title: Anxiety and motor fluctuations in Parkinson's disease: a cross-sectional observational study.
abstract: BACKGROUND
  Some studies have suggested a relationship between anxiety and motor fluctuations in patients with Parkinson's disease (PD).
  
  
  OBJECTIVE
  To describe the nature of the relationship between anxiety symptoms and motor fluctuations and to describe the anxiety symptoms encountered during 'off', 'on' and 'on with dyskinesia' phases.
  
  
  METHODS
  In this cross-sectional study, 250 patients with idiopathic PD, of whom 118 had motor fluctuations, underwent a standardized clinical assessment including the Unified Parkinson's Disease Rating Scale (UPDRS), the DSM IV criteria for major depression and anxiety disorders, the Hamilton Depression Rating Scale (HAMD), and the Hamilton Anxiety Rating Scale (HARS). In addition, patients with motor fluctuations were administered a questionnaire to assess the presence of anxiety symptoms and their relation to motor states.
  
  
  RESULTS
  Patients with motor fluctuations suffer from generalized anxiety disorder more often than patients without motor fluctuations. When patients with motor fluctuations have anxiety symptoms, the majority report that these have no temporal relationship with specific motor states. When there was a relationship, symptoms were almost always related to 'off' periods. However, a minority of patients experience anxiety symptoms during 'on' or "on with dyskinesia" periods exclusively.
  
  
  CONCLUSIONS
  Our findings suggest that the relationship between anxiety and motor fluctuations is more complex than can be explained solely by 'wearing off' phenomena of levodopa. Further studies investigating the temporal dynamics of anxiety and motor fluctuations are needed.
authors: Department of Psychiatry, Maastricht University Medical Center, Maastricht, PO Box 5800, 6202 AZ Maastricht, The Netherlands. a.leentjens@maastrichtuniversity.nl
authors: A F G
authors: AF
authors: Leentjens
authors: K
authors: K
authors: Dujardin
authors: L
authors: L
authors: Marsh
authors: P
authors: P
authors: Martinez-Martin
authors: I H
authors: IH
authors: Richard
authors: S E
authors: SE
authors: Starkstein
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000368:Aged; D000978:Antiparkinson Agents / Q000627:therapeutic use; D014150:Antipsychotic Agents / Q000627:therapeutic use; D001008:Anxiety Disorders / Q000188:drug therapy / Q000453:epidemiology*; D018680:Cholinergic Antagonists / Q000627:therapeutic use; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003866:Depressive Disorder / Q000188:drug therapy / Q000453:epidemiology; D020820:Dyskinesias / Q000188:drug therapy / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008996:Monoamine Oxidase Inhibitors / Q000627:therapeutic use; D010300:Parkinson Disease / Q000188:drug therapy / Q000453:epidemiology*
chemical_list: D000319:Adrenergic beta-Antagonists; D000978:Antiparkinson Agents; D014150:Antipsychotic Agents; D018680:Cholinergic Antagonists; D008996:Monoamine Oxidase Inhibitors