治疗合并症的症状。结论：检测和治疗焦虑可能对帕金森病患者有益，尽管目前针对特定治疗或特定药物治疗的证据基础仍然有限。需要进一步的工作来研究不同的基于证据的方法来管理帕金森病的焦虑。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Movement Disorders Clinical Practice CLINICAL NEUROLOGY-

CiteScore

4.00

自引率

7.50%

发文量

218

期刊介绍： Movement Disorders Clinical Practice- is an online-only journal committed to publishing high quality peer reviewed articles related to clinical aspects of movement disorders which broadly include phenomenology (interesting case/case series/rarities), investigative (for e.g- genetics, imaging), translational (phenotype-genotype or other) and treatment aspects (clinical guidelines, diagnostic and treatment algorithms)